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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JUNE is Domestic Violence Against Men Awareness Month