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Try out PMC Labs and tell us what you think. Learn More. Conceived and deed the experiments: TFB. Analyzed the data: TFB. Inequalities between men and women in morbidity and mortality show a contrast, which has been called gender paradox.
Most studies evaluating this paradox were conducted in high-income countries and, until now, few investigations have been performed in Brazil. This study aims to estimate the magnitude of inequalities between adult men and women in several dimensions: demographic and socioeconomic, health behaviors, morbidity, use of health services and mortality. Prevalences and prevalence ratios were analyzed in order to verify the differences between men and women regarding socioeconomic and demographic variables, health behaviors, morbidities and consultations in the last two weeks.
Mortality rates and the ratio between coefficients considering the underlying causes of death were calculated. Women had a greater disadvantage in socioeconomic indicators, chronic diseases diagnosed by a health professional and referred health problems as well as make more use of health services, while men presented higher frequency of most unhealthy behaviors and excessive mortality for all causes investigated.
The findings contribute to the discussion of gender paradox and demonstrate the need to employ health actions that consider the differences between men and women in the various health dimensions analyzed. The premature male mortality from preventable causes was outstanding, making clear the need for more effective prevention and health promotion directed to this segment of the population.
The higher prevalence of morbidity in women and, on the other hand, the higher male mortality rate is a contrast that it was first investigated in by Nathanson[ 1 ] and has been evidenced in several health research called gender paradox. It is noteworthy that men have higher mortality rates at all ages and by the main groups of causes of death cancer, diseases of the circulatory, respiratory and digestive tract, and external causes when compared to women. Overall, the studies indicate poorer health in women, such as self-rated health, physical illness, mental health and disabilities [ 10 , 11 , 12 , 13 ].
However, the finding of poorer health in women does not seem so clear, since, according review conducted by Oksuzyan[ 14 ], depends on the definition, severity and of the trajectory of the disease. Furthermore, the gender gap in morbidity and mortality vary over time and across places[ 15 ]. Among the possible explanations of the paradox are differentials between the sexes in biological risk, in health behaviors and social roles, in perception and behavior in facing disease and in the access to health services and treatments.
Most of the studies on the gender paradox are conducted in high-income countries and focus on gender differences in life expectancy and mortality in middle-aged or older adults. There are no Brazilian studies evaluating the inequalities between adults men and women in different dimensions of health using tly data from population-based health surveys and Mortality Information System seeking to analyze the gender paradox in a given population. The purpose of this article is to identify and discuss the possible explanations of the gender paradox by analyzing the inequalities between men and women in the prevalence of demographic and socioeconomic conditions, unhealthy behaviors, morbidities and health problems, consultations in the last two weeks and in mortality rates of the population of adults living in Campinas, Brazil.
In , the population was 1, Data collection was made through a questionnaire, structured in thematic blocks that included: morbidities, accidents and violence episodes, emotional health, health-related behaviors, quality of life, use of health services, preventive practices, medication use and socioeconomic characteristics.
The population that participated in the survey was obtained by probabilistic sampling, carried out in two stages. First, 50 census tracts of the urban area of Campinas were selected with probability proportional to the of households, followed by a field survey to list all the private households of the selected tracts. In the next stage, households were drawn, aiming to get the sample size defined for three population subgroups: adolescents 10—19 years , adults 20—59 years and elderly 60 years or older , who composed the domains of the study.
Equal sized samples of 1, people for each one of these domains were drawn. With this of interviews is possible to estimate proportions of 0. The variables analyzed in this study are listed below:. Health behaviors : alcohol abuse, measured by the Alcohol Use Disorders Identification Test—AUDIT, with 8 or more points being considered positive for the abuse; current smoker, regardless of the of cigarettes, frequency and duration of habit; passive smoker nonsmoker exposed to cigarette smoke for at least 1 hour per day ; inactive in leisure physical activity: those who responded negatively to the question " Do you practice regularly , at least once a week , some sort of physical exercise or sport?
Use of health services : consultations in the last two weeks with physicians or other health professionals. Death data from the residents of Campinas, between and , were obtained from the Mortality Information System SIM and used for the analysis of the mortality profile according to sex.
The prevalence ratios were adjusted for age and years of schooling to control for confounding. Data were analyzed using Stata software Mortality rates were calculated for each sex and age groups using the average of deaths in the three-year period to as numerator, and the population of referent to each age group and sex in the denominator.
Mortality rate ratios MR between men and women were also calculated to verify the magnitude of inequalities between the sexes. The written informed consent was obtained from each participant prior to the interview. The studied adult population 20—59 years of age is composed of men with a mean age of The analysis of demographic and socioeconomic conditions showed statistically ificant differences between the sexes in age, religion, marital status, of years of schooling, occupation and per capita income Table 1. Much of the adult population was Catholic, but it was observed predominance of women in evangelical religion Women had a lower level of education and lower per capita income than men.
In terms of occupation, As for health-related behaviors, there was a lower frequency of consumption of fruits, vegetables and milk and higher intake of soft drinks among men. The alcohol abuse was 4. Among the health behaviors, only inactivity in physical activity in leisure context was higher among women Table 2. In the dimension of health status, sex was observed to be strongly associated with most events, even after adjustment for age and level of education. The prevalence of common mental disorder was 2. There were no statistically ificant differences between the sexes for the others chronic diseases investigated.
Concerning to mortality, the rates were more than two times superior in men in all age groups, ranging from 3. Considering the five top groups of the underlying causes of death, men had a higher risk of dying in all of them, achieving a 6.
Except for hypertension and cerebrovascular diseases, in all other specific causes, men had coefficients superior to two times when compared to those of the women Table 4. The of the study revealed inequalities between men and women in all dimensions analyzed. Women had lower levels of education and income and entry into the labor market than men.
While men showed, in general, higher frequency of unhealthy habits, women reported more health problems, with remarkable inequality in arthritis, circulatory problems, common mental disorders and emotional problems. However, the highest mortality rates are found in the male population in the main groups of causes of death and in all age groups analyzed, confirming the gender paradox. In the dimension of health-related behaviors, corroborating the national[ 19 , 20 ] and abroad[ 21 ] literature, men showed greater disadvantage compared to women regarding alcohol abuse.
A research undertaken in in Campinas found that prevalence of alcohol abuse among men was 3,53 times higher than for women,[ 22 ] as in the present study. Regarding physical activity in leisure context, the inactivity was higher among women. This behavior was also observed in other Brazilian studies. There were also inequalities between the sexes, although with lower prevalence ratios, in food intake. Men reported less frequently intake of fruits, vegetables and milk lessand more frequently of soft drinks. Likewise in Campinas, gender inequalities were observed in the consumption of these foods in the Brazilian population in ,[ 29 ] and ,[ 30 ] with consumption of poorer quality among men.
A review of anthropological research on the practices and preferences of food consumption among low-income population segments detected the lower appreciation for consumption of fruits and vegetables, classified as "weak" or "soft" foods due to the fact that these do not satisfy the sensation of hunger and do not offer the body strength and energy needed to work. A variety of health indicators was used to verify gender differences in the dimension of morbidities. Likewise in this study, the National Research by Household Sampling, held in ,[ 33 ] found higher prevalences in women in the majority of the chronic diseases analyzed.
Literature show that, in general, women have lower socioeconomic status as seen in this article and high exposure to social stressors associated with the emergence of non-fatal acute and chronic conditions, resulting in a greater proportion of morbidity in relation to men. The largest morbidity prevalence referred by women may also be related to their greater access to health services, as found in this study and in national[ 34 ] and international[ 3 , 10 ] health surveys.
In general, men have a lower demand for health services and some of the factors identified by other studies were the outpatient appointment hours coincide with their working hours and due to the way they deal with their health and well-being, influenced by beliefs reflected in their health behavior. However, in the case of health problems or referred symptoms with no need for medical diagnosis, men tend to have them or report them less often than women, supporting gender studies that highlight the difficulty of man to recognize health problems.
The lower report of morbidities is not indicative of good health, as illustrated by the fact that men have the highest mortality rates, especially at early ages, evidenced by the higher male mortality in all age groups and in the major groups of underlying cause of death, as seen in this study and in studies that investigated the mortality profile in Brazil. These deaths have multiple factors associated with their causes, including, with great relevance, the unhealthy behaviors smoking, alcohol abuse, and worse food consumption , adopted by men in higher proportion.
The differences between men and women in morbidity and mortality found in this research confirm the gender paradox. The detailed analysis of the differences between men and women in each of the dimensions of health, showed some of the possible explanations for this paradox. It was also observed a gender paradox between the dimensions of health behaviors and health status: women report healthier behaviors than man, but have more chronic diseases and health problems compared to them.
So far we have not found Brazilian studies using together data from population-based health survey and mortality to measure inequalities in the various dimensions of health of adult men and women, aiming to contribute to the discussion of gender paradox. In addition to the explanations for the paradox discussed so far, men and women have different relations with their own bodies, what is shaped by moral and aesthetic reasons allied to the constitution of femininity and masculinity patterns, turning more socially acceptable a greater attention dedicated by women to their bodies and their sensations than men, in which such practices would compromise the image of virility associated with their bodily behaviors and health care.
Gender divisions also have repercussions on ways to endure the pain in silence, aling virility in some cultures, while women value the explicit expression of their feelings. The observed differences between men and women should be considered in order to promote health actions equitably between these segments. Given the higher adoption of unhealthy behavior and lower demand for health services, by men, which may explain the lower presence of morbidities among them and the higher mortality rates, it is suggested that young men are still poorly supported by health services.
Recognizing the men singularities in the context of morbidity and excess mortality, the National Policy for Integral Attention to Men's Health was launched in Brazil in In support of the policy, this study reinforces the importance of promoting strategies approaching men of health services, especially primary care, and investing in health education to stimulate self-care and changes in behaviors that may endanger their lives at an early age.
The funders had no role in study de, data collection and analysis, decision to publish, or preparation of the manuscript. National Center for Biotechnology Information , U. PLoS One. Published online Dec 7. Massimo Ciccozzi, Editor. Author information Article notes Copyright and information Disclaimer.
Competing Interests: The authors have declared that no competing interests exist. Received Sep 13; Accepted Nov This is an open-access article distributed under the terms of the Creative Commons Attribution , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. This article has been cited by other articles in PMC. Associated Data Supplementary Materials S1 Table: Socioeconomic and demographic characteristics of adults, according to sex.
S2 Table: Prevalence and prevalence ratios of health behaviors of adults, according to sex. S3 Table: Prevalence and prevalence ratio for health conditions and use of health services of adults, according to sex. Campinas, SP, Brazil, — Abstract Background Inequalities between men and women in morbidity and mortality show a contrast, which has been called gender paradox. Conclusions The findings contribute to the discussion of gender paradox and demonstrate the need to employ health actions that consider the differences between men and women in the various health dimensions analyzed.
Introduction The higher prevalence of morbidity in women and, on the other hand, the higher male mortality rate is a contrast that it was first investigated in by Nathanson[ 1 ] and has been evidenced in several health research called gender paradox. Table 1 Socioeconomic and demographic characteristics of adults, according to sex. Open in a separate window. Table 2 Prevalence and prevalence ratios of health behaviors of adults, according to sex. Table 3 Prevalence and prevalence ratio for health conditions and use of health services of adults, according to sex.
Neoplasms tumors Circulatory diseases Respiratory diseases Digestive tract diseases External causes Discussion The of the study revealed inequalities between men and women in all dimensions analyzed. Supporting Information S1 Table Socioeconomic and demographic characteristics of adults, according to sex. DOCX for additional data file. S2 Table Prevalence and prevalence ratios of health behaviors of adults, according to sex. S3 Table Prevalence and prevalence ratio for health conditions and use of health services of adults, according to sex. Data Availability All relevant data are within the paper and its Supporting Information files.
References 1. Nathanson CA. Illness and the feminine role: a theoretical review. Soc Sci Med , Case A, Paxson CH. Sex differences in morbidity and mortality. Demography , Gender disparities in health and healthcare: from the Portuguese National Health Interview Survey. Cad Saude Publica , Gender and Health Inequality. Annu Rev Sociol , Courtenay WH. Behavioral factors associated with disease, injury, and death among men: evidence and implications for prevention. J Mens Stud , World Health Organization.
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Prevalence of weight excess according to age group in students from Campinas, SP, Brazil