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Differences in disability among older women and men in Egypt and Tunisia

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Demography

Abstract

Research on child survival and health has indicated disparities between boys and girls in selected Middle Eastern countries. Health disparities in later life are understudied in this region. In this article, we examine differences between women and men in later-life activity limitation in Egypt and Tunisia. Difficulty executing physical tasks is more common for women than for men in both study sites, although differences are smaller after adjustment for underlying illness. Differences in the difficulty of executing physical tasks also are sensitive to environmental controls in variable ways across the study sites. The findings caution against the sole use of reported disability in comparative studies of gender and aging.

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References

  • Aloui, T., M. Ayad, and H. Fourati. 1989. Enquête Démographique et de Santé en Tunisie 1988 [Tunisia Demographic and Health Survey]. Columbia, MD: Institute for Resource Development/ Macro Systems.

    Google Scholar 

  • Andersen, K., L.J. Launer, M.E. Dewey, L. Letenneur, A. Ott, J.R.M. Copeland, J.-F. Dartigues, P. Kragh-Sorensen, M. Baldereschi, C. Brayne, A. Lobo, J.M. Martinez-Lage, T. Stijnen, A. Hofman, and the EURODEM Incidence Research Group. 1999. “Gender Differences in the Incidence of AD and Vascular Dementia: The EURODEM Studies.” Neurology 53:1992–97.

    Google Scholar 

  • Andrews, G. 1998. World Health Organization Collaborative Study on Social and Health Aspects of Aging in Bahrain, Egypt, Jordan, and Tunisia, 1991 [Computer file]. ICPSR version. Alexandria, Egypt: World Health Organization, Regional Office for the Eastern Mediterranean [producer], 1993. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor].

    Google Scholar 

  • Arber, S. and H. Cooper. 1999. “Gender Differences in Health in Later Life: The New Paradox?” Social Science and Medicine 48:61–76.

    Article  Google Scholar 

  • Casterline, J. and L. El-Zeini. 2003. “Consanguinity in the Arab Region: A Demographic Analysis.” Paper presented at the conference on “Institutions, Ideologies, and Agency: Family Change in the Arab Middle East and Diaspora,” University of North Carolina at Chapel Hill, September 13.

  • Crimmins, E.M. 2004. “Trends in the Health of the Elderly.” Annual Review of Public Health 25:79–98.

    Article  Google Scholar 

  • Crimmins, E.M., J.K. Kim, and A. Hagedorn. 2002. “Life With and Without Disease: Women Experience More of Both.” Journal of Women and Aging 14:47–59.

    Article  Google Scholar 

  • Crimmins, E.M. and Y. Saito. 2001. “Trends in Disability-Free Life Expectancy in the United States, 1970–1990: Gender, Racial, and Educational Differences.” Social Science and Medicine 52:1629–41.

    Article  Google Scholar 

  • Dunlop, D.D., L.M. Manheim, M.W. Sohn, X. Liu, and R.W. Chang. 2002. “Incidence of Functional Limitation in Older Adults: The Impact of Gender, Race, and Chronic Conditions.” Archives of Physical and Medical Rehabilitation 83:964–71.

    Article  Google Scholar 

  • El-Zanaty, F.H., Hussein A.A. Sayed, Hassan H.M. Zaky, and A.A. Way. 1993. Egypt Demographic and Health Survey, 1992. Calverton, MD: Macro International.

    Google Scholar 

  • El-Zanaty, F.H., E.M. Hussein, G.A. Shawky, A.A. Way, and S. Kishor. 1996. Egypt Demographic and Health Survey, 1995. Calverton, MD: Macro International.

    Google Scholar 

  • Gage, T.B. 1994. “Population Variation in Cause of Death: Level, Gender, and Period Effects.” Demography 31:271–96.

    Article  Google Scholar 

  • Gijsbers van Wijk, C.M., K.P. van Vliet, A.M. Kolk, and W.T. Everaerd. 1991. “Symptom Sensitivity and Sex Differences in Physical Morbidity: A Review of Health Surveys in the United States and the Netherlands.” Women and Health 17:91–124.

    Google Scholar 

  • Gittelsohn, J. 1991. “Opening the Black Box: Intrahousehold Food Allocation in Rural Nepal.” Social Science and Medicine 33:1141–54.

    Article  Google Scholar 

  • Goldman, N., M. Weinstein, J. Cornman, B. Singer, T. Seeman, and M.C. Chang. 2004. “Sex Differentials in Biological Risk Factors for Chronic Disease: Estimates From Population-Based Surveys.” Journal of Women’s Health 13:393–403.

    Article  Google Scholar 

  • Gragnolati, M., I.T. Elo, and N. Goldman. 1999. “New Insights Into the Far Eastern Pattern of Mortality.” Population Studies 53:81–95.

    Article  Google Scholar 

  • Hibbard, J.H. and C.R. Pope. 1986. “Another Look at Sex Differences in the Use of Medical Care: Illness Orientation and the Types of Morbidities for Which Services Are Used.” Women and Health 11:21–36.

    Article  Google Scholar 

  • Hill, K. and D.M. Upchurch. 1995. “Gender Differences in Child Health: Evidence From the Demographic and Health Surveys.” Population and Development Review 21:127–51.

    Article  Google Scholar 

  • Holmes-Eber, P. 1997. “Migration, Urbanization, and Women’s Kin Networks in Tunis.” Journal of Comparative Family Studies 28:54–72.

    Google Scholar 

  • Kamel, N.M., Y.A. Badawy, N.A. El-Zeiny, and I.A. Merdan. 1999. “Sociodemographic Determinants of Management Behaviour of Diabetic Patients Part II. Diabetics’ Knowledge of the Disease and Their Management Behaviour.” Eastern Mediterranean Health Journal 5: 974–83.

    Google Scholar 

  • Kane, T.T., A.A. El-Kady, S. Saleh, M. Hage, J. Stanback, and L. Potter. 1992. “Maternal Mortality in Giza, Egypt: Magnitude, Causes, Prevention.” Studies in Family Planning 23:45–57.

    Article  Google Scholar 

  • Katz, S. 1983. “Assessing Self-Maintenance: Activities of Daily Living, Mobility, and Instrumental Activities of Daily Living.” Journal of the American Geriatric Society 31:721–27.

    Google Scholar 

  • Knodel, J. and M.B. Ofstedal. 2003. “Gender and Aging in the Developing World: Where Are the Men?” Population and Development Review 29:677–98.

    Article  Google Scholar 

  • Kovar, M.G. 1991. “Functional Ability and the Need for Care: Issues for Measurement Research.” Vital Health Stat 5(6):97–103.

    Google Scholar 

  • Lamb, V.L. 1997. “Gender Differences in Correlates of Disablement Among the Elderly in Egypt.” Social Science and Medicine 45:127–36.

    Article  Google Scholar 

  • Langford, C. and P. Storey. 1993. “Sex Differentials in Mortality Early in the Twentieth Century: Sri Lanka and India Compared.” Population and Development Review 19:263–82.

    Article  Google Scholar 

  • Langsten, R. and K. Hill. 1994. “Diarrhoeal Disease, Oral Rehydration, and Childhood Mortality in Rural Egypt.” Journal of Tropical Pediatrics 40:272–78.

    Google Scholar 

  • Larrieu, S., K. Pérès, L. Letenneur, C. Berr, J.F. Dartigues, K. Ritchie, B. Février, A. Alpérovitch, and P. Barberger-Gateau. 2004. “Relationships Between Body Mass Index and Different Domains of Disability in Older Persons: The 3C Study.” International Journal of Obesity 28: 1555–60.

    Article  Google Scholar 

  • Lawton, M.P. 1975. “The Philadelphia Geriatric Center Morale Scale: A Revision.” Journal of Gerontology 30:85–89.

    Google Scholar 

  • Leveille, S.G., B.W. Penninx, D. Melzer, G. Izmirlian, and J.M. Guralnik. 2000. “Sex Differences in the Prevalence of Mobility Disability in Old Age: The Dynamics of Incidence, Recovery, and Mortality.” Journal of Gerontology: Social Sciences 55:S41-S50.

    Google Scholar 

  • Leveille, S.G., H.E. Resnick, and J. Balfour. 2000. “Gender Differences in Disability: Evidence and Underlying Reasons.” Review. Aging (Milano) 12:106–12.

    Google Scholar 

  • Liang, J., S. Gu, and N. Krause. 1992. “Social Support Among the Aged in Wuhan, China.” Asia-Pacific Population Journal 7(3):33–62.

    Google Scholar 

  • Lillard, L.A. and C.W. Panis. 1996. “Marital Status and Mortality: The Role of Health.” Demography 33:313–27.

    Article  Google Scholar 

  • MacIntyre, S. 1993. “Gender Differences in the Perceptions of Common Cold Symptoms.” Social Science and Medicine 36:15–20.

    Article  Google Scholar 

  • Murray, C.J. and J.D. Lopez. 1997. “Alternative Projections of Mortality and Disability by Cause 1990–2020: Global Burden of Disease Study.” Lancet 349(9064):1498–504.

    Article  Google Scholar 

  • Murray, C.J.L. and L.C. Chen. 1992. “Understanding Morbidity Change.” Population and Development Review 18:481–503.

    Article  Google Scholar 

  • Murray, J.E. 2000. “Marital Protection and Marital Selection: Evidence From a Historical Prospective Sample of American Men.” Demography 37:511–21.

    Article  Google Scholar 

  • Murtagh, K.N. and H.B. Hubert. 2004. “Gender Differences in Physical Disability Among an Elderly Cohort.” American Journal of Public Health 94:1406–11.

    Article  Google Scholar 

  • Myers, G.C., V.L. Lamb, and E.M. Agree. 2003. “Patterns of Disability Change Associated With the Epidemiologic Transition.” Pp. 59–74 in Determining Health Expectancies, edited by J.M. Robine, C. Jagger, C. Mathers, E. Crimmins, and R. Suzman. Chichester, England: John Wiley & Sons.

    Google Scholar 

  • Nagi, S.Z. 1976. “An Epidemiology of Disability Among Adults in the United States.” Milbank Memorial Fund Quarterly Health and Society 54:439–67.

    Article  Google Scholar 

  • Obermeyer, C.M. and R. Cardenas. 1997. “Son Preference and Differential Treatment in Morocco and Tunisia.” Studies in Family Planning 28:235–44.

    Article  Google Scholar 

  • Ofstedal, M.B., Z.S. Zimmer, and H.S. Lin. 1999. “A Comparison of Correlates of Cognitive Functioning in Older Persons in Taiwan and the United States.” Journal of Gerontology Series B: Psychological Sciences and Social Sciences 54:S291-S301.

    Google Scholar 

  • Oman, D., D. Reed, and A. Ferrara. 1999. “Do Elderly Women Have More Physical Disability Than Men Do?” American Journal of Epidemiology 15:834–42.

    Google Scholar 

  • O’Rand, A.M. 1996. “The Precious and the Precocious: Understanding Cumulative Disadvantage and Cumulative Advantage Over the Life Course.” The Gerontologist 36:230–38.

    Google Scholar 

  • Pande, R. 2003. “Selective Gender Differences in Child Nutrition and Immunization in Rural India: The Role of Siblings.” Demography 43:395–418.

    Article  Google Scholar 

  • Popkin, B.M. 2004. “The Nutrition Transition: An Overview of World Patterns of Change.” Nutrition Reviews 62(7) Suppl. 1:140–43.

    Article  Google Scholar 

  • Rahman, M.O. and J. Liu. 2000. “Gender Differences in Functioning for Older Adults in Rural Bangladesh. The Impact of Differential Reporting?” Journal of Gerontology. Series A: Biological Sciences and Medical Sciences 55:M28-M33.

    Google Scholar 

  • Rao, J.N.K. and A.J. Scott. 1981. “The Analysis of Categorical Data From Complex Sample Surveys: Chi-squared Tests for Goodness of Fit and Independence in Two-Way Tables.” Journal of the American Statistical Association 76:221–30.

    Article  Google Scholar 

  • —. 1984. “On Chi-squared Tests for Multiway Contingency Tables With Cell Proportions Estimated From Survey Data.” Annals of Statistics 12:46–60.

    Article  Google Scholar 

  • Robine, J.-M. and I. Romieu. 1998. “Healthy Active Ageing: Health Expectancies at Age 65 in the Different Parts of the World.” REVES Paper No. 318. Montpellier, France: INSERM.

    Google Scholar 

  • Rudkin, L. 1993. “Gender Differences in Economic Well-being Among the Elderly of Java.” Demography 39:209–26.

    Article  Google Scholar 

  • Sayed, H.A.-A., M.I. Osman, F. El-Zanaty, and A.A. Way. 1989. Egypt Demographic and Health Survey 1988. Columbia, MD: Institute for Resource Development/Macro Systems.

    Google Scholar 

  • Shriver, S.P., H.A. Bourdeau, C.T. Gubish, D.L. Tirpak, A.L. Davis, J.D. Luketich, and J.M. Siegfried. 2000. “Sex-Specific Expression of Gastrin-Releasing Peptide Receptor: Relationship to Smoking History and Risk of Lung Cancer.” Journal of the National Cancer Institute 92(1):24–33.

    Article  Google Scholar 

  • Silverstein, M.B. and V.L. Bengtson. 1991. “Do Close Parent-Child Relations Reduce the Mortality Risk of Older Parents?” Journal of Health and Social Behavior 32:382–95.

    Article  Google Scholar 

  • Social Security Administration, Office of Policy. 1999. Social Security Programs Throughout the World 1999. Available on-line at http://www.ssa.gov/statistics/ssptw/1999/English/index.html

  • Touati, S., A. Ben Abdelaziz, A. Mtiraoui, and M. Marzouki. 2001. “Contraceptive Use Prevalence in a Suburban Zone Around Sousse (Tunisia).” East Mediterranean Health Journal 7:943–55.

    Google Scholar 

  • United Nations. 1998. Too Young to Die: Genes or Gender? New York: Department of Economic and Social Affairs, Population Division, United Nations.

  • —. 2002. World Population Prospects: The 2000 Revision, Volume III Analytical Report. New York: United Nations Publications.

    Google Scholar 

  • United Nations Development Program. 2004. Human Development Report 2004: Cultural Liberty in Today’s Diverse World. New York: United Nations Publications.

    Google Scholar 

  • —, Regional Bureau for Arab States. 2002. Arab Human Development Report: Creating Opportunities for Future Generations. New York: United Nations Publications.

    Google Scholar 

  • Verbrugge, L.M. 1985. “Gender and Health: An Update on Hypotheses and Evidence.” Journal of Health and Social Behavior 26:156–82.

    Article  Google Scholar 

  • Verbrugge, L.M. and A.M. Jette. 1994. “The Disablement Process.” Social Science and Medicine 38:1–14.

    Article  Google Scholar 

  • Watkins, S.C. 1993. “If All We Knew About Women Was What We Read in Demography, What Would We Know?” Demography 30:551–77.

    Article  Google Scholar 

  • Wingard, D.L., B.A. Cohn, G.A. Kaplan, P.M. Cirillo, and R.D. Cohen. 1989. “Sex Differentials in Morbidity and Mortality Risks Examined by Age and Cause in the Same Cohort.” American Journal of Epidemiology 130:601–10.

    Google Scholar 

  • World Bank Group. 2002. Gender Stats: Database of Gender Statistics. Available on-line at http:// genderstats.worldbank.org

  • World Health Organization. 2000. The World Health Report 2000. Health Systems: Improving Performance. Geneva: World Health Organization.

    Google Scholar 

  • —. 2001. International Classification of Functioning, Disability, and Health. Geneva: World Health Organization.

    Google Scholar 

  • Yount, K.M. 2001. “Excess Mortality of Girls in the Middle East in the 1970s and 1980s: Patterns, Correlates, and Gaps in Research.” Population Studies 55:291–308.

    Article  Google Scholar 

  • —. 2003a. “Gender Bias in the Allocation of Curative Care in Minia, Egypt.” Population Research and Policy Review 22:267–95.

    Article  Google Scholar 

  • —. 2003b. “Provider Bias in the Treatment of Diarrhea Among Boys and Girls in Minia, Egypt.” Social Science and Medicine 56:753–68.

    Article  Google Scholar 

  • —. 2004. “Research Note: Maternal Resources, Proximity of Services, and Curative Care of Boys and Girls in Minya, Egypt.” Population Studies 58:345–55.

    Article  Google Scholar 

  • Yount, K.M. Forthcoming. “The Patriarchal Bargain and Intergenerational Coresidence in Egypt.” Sociological Quarterly 46:139–66.

  • Yount, K.M. and E.M. Agree. 2004. “The Power of Older Women and Men in Egyptian and Tunisian Families.” Journal of Marriage and Family 66:126–46.

    Google Scholar 

  • Yount, K.M., E.M. Agree, and C. Rebellon. 2004. “Gender, Health, and Use of Modern Health Care Among Older Adults in Egypt and Tunisia.” Social Science and Medicine 59:2479–97.

    Article  Google Scholar 

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The research was supported by Grant URC 00-01 YOUNT from the University Research Committee of Emory University. The comments of anonymous reviewers on an earlier version of this article are greatly appreciated, as is assistance from Maria Sullivan in the preparation of the manuscript.

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Yount, K.M., Agree, E.M. Differences in disability among older women and men in Egypt and Tunisia. Demography 42, 169–187 (2005). https://doi.org/10.1353/dem.2005.0009

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