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01.12.2012 | Research | Ausgabe 1/2012 Open Access

International Journal for Equity in Health 1/2012

Social determinants of sex differences in disability among older adults: a multi-country decomposition analysis using the World Health Survey

International Journal for Equity in Health > Ausgabe 1/2012
Ahmad Reza Hosseinpoor, Jennifer Stewart Williams, Ben Jann, Paul Kowal, Alana Officer, Aleksandra Posarac, Somnath Chatterji
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1475-9276-11-52) contains supplementary material, which is available to authorized users.
Ahmad Reza Hosseinpoor, Jennifer Stewart Williams contributed equally to this work.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

AH designed the study and undertook the statistical analysis. JSW undertook the literature review and drafted the manuscript with input from AH and SC. BJ, AP, PK and AO read the draft and provided input and critical comment. All co-authors read and approved the final draft.



Women represent a growing proportion of older people and experience increasing disability in their longer lives. Using a universally agreed definition of disability based on the International Classification of Functioning, Disability and Health, this paper examines how, apart from age, social and economic factors contribute to disability differences between older men and women.


World Health Survey data were analyzed from 57 countries drawn from all income groups defined by the World Bank. The final sample comprises 63638 respondents aged 50 and older (28568 males and 35070 females). Item Response Theory was applied to derive a measure of disability which ensured cross country comparability. Individuals with scores at or above a threshold score were those who experienced significant difficulty in their everyday lives, irrespective of the underlying etiology. The population was then divided into “disabled” vs. “not disabled”. We firstly computed disability prevalence for males and females by socio-demographic factors, secondly used multiple logistic regression to estimate the adjusted effects of each social determinant on disability for males and females, and thirdly used a variant of the Blinder-Oaxaca decomposition technique to partition the measured inequality in disability between males and females into the “explained” part that arises because of differences between males and females in terms of age and social and economic characteristics, and an “unexplained” part attributed to the differential effects of these characteristics.


Prevalence of disability among women compared with men aged 50+ years was 40.1% vs. 23.8%. Lower levels of education and economic status are associated with disability in women and men. Approximately 45% of the sex inequality in disability can be attributed to differences in the distribution of socio-demographic factors. Approximately 55% of the inequality results from differences in the effects of the determinants.


There is an urgent need for data and methodologies that can identify how social, biological and other factors separately contribute to the health decrements facing men and women as they age. This study highlights the need for action to address social structures and institutional practices that impact unfairly on the health of older men and women.
Additional file 1:Table S1. Study sample size, by country. Pooled analysis of 57 countries, World Health Survey, 2002–2004. (DOCX 25 KB)
Additional file 2:Table S2. Questions on Health Domains. World Health Survey, 2002–2004. (DOC 42 KB)
Additional file 3:Table S3. Distribution of determinants in men and women aged 50 and older. Pooled analysis of 57 countries, World Health Survey, 2002–2004. (DOC 56 KB)
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