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

Ahmad Reza Hosseinpoor1, Jennifer Stewart Williams2*, Ben Jann3, Paul Kowal12, Alana Officer4, Aleksandra Posarac5 and Somnath Chatterji1

Author Affiliations

1 Department of Health Statistics and Information Systems, World Health Organization, 20 Avenue Appia, Geneva, 27 1211, Switzerland

2 Research Centre for Gender Health & Ageing, Faculty of Health, University of Newcastle, Callaghan, 2308, Australia

3 Institute of Sociology, University of Bern, Lerchenweg 36, 3000, Bern 9, Switzerland

4 Department of Violence, Injury Prevention and Disability, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland

5 Social Protection and Labor, Human Development Network, The World Bank, Washington, DC, 20433, USA

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International Journal for Equity in Health 2012, 11:52  doi:10.1186/1475-9276-11-52

Published: 8 September 2012



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.

Disability; Chronic disease; Functional limitation; Ageing; Aging; Equity; Inequalities; Social determinants