Macrolevel gender inequality is defined as the unequal distribution of power and resources between men and women shaped by macrolevel social structures and institutions. An emerging line of health ...research is emphasising its negative consequences on women's health and healthcare access. The present study examines how gender inequality contexts affect women's mammography screening uptake. It adopts a macrosociological and institutionalist approach on preventive healthcare use and compares women who live with a partner with those who do not. This is the first study to test the effect of macrolevel gender inequality on mammography uptake across the 26 Swiss cantons (i.e. regions). The Swiss cantons' autonomy to manage their political and healthcare systems, as provided by the federal system, offers an ideal setting for the comparative analysis of macrolevel factors. Data on 9724 women aged 50–70 from the Swiss Health Interview Survey (waves 2007, 2012 and 2017) is analysed. Multilevel logistic models estimate two canton-level indicators of gender inequality, the gender gaps in time use and full-time employment, and their association with mammography uptake, controlling for women's socioeconomic and demographic characteristics, health status and healthcare use. Cross-level interactions assess how these indicators moderate the mammography uptake of women living with and without a partner. Results show that in cantons with higher gender inequality, women have a lower probability of mammography uptake. Women who live with a partner have a higher mammography uptake than those who do not. However, this advantage is moderated by canton-level gender inequality, namely, women who live with a partner in more gender unequal cantons have a lower mammography uptake than their counterparts who reside in more gender equal cantons. Results support the hypothesis that macrolevel gender inequality moderates women's preventive healthcare uptake, from an institutionalist approach.
•Gender unequal contexts and institutions may hinder mammography screening uptake.•Living with a partner improves mammography uptake yet macrolevel gender inequality modifies this effect.•Regional screening programmes and opportunistic screening may reproduce screening inequalities.•Policymakers should consider (macrolevel) gender inequality in preventive health policies.
The relationship between mortality and marital status has long been recognized, but only a small number of investigations consider also the association with cohabitation status. Moreover, age and ...gender differences have not been sufficiently clarified. In addition, little is known on this matter about the Italian elderly population. The aim of this study is to examine differentials in survival with respect to marital status and cohabitation status in order to evaluate their possible predictive value on mortality of an Italian elderly cohort. This paper employs data from the Italian Longitudinal Study on Aging (ILSA), an extensive epidemiologic project on subjects aged 65–84 years. Of the 5376 individuals followed-up from 1992 to 2002, 1977 died, and 1492 were lost during follow-up period. The baseline interview was administered to 84% of the 5376 individuals and 65% of them underwent biological and instrumental examination. Relative risks of mortality for marital (married vs. non-married) and cohabitation (not living alone vs. living alone) categories are estimated through hazard ratios (HR), obtained by means of the Cox proportional hazards regression model, adjusting for age and several other potentially confounding variables. Non-married men (HR
=
1.25; 95% CI: 1.03–1.52) and those living alone (HR
=
1.42; 95% CI: 1.05–1.92) show a statistically significant increased mortality risk compared to their married or cohabiting counterparts. After age-adjustment, women's survival is influenced neither by marital status nor by cohabitation status. None of the other covariates significantly alters the observed differences in mortality, in either gender. Neither marital nor cohabitation status are independent predictors of mortality among Italian women 65+, while among men living alone is a predictor of mortality even stronger than not being married. These results suggest that Italian men benefit more than women from the protective effect of living with someone.
Objectives: The aim of this study was to identify the association between cohabitation status and sleep quality in family members of people with dementia (PwDs).Methods: Data of 190 365 participants ...aged ≥19 years from the 2018 Korea Community Health Survey were analyzed. Participants were categorized according to their cohabitation status with PwDs. Multiple logistic regression and ordinal logistic regression analyses were performed to evaluate the relationship between the cohabitation status of PwDs’ relatives and sleep quality measured using the Pittsburgh Sleep Quality Index (PSQI) and PSQI subscales.Results: Compared to participants without PwDs in their families, both cohabitation and non-cohabitation with PwDs were associated with poor sleep quality (cohabitation, male: odds ratio OR,1.28; 95% confidence interval CI, 1.08 to 1.52; female: OR, 1.40; 95% CI, 1.20 to 1.64; non-cohabitation, male: OR, 1.14; 95% CI, 1.05 to 1.24; female: OR, 1.23; 95% CI, 1.14 to 1.33). In a subgroup analysis, non-cohabiting family members showed the highest odds of experiencing poor sleep quality when the PwD lived alone (male: OR, 1.48; 95% CI, 1.14 to 1.91; female: OR, 1.58; 95% CI, 1.24 to 2.01). Cohabiting male and female participants had higher odds of poor subjective sleep quality and use of sleeping medications than non-cohabiting male and female participants, respectively.Conclusions: The residence of PwDs and cohabitation status may contribute to poor sleep quality among PwDs’ family members. The circumstances faced by cohabiting and non-cohabiting family members should be considered when evaluating sleep quality in family members of PwDs, and appropriate interventions may be needed to improve sleep quality in both cohabiting and non-cohabiting family members.
To examine whether current and/or history of marital/cohabitation status are associated with sleep, independent of demographic and general health risk factors.
Longitudinal, observational study of ...women, with sleep measured via multi-night in-home polysomnography and up to 35 nights of actigraphy.
Participants' homes.
Caucasian (n = 170), African American (n = 138), and Chinese women (n = 59); mean age 51 years.
None.
Sleep quality was assessed via questionnaire. Sleep duration, continuity, and architecture were calculated using in-home polysomnography (PSG). Sleep continuity was also assessed by actigraphy. Categories of marital/cohabiting status or changes in status were inclusive of women who were legally married or living as married as well as transitions into or out of those partnership categories.
Partnered (married or cohabiting) women at the time of the sleep study had better sleep quality and PSG and actigraphy-assessed sleep continuity than unpartnered women; however, with covariate adjustment, most of these associations became non-significant. Analyses of women's relationship histories over the 6-8 years prior to the sleep study showed advantages in sleep for women who were consistently partnered versus women who were unpartnered throughout this interval, or those who had lost or gained a partner over that time course. These results persisted after adjusting for potential confounders.
The stable presence of a partner is an independent correlate of better sleep quality and continuity in women.
In a follow-up study of 1265 women and men aged 50, 60 and 70 years, we analysed how mortality was associated with cohabitation status (living alone/not living alone), living with/without a partner, ...and marital status respectively. Data originate from a longitudinal questionnaire study of a random sample of people born in 1920, 1930 and 1940 with baseline in 1990. Survival time for all individuals were established during the next 8 years until May 1998. Multivariate Cox analysis stratified by age and gender showed that individuals living alone experienced a significantly increased mortality compared to individuals living with somebody HR=1.42(1.04–1.95) adjusted for functional ability, self-rated health, having children, smoking, diet and physical activity. Similar analyses were performed for the variable living with/without a partner
HR=1.38(1.01–1.88) and marital status
HR=1.25(0.93–1.69), adjusted for the same covariates. Inclusion of the health behaviour variables—smoking, diet and physical activity—one by one to a model with functional ability, self-rated health and one of the three determinants (cohabitation status, living with/without partner, marital status) showed no effect on the association with mortality. Hereby, we found no evidence of an indirect effect of health behaviours on the association between living arrangements and mortality. In contrast to many previous studies, we found no significant gender and age differences in the association between living arrangement and mortality. We suggest that in future studies of social relations and mortality, cohabitation status is considered to replace marital status as this variable may account for more of the variation in mortality.
Objectives: To investigate the effect of cohabitation status in older men and women on (a) onset of disability at 3- and 4.5-year follow-up and (b) changes in functional ability between 3- and ...4.5-year follow-up, and to analyze whether this effect was mediated by social participation. Method: A total of 2,533 nondisabled older men and women enrolled in the Danish Intervention Study on Preventive Home Visits constituted the study population. Data were collected by mailed questionnaires in 1998-1999, 2000, 2001-2002, and 2003. Results: Living alone significantly increased the risk of onset of disability (T3 OR = 1.601.06-2.43, T4 OR = 1.741.22-2.47) and the risk of sustained poor functional ability (OR = 2.351.44-3.84) among men, but not among single-living women. Social participation mediated only a small part of the effect of cohabitation status on functional ability. Discussion: Our results underline the importance of cohabitation/marriage for maintaining a high functional ability among older men.
Abstract
Objective: This preliminary study aimed at investigating (1) changes in the status of family members between time of injury and follow-up in the chronic phase and (2) the most important ...needs within the family in the chronic phase and whether the needs were perceived as met.
Participants: The sample comprised 42 relatives (76% female, mean age = 53 years) of patients with severe brain injury, who had received intensive sub-acute rehabilitation. The relatives were contacted in the chronic phase after brain injury.
Outcome measure: A set of questions about demographics and time spent caregiving for the patient was completed. The relatives completed the revised version of the Family Needs Questionnaire, a questionnaire consisting of 37 items related to different needs following brain injury.
Results: Significant changes in status were found in employment (z = −3.464, p = 0.001) and co-habitation (z = −3.317, p = 0.001). The sub-scale 'Health Information' (Mean = 3.50, SD = 0.73) had the highest mean importance rating, whereas the sub-scale 'Emotional support' (Mean = 3.07, SD = 0.79) had the lowest. When combining importance and met ratings, it was found that the five most important needs were only met in 41-50% of the total sample.
Conclusion: Occupational and co-habitation status of the relatives was significantly affected by brain injury. A high number of relatives reported family needs not satisfied in the chronic phase. This requires an interventional approach for families to get these needs fulfilled individually, even after rehabilitation.
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