Elsevier

Social Science & Medicine

Volume 59, Issue 12, December 2004, Pages 2479-2497
Social Science & Medicine

Gender and use of health care among older adults in Egypt and Tunisia

https://doi.org/10.1016/j.socscimed.2004.04.004Get rights and content

Abstract

In Western industrialized countries, women report using health services more often than do men. We explore the applicability of existing theory to explain gender differences in use of health care among older adults in Egypt and Tunisia, where females have received less health care than males in early life. Findings show that women report visiting providers and using medications more often than do men; however, adjusted odds of visiting doctors are comparable for women and men in Tunisia and lower for women than men in Egypt. Odds of using health care are higher for women than men among those reporting no morbidity or functional impairment, but these relative odds diminish or reverse among those reporting multiple morbidities or severe impairments. The contributions of subjective and objective illness, quality of social support, and availability of services on gender differences in care in later life should be assessed in these and other settings where girls’ excess mortality persists.

Section snippets

Background

Despite women's greater longevity than men in most settings, higher levels of morbidity among older women diminish this advantage (e.g., Kaplan & Erickson, 2000). Older women more often experience acute conditions, disability and functional limitation, longer durations of disability, proportionately more remaining years of life disabled, and a higher prevalence of risk factors for cardiovascular disease (Arber & Cooper, 1999; Leveille, Penninx, Melzer, Izmirlian, & Guralnik, 2000; NAS [National

The settings

From the 1950s to the 1990s, life expectancy at birth increased from 44 to 65 years among women and from 41 to 62 years among men in Egypt (UNDP, 2002). In Tunisia, these figures increased from 45 to 69 years among women and from 44 to 67 years among men (UNDP, 2002). Despite women's higher life expectancy at birth in both settings, estimates for 1998 suggest that women live as many or more years of life disabled (5.7 versus 5.6 in Egypt; 7.2 versus 5.0 in Tunisia) so that estimates of

Data and method

Data comes from the World Health Organization Collaborative Study on Social and Health Aspects of Aging that was conducted around 1990 in Bahrain, Egypt, Jordan, and Tunisia (Andrews, 1998).10 Samples in Egypt (n=1179) and Tunisia (n=1236) consist of non-institutionalized women and men aged 60 years and over. Multi-stage, age-stratified cluster sampling procedures were used to identify eligible respondents. The Egyptian sample

Characteristics of study samples

Table 1 compares background characteristics of women and men in each study site. Higher percentages of women than men report having at least three morbidities (27 versus 17; 40 versus 22), and severe functional limitation (31 versus 16; 24 versus 13). In Tunisia, the percentage interviewed by proxy is greater among women than men (5 versus 3), and a higher percentage of women than men have severe cognitive impairment (91 versus 61). Higher percentages of women than men report having no

Discussion

This study extends research on gender differences in use of care in early life in the Middle East (e.g., Yount, 1999, Yount, 2001, Yount, 2003a, Yount, 2003b) by examining the direction and determinants of gender differences in use of care in later life, and comparison of the effects of gender across two Middle Eastern settings is important because family laws, public opportunities for women, and the degree of development of health infrastructures vary in the region. This study also extends

Acknowledgements

This research was supported by grant #2-80323 from the University Research Committee and by the Departments of International Health and Sociology at Emory University. We greatly appreciate the comments of anonymous reviewers on an earlier version of this manuscript.

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