Sex/Gender Disparities in Health Outcomes of Individuals With Long-Term Disabling Conditions

• Published in: Rehabilitation psychology 2019-05, Vol.64 (2), p.221-228
• Main Authors: Thakral, Manu, Lacroix, Andrea Z., Molton, Ivan R.
• Format: Article
• Language: English
• Subjects: Activities of Daily Living - psychology; Adult; Age Factors; Aged; Diagnosis Related Groups; Disabled Persons - rehabilitation; Disabled Persons - statistics & numerical data; Female; Health Disparities; Health Status; Health Status Disparities; Human; Human Sex Differences; Humans; Longitudinal Studies; Male; Middle Aged; Multiple Sclerosis; Neuromuscular Disorders; Personal Satisfaction; Poliomyelitis; Severity of Illness Index; Sex Factors; Spinal Cord Injuries; Syndromes; Test Construction
• ISSN: 0090-5550; 1939-1544; 1939-1544
• DOI: 10.1037/rep0000248

Background: Women with disabling conditions experience health disparities relative to nondisabled women, but few studies have compared women and men with disabling conditions. Objectives: To investigate gender differences in physical functioning and emotional health among individuals with long-term disabling conditions, that is, neuromuscular disease, multiple sclerosis, postpolio syndrome, or spinal cord injury. Method: From a mailed survey of 1,862 adults with long-term disabling conditions, we used the 12-item Patient-Reported Outcomes Measurement Information System (PROMIS) physical functioning to assess physical limitations in activities and Patient Health Questionnaire-9 (PHQ-9) for emotional health and severity of secondary conditions (rated 0-10). Least square means models were used to estimate marginal mean PHQ-9 scores and severity of secondary conditions by age and sex adjusted for diagnosis. Generalized linear models were performed to determine the association between sex/gender and PROMIS physical function t score, controlling for age and diagnostic group with potential Age × Sex interaction. Results: Women reported more fatigue than men (5.48 ± .08 vs. 5.13 ± .11, p = .01) and more pain (3.99 ± .08 vs. 3.67 ± .11, p = .03). Women aged 45-54 had higher average PHQ-9 scores than men aged 45-54 (M = 8.05, SE = .33 vs. M = 6.35, SE = .42, p < .007) adjusted for diagnosis. Younger women had higher physical functioning than younger men while older women had lower physical functioning than older men adjusted for diagnostic group (p = .0003 for the interaction term). Conclusion: Middle-aged and older women with long-term disabling conditions experience considerable health disparities in physical functioning and emotional health compared with middle-aged and older men with similar conditions. Impact and Implications Although health disparities of individuals with disabilities are recognized, there is less awareness of health disparities of women compared to men with disabilities. The differences in health between men and women are the result of both biological and social influences that occur simultaneously such that the effect of sex biology cannot be distinguished from that of gender roles. Among individuals with long-term disabling conditions, we found that sex/gender and age contributed to health disparities in physical functioning and emotional health, making middle-aged and older women with disabilities a particularly vulnerable subpopulation. W