Masculine gender affects sex differences in the prevalence of chronic health problems - The Doetinchem Cohort Study

Both (biological) sex and (socio-cultural) gender are relevant for health but in large-scale studies specific gender measures are lacking. Using a masculine gender-score based on 'traditional masculine-connotated aspects of everyday life', we explored how masculinity may affect sex differences in the prevalence of chronic health problems. We used cross-sectional data (2008-2012) from the Doetinchem Cohort Study to calculate a masculine gender-score (range 0-19) using information on work, informal care, lifestyle and emotions. The sample consisted of 1900 men and 2117 women (age: 40-80). Multivariable logistic regressions including age and SES were used to examine the role of masculine gender on sex differences in the prevalence of diabetes, coronary heart disease, CVA, arthritis, chronic pain and migraine. Men had higher masculine gender-scores than women (12.2 vs 9.1). For both sexes, a higher masculine gender-score was associated with lower prevalence of chronic health problems. Diabetes, CHD, and CVA were more prevalent in men, and gender-adjustment resulted in greater sex differences: e.g. for diabetes the OR sex changed from 1.21 (95 %CI 0.93-1.58) to 1.60 (95 %CI 1.18-2.17). Arthritis, chronic pain, and migraine were more prevalent in women, and gender-adjustment resulted in smaller sex differences: e.g. for chronic pain the OR sex changed from 0.53 (95 %CI 0.45-0.60) to 0.73 (95 %CI 0.63-0.86). Gender measured as 'everyday masculinity' is associated with lower prevalence of chronic health problems in both men and women. Our findings also suggest that the commonly found sex differences in the prevalence of chronic health problems have a large gender component.