GENDER DIFFERENCES IN FIVE HEALTH-RELATED QUALITY OF LIFE INDEXES ARE ASSOCIATED WITH SOCIODEMOGRAPHIC AND SOCIOECONOMIC DIFFERENTIAL BETWEEN ADULT MEN AND WOMEN IN THE US: A STUDY OF FOUR US NATIONALLY REPRESENTATIVE DATA SETS

Purpose: Women have longer life expectancies than men at all ages.  The epidemiology of many chronic diseases differs between men and women.  We ask here whether there are gender differences in health-related quality of life (HRQoL) measured by five HRQoL indexes commonly used in US nationally representative data sets.

Method: We analyzed data on African Americans and Caucasians aged 35-89 from 4 surveys using 1 or more of the indexes: Joint Canada/United States Survey of Health, Medical Expenditure Panel Survey, National Health Measurement Study, and US Valuation of the EuroQol EQ-5D Health States Survey. Gender differences measured by SF-6D, EQ-5D, HUI2, HUI3 and QWB-SA were estimated for indexes common to each dataset and in a pooled dataset using survey-weighted least-squares regression. Differences in HRQoL were estimated with and without adjustment for sociodemographic and socioeconomic (SES) indicators. 

Result: Distributions of age, race and education were similar between men and women across the 4 studies. In the age range analyzed, women were twice as likely than men to report being ‘widowed, divorced or separated’ and 1.5 times more likely to be in the lowest income category (<$20,000). Women had lower HRQoL scores than men on all HRQoL measures prior to adjustment for marital status, education and income (p<0.05).  The average HRQoL difference (men minus women) was 0.023 before and 0.014 after adjustment. Average differences (favoring men) by index were: 0.027 (SF-6D), 0.018 (EQ-5D), 0.024 (HUI2), 0.024 (HUI3), and 0.03 (QWB-SA). Marital status and income had similar and the largest impact on the estimated differences.  Simultaneous adjustment for all covariates substantially reduced the differences with QWB-SA and SF-6D scores being least affected and HUI3 most.  Differences between black men and women were much larger than for whites on all measures and persisted after adjustment.

Conclusion: Older women in the US have slightly lower HRQoL than men on five commonly used measures. Difference in HRQoL between women and men may be due in part to women being lower on the SES gradient in HRQoL noted in many epidemiologic studies. Differences between black men and women are large and not explained by differential SES. The HRQoL indexes seem to differ in sensitivity to gender-associated HRQoL.