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The hidden half of domestic violence

How to have eternal life

MEN'S HEALTH: A WOMAN'S ISSUE

By Edward E. Bartlett, PhD
Newsletter of the Medical Care Section of the American Public Health
Association
Summer 2001
http://www.apha.org/sections/newsletters/medicalcaresummer2001.htm

  The disparities affecting men's health have been well-documented.
These are the most recent data, according to the DHHS publication,
Health, United States, 2000 (table numbers indicated in parentheses):

• American men live an average of 73.8 years, and women live 79.5
years, a 5.7 year life span gender gap (Table 28).

• Men have a higher age-adjusted death rate for every one of the top
10 leading causes of death (Table 30).

• Males under 65 years of age are more likely to have no health
insurance, compared to females: 18.5% vs. 16.2% in 1997 (Table 128).

• 23.2% of males have no usual source of health care, compared to 11.9%
of females (Table 78).

  Ironically, despite these documented disparities, men composed only
32% of enrollees in all NIH extramural research studies in 1998, down
from 45% male participation in 1994 (1). Although it has been alleged
that the current imbalance in NIH enrollments is justified by the prior
underrepresentation of women, empirical analyses do not support this
claim (2-5).

  The research documents that premature male death has a broad range of
effects on women. But first, we need to understand the age-specific
patterns of elevated male mortality risk.

  An analysis of relative mortality risk by age group reveals that
males in the 15-24 year age group have a death rate almost three times
higher than females of the same age (124.6/100,000 vs. 45.3/ 100,000)
(Health, United States, Table 36). Even in the 35-44 year age group,
men have a relative risk of death that is two times higher than women
of the same age (274.0/100.000 vs. 142.7/100,000).

  Men who die prematurely have mothers, and they often have sisters,
wives, girlfriends, and daughters as well. The death of these men has
an effect on the women in their lives. Although women of all ages are
affected, the greatest effects appear to be among widows. By age 65,
over half of all women have been widowed, and among women 85 years and
older, the percentage reaches 81% (6). This article briefly summarizes
selected studies on bereavement and widowhood on women's financial
status, mental health, physical health, life satisfaction, and risk of
institutionalization.

1. Widows typically lose their primary source of income. Research
documents the economic loss experienced by the widow (7). For example,
the Retirement History Study followed a cohort of widows over a 10-year
period, and found that 50% of women became poor at least once during
that period of time (8).

2. Premature male mortality is associated with a range of psychological
changes in women. Depression, anxiety, and substance abuse are the most
commonly reported characteristics of spousal bereavement. According to
the review by Rosenzweig, about one-third of elderly widows meet the
DSM criteria for a major depressive episode one month after the loss
(6).

3. Premature male mortality appears to have an adverse effect on the
physical health of wives and mothers:

• Verbrugge analyzed the effects of marriage, parenthood, and
employment status on the physical health of 412 women in the Health in
Detroit Study (9). Using multiple regression analyses, she found
widowhood had a direct negative association with poorer health status
of women.

• Brezinka and Kittel reviewed the research analyzing the effects of
bereavement on female mortality (10). One prospective study in Finland
found a twofold greater risk during the first week after the husband's
death. Another study reported that compared to pre-bereavement, women
had a relative risk of mortality of 3.8 during the first six months
after their partner's death. It should be noted, however, that two
other studies found no increased probability of female death after
adjusting for risk factors.

• Levav and colleagues followed a cohort of 6,284 Israeli parents who
lost a son to war or injury over a 20-year period (11). They found that
the bereaved mothers experienced a significantly higher incidence of
lymphatic/hematopoietic and respiratory cancers, even after controlling
for age, region of origin, and period of immigration.

4. Anecdotal reports suggest that a segment of the U.S. adult female
population is actively searching for a male partner. An analysis of the
U.S. age structure reveals that in the 45-64 year age group, there were
1.7 million more women than men in 1996. The effects of being
unsuccessful in this search for male partnership have not been well-
documented by scientific research, but form the staple of extensive
treatment by the popular media.

5. Elderly widows are at greater risk of being institutionalized.
Verbrugge analyzed the association between widowhood and various
measures of health status (12). She found that widows had an overall
risk of insitutionalization that was more than four times greater than
married women (all rates are age-adjusted, per 10,000 population):

                                  Married     Widowed
Mental Hospitals             11              26
Nursing Homes               22              97
Overall                           34             148

Conclusions
  Gender health disparities are inconsistent with the principles of
equity and social justice. And now, there is mounting evidence that
these disparities end up hurting women's economic status, psychological
well-being, physical health, life satisfaction, and ability to avoid
institutionalization in later years.

  Paying more attention attention to men's health will end up
benefiting men and women alike.

References
1. National Institutes of Health. Implementation of the NIH Guidelines
on the Inclusion of Women and Minorities as Subjects in Clinical
Research, September 1, 2000.
2. Dickersin K,  Min Y. NIH clinical trials and publication bias.
Online J Current Clin Trials. Doc. 50. Vol. 2, April 28, 1993.
3. Ungerleider RS, Friedman MA: Sex, trials, and datatapes. J National
Cancer Institute 1991; 83: 16-17.
4. Meinert CL, Gilpin AK, Unalp A, et al. Gender representation in
trials. Controlled Clin Trials 2000; 21: 462-475.
5. Bartlett EE. Gender participation in medical research: An
examination of the evidence. Epidemiology 2001; in press.
6. Rosenzweig A, Prigerson H, Miller MD et al. Bereavement and late-
life depression: Grief and its complications in the elderly. Annu Rev
Med 1997; 48: 421-428.
7. Zick CD, Smith KR. Patterns of economic change surrounding the death
of a spouse. J Gerontology 1991; 46: S310-320.
8. Holden KC, Burkhauser RV, Myers DA. Income transitions at older
stages of life: The dynamics of poverty. Gerontologist 1986; 26: 292-7.
9. Verbrugge LM. Multiple roles and physical health of women and men. J
Health Soc Behavior 1983; 24: 16-30.
10. Brezinka V, Kittle F. Psychosocial factors of coronary heart
disease in women: A review. Soc Sci Med 1995; 42: 1351-1365.
11. Levav I, Kohn R, Iscovich J et al. Cancer incidence and survival
following bereavement. Am J Publ  Health 2000; 90: 1601-1607.
12. Verbrugge LM. Marital status and health. Journal of Marriage and
Family 1979; 41: 267-285.

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