SDHs and sociodemographic and clinical variables stratified by sex
In the fifth wave differences were observed between men and women when analyzing the SDHs. The average age for women was 63.7 (SD 10.2) years, while for men, it was 64.8 (SD 9.4) years. The most represented age group was the 50-64 age group, encompassing 54.4% of women and 50.0% of men. Regarding education, 37.0% of women had a low education level compared to 32.9% of men (p<0.001). Economic difficulty was observed in 30.5% of women and 26.7% of men (p<0.001). Additionally, over 90% of respondents of both sexes were native to the country where the interview took place. The CASP-12 score was higher among men than among women (p<0.001). For complete data, refer to Table 1.
Table 1. Social determinants of health, differentiated by sex in wave 5 of recruitment and changes in CASP-12.
Variables, %
|
Female
n=6236
|
Male
n=5257
|
p
|
Age
|
|
|
|
Mean (SD)a
|
63.7 (10.2)
|
64.8 (9.4)
|
<0.001
|
Age groups
50-64
65-74
75-84
>85
|
3.392 (54.4%)
1.753 (28.1%)
885 (14.2%)
206 (3,3%)
|
2.629 (50.0%)
1.668 (31.7%)
819 (15.6%)
141 (2,7%)
|
<0.001
|
Education level
High
Medium
Low
|
1.600 (25,7%)
2.326 (37,3%)
2.310 (37,0%)
|
1.493 (28,4%)
2.037 (38,7%)
1.727 (32.9%)
|
<0.001
|
Economic situation
(making ends meet)
With difficulty
Without difficulty
|
1.899 (30,5%)
4.337 (69,5%)
|
1.404 (26,7%)
3.853 (73,3%)
|
<0.001
|
External financial assistance
Yes
No
|
1.174 (18,8%)
5.062 (81,2%)
|
833 (15.8%)
4.424 (84,2%)
|
<0.001
|
Born in interview country
Yes
No
|
5.630 (90,3%)
606 (9,7%)
|
4.744 (90,2%)
513 (9,8%)
|
0.967
|
Area of residence
Large city/town
Small /rural town
Suburbs of a major city
|
1.907 (30,6%)
3.696 (59,3%)
633 (10,2%)
|
1.537 (29,2%)
3.201 (60,9%)
519 (9,9%)
|
0.406
|
European region
South
Continental
North
East
|
1499 (24.0%)
2383 (38.2%)
1474 (23.6%)
880 (14.1%)
|
1271 (24.2%)
2060 (39.2%)
1273 (24.2%)
653 (12.4%)
|
0.065
|
CASP-12 Mean (SD)a
|
38.0 (6,4)
|
38.6 (6,2)
|
<0.001
|
CASP-12 change Wave 6-5 (SD)a
CASP-12 change Wave 7-5 (SD)a
|
-0.005 (5,8)
-0.43 (6,1)
|
0.02 (5,8)
-0.29 (6,3)
|
0.519
0.247
|
Notes:
a Mean (standard deviation)
CASP-12: Quality of Life and Well-being Index
When analyzing the sociodemographic and clinical variables, notable differences were found between men and women. Regarding marital status, the majority of participants of both sexes were married, but there was a higher proportion of widows (13.4%) than widowers (4.5%) (p<0.001), as well as a higher proportion of women living alone than men (19.4% vs. 12.6%) (p<0.001). Self-perceived health was significantly lower among women. Although limitations in activities of daily living (ADLs) were infrequent and participants of both sexes had few mobility difficulties, they were more common among women (p<0.001). Regarding depression (EURO-D), a significant difference was observed between women (30.3%) and men (17.5%). Physical inactivity was more frequent among women (49.8%) than among men (42.4%) (p<0.001). Additionally, tobacco and alcohol consumption were significantly higher among men than among women. For complete data, refer to Table 2.
Table 2. Sociodemographic and clinical variables, differentiated by sex in wave 5 of recruitment
|
Variables, %
|
Female
n=6236
|
Male
n=5257
|
p
|
Marital status
Married
Divorced
Single
Widowed
|
4443 (71.2%)
638 (10.2%)
319 (5.1%)
836 (13.4%)
|
4241 (80.7%)
432 (8.2%)
350 (6.7%)
234 (4.5%)
|
<0.001
|
Employment status
Retired
Employed
Unemployed
Disabled
Homemaker
|
3233 (51.8%)
2384 (38.2%)
0 (0.0%)
1 (0.0%)
618 (9.9%)
|
2905 (55.3%)
1997 (38.0%)
207 (3.9%)
148 (2.8%)
0 (0.0%)
|
<0.001
|
Household composition
Living alone
2 people
3 or more
|
1207 (19,4 %)
3601 (57,7%)
1428 (23,35)
|
664 (12,6%)
3256 (61,9%)
1337 (25,5%)
|
<0.001
|
Number of children
None
1-2
3 or +
|
521 (8,4%)
3810 (61,1%)
1905 (30,65)
|
532 (10,1%)
3119 (59,3%)
1606 (30,5%)
|
0.153
|
Number of grandchildren
None
1-4
5 or +
|
2313 (37,1%)
2856 (45,6%)
1067 (16,9%)
|
2173 (41,3%)
2306 (43,9%)
778 (14,8%)
|
<0.001
|
Self-perceived health
Excellent/very good
Good
Fair
Poor
|
1968 (31,6%)
2279 (36.5%)
1500 (24.1%)
489 (7.8%)
|
1693 (32,2%)
2072 (39.4%)
1138 (21.6%)
354 (6.7%)
|
<0.001
|
Chronic diseases
None
1-2
3 or +
|
2510 (40,3%)
2985 (47,9%)
741 1(1,9%)
|
1833 (34,9%)
2682 (51,0%)
742 1(4,1%)
|
<0.001
|
Mobility difficulty
No difficulty
Some difficulty
Severe difficulty
|
4616 (74,0%)
1346 (21,6%)
274 (4,4%)
|
4313 (82,0%)
778 (14,8%)
166 (3,2%)
|
<0.001
|
Physical activity
Active
Inactive
|
3132 (50,2%)
3104 (49,8%)
|
3027 (57,6%)
2230 (42,4%)
|
<0.001
|
Depression scale (EURO-D)
No depression
With depression
|
4349 (69.7%)
1887 (30,3%)
|
4339 (82.5%)
918 (17,5%)
|
<0.001
|
Doctor visits/year
1-5
6-10
11 or +
|
3951 (63,4%)
1241 (19,9%)
1044 (16,7%)
|
3568 (67,9%)
902 (17,1%)
787 (15,0%)
|
<0.001
|
Body mass index
Underweight
Normal
Overweight
Obese
|
102 (1,6%)
2730 (43,8%)
2159 (34,6%)
1245 (20,0%)
|
23 (0,4%)
1584 (30,3%)
2589 (49,2%)
1051 (20,0%)
|
<0.001
|
Daily smoking
Yes
No
|
2314 (37,1%)
3922 (62.9%)
|
2944 (56%)
2313 (44%)
|
<0.001
|
Daily drinking
Does not drink or less than 1-2 times per month
Drinks between 1 and 4 days a week
Drinks almost every day
|
3801 (61,0%)
1719 (27,6%)
716 (11,4%)
|
1950 (37,1%)
1790 (34,0%)
1517 (28,9%)
|
<0.001
|
SDHs and QoL differentiated by sex and European region in the 5th wave of recruitment
When analyzing the SDHs and QoL, significant differences were observed in terms of sex and European region. Regarding SDHs, the southern region had an older population of people of both sexes, with 6% of women over 85 years of age. In contrast, the continental and northern regions had the lowest proportions of this age group, at 2.3% and 2.4%, respectively (p<0.001). In terms of educational level, the southern region showed the highest percentage of women with a low education level, 76.3% of the respondents, while in the northern region, this proportion was 23.7% (p<0.001). In relation to economic difficulty in making ends meet, the eastern and southern regions had the highest percentages, especially among women, with 50.8% and 46.1%, respectively, compared to 13.4% in the northern region and 23.7% in the continental region (p<0.001). In terms of nativity, the continental region had a proportion of 16% of respondents of both sexes who were not native to the country of residence, while in the southern region, this percentage was 4.8% (p<0.001).
Regarding QoL measured by the CASP-12, 49.0% and 40.7% of women in the southern and eastern regions, respectively, reported having low QoL. This contrasts with 14.4% in the northern region and 25% in the continental region (p<0.001). This trend was also observed among males. For complete data, refer to Table 3.
Table 3. Social determinants of health and quality of life differentiated by sex and European region in wave 5 of recruitment.
Variables, %
|
North n = 2747
|
Continental n = 4443
|
East n = 1533
|
South n = 2770
|
p
|
|
Female n = 1474
|
Male n = 1273
|
Female n = 2383
|
Male n = 2060
|
Female n = 880
|
Male n = 653
|
Female n = 1499
|
Male n = 1271
|
|
Age groups
|
|
|
|
|
|
|
|
|
< 0.001
|
50-64
|
49.3
|
45
|
61.1
|
54.6
|
50.3
|
45.8
|
51.2
|
49.7
|
|
65-74
|
33.4
|
35.1
|
25
|
30.4
|
31.9
|
36.6
|
25.6
|
27.9
|
|
75-84
|
14.9
|
17.2
|
11.5
|
13
|
14.9
|
15.6
|
17.3
|
18.1
|
|
> 85
|
2.3
|
2.7
|
2.4
|
1.9
|
2.8
|
2
|
6
|
4.2
|
|
Education level
|
|
|
|
|
|
|
|
|
0
|
High
|
41.6
|
39.6
|
28.3
|
34.7
|
16.4
|
18.5
|
11.3
|
12
|
|
Medium
|
34.7
|
37.9
|
47.6
|
47.3
|
56
|
61.1
|
12.4
|
14.2
|
|
Low
|
23.7
|
22.5
|
24.1
|
18
|
27.6
|
20.4
|
76.3
|
73.7
|
|
Economic situation (making ends meet)
|
|
|
|
|
|
|
|
|
< 0.001
|
With difficulty
|
13.4
|
10.5
|
23.7
|
20.7
|
50.8
|
43.5
|
46.1
|
44.1
|
|
Without difficulty
|
86.6
|
89.5
|
76.3
|
79.3
|
49.2
|
56.5
|
53.9
|
55.9
|
|
External financial assistance
|
|
|
|
|
|
|
|
|
< 0.001
|
Yes
|
23.9
|
19.3
|
17.9
|
15.4
|
24
|
22.7
|
12.2
|
9.5
|
|
No
|
76.1
|
80.7
|
82.1
|
84.6
|
76
|
77.3
|
87.8
|
90.5
|
|
Born in interview country
|
|
|
|
|
|
|
|
|
< 0.001
|
Yes
|
94.6
|
94.8
|
83.7
|
84.5
|
92.8
|
89.6
|
95
|
95.3
|
|
No
|
5.4
|
5.2
|
16.3
|
15.5
|
7.2
|
10.4
|
5
|
4.7
|
|
Area of residence
|
|
|
|
|
|
|
|
|
< 0.001
|
Large city/town
|
37.2
|
34.3
|
24.3
|
22.9
|
26.3
|
26.3
|
36.5
|
36
|
|
Small/rural town
|
46.5
|
50
|
65.8
|
67.9
|
67.3
|
66.2
|
56.8
|
57.8
|
|
Suburbs of a major city
|
16.3
|
15.7
|
9.9
|
9.3
|
6.5
|
7.5
|
6.7
|
6.2
|
|
CASP-12 group
|
|
|
|
|
|
|
|
|
< 0.001
|
Very high QoL
|
65.7
|
66.7
|
52.5
|
56.2
|
36.4
|
39.5
|
27.4
|
31.8
|
|
High QoL
|
12.2
|
11.4
|
12.4
|
12.6
|
13.3
|
11.3
|
12
|
12.5
|
|
Moderate QoL
|
7.7
|
7.9
|
10.1
|
10.3
|
9.7
|
12.6
|
11.7
|
12.9
|
|
Low QoL
|
14.4
|
14
|
25
|
20.9
|
40.7
|
36.6
|
49
|
42.8
|
|
Notes:
CASP-12: Quality of life and well-being index.
Relationship between QoL and SDHs differentiated by sex, region, and consecutive waves
In the fifth wave, a lower QoL score was observed in the southern region of Europe for both sexes, with the most significant differences observed between women in the southern region and women in the northern region, 34.9 (SD 6.5) vs. 40.7 (SD 5.2) (p<0.001), respectively. This trend also persisted in subsequent waves (6 and 7). In all European regions, men obtained higher QoL scores than women, although the sex difference was smaller in the northern region of Europe in all waves (p<0.005). Furthermore, the score decreased with age for both sexes and in all European regions and consecutive waves (p<0.001).
Regarding educational level, women in the southern region of Europe with a low level of education obtained the lowest QoL score, 34.3 (SD 6.6), compared to men, 35.6 (SD 6.3) (p<0.005), and this trend persisted during the follow-up. The variable that showed the greatest significant sex differences in QoL scores in all European regions and consecutive waves was economic difficulty, which was notably lower in the southern and eastern regions and among women (p<0.001). Additionally, in all waves, both native men and women obtained a better score than immigrants, except in the southern region of Europe. For complete data, refer to Table 4.
Table 4. Relationship between score QoL and SDHs differentiated by sex, region, and consecutive waves
Variables
|
South
|
East
|
Continental
|
North
|
|
Female n = 1499
|
Male n = 1271
|
Female n = 880
|
Male n = 653
|
Female n = 2383
|
Male n = 2060
|
Female n = 1474
|
Male n = 1273
|
Wave 5 (2013)
|
|
|
|
|
|
|
|
|
Alla (f)
|
34.9 (6.5)
|
36.0 (6.2)
|
36.9 (6.3)
|
37.4 (6.4)
|
38.8 (6.1)
|
39.2 (6.0)
|
40.7 (5.2)
|
40.9 (5.0)
|
Age groupsa
|
|
|
|
|
|
|
|
|
50-64 (ref.)
|
35.9 (6.2)
|
36.3 (6.0)
|
37.9 (6.2)
|
38.0 (6.1)
|
38.9 (6.1)
|
39.3 (5.9)
|
40.9 (5.0)
|
40.8 (5.1)
|
65-74
|
35.4 (6.3)
|
36.3 (6.2)
|
36.2 (6.1)
|
37.0 (6.9)
|
39.0 (6.0)
|
39.2 (6.1)
|
41.2 (4.9)
|
41.8 (4.4)
|
75-84 (g)
|
32.9 (6.7)
|
34.9 (6.5)
|
35.2 (6.6)
|
36.5 (5.7)
|
38.2 (5.7)
|
39.1 (5.9)
|
39.3 (5.7)
|
39.9 (5.8)
|
Over 85 (g)
|
31.0 (7.6)
|
34.3 (6.6)
|
36.0 (5.0)
|
36.1 (7.2)
|
36.7 (7.1)
|
37.6 (6.6)
|
38.9 (6.0)
|
38.7 (4.4)
|
Education levela
|
|
|
|
|
|
|
|
|
High (ref.)
|
36.2 (9.2)
|
41.2 (4.0)
|
39.9 (3.0)
|
39.4 (4.0)
|
40.0 (5.5)
|
40.1 (6.4)
|
42.6 (3.7)
|
42.2 (4.4)
|
Medium (g)
|
37.4 (5.7)
|
37.1 (5.8)
|
37.4 (6.1)
|
37.7 (6.2)
|
39.1 (5.9)
|
39.5 (5.8)
|
40.9 (4.9)
|
41.0 (5.0)
|
Low (g)
|
34.3 (6.6)
|
35.6 (6.3)
|
35.6 (6.5)
|
36.0 (7.1)
|
37.6 (6.4)
|
37.8 (6.8)
|
39.9 (5.9)
|
40.6 (5.1)
|
Making ends meet a
|
|
|
|
|
|
|
|
|
With difficulty (ref.)
|
32.7 (6.4)
|
34.2 (6.3)
|
35.4 (5.9)
|
35.9 (6.2)
|
34.8 (6.5)
|
35.4 (6.7)
|
36.9 (5.8)
|
36.7 (6.0)
|
Without difficulty (g)
|
36.9 (6.0)
|
37.4 (5.8)
|
38.5 (6.2)
|
38.5 (6.3)
|
40.0 (5.4)
|
40.2 (5.4)
|
41.3 (4.8)
|
41.4 (4.7)
|
External financial assistancea
|
|
|
|
|
|
|
|
|
Yes (ref.)
|
31.3 (7.2)
|
33.1 (6.6)
|
34.5 (5.7)
|
35.7 (5.6)
|
36.8 (6.4)
|
37.9 (5.8)
|
39.7 (5.5)
|
40.0 (5.6)
|
No (g)
|
35.5 (6.3)
|
36.3 (6.1)
|
37.7 (6.2)
|
37.8 (6.5)
|
39.2 (5.9)
|
39.5 (6.0)
|
41.0 (5.0)
|
41.1 (4.9)
|
Born in interview country
|
|
|
|
|
|
|
|
|
Yes (ref.)
|
34.9 (6.6)
|
35.9 (6.2)
|
36.9 (6.2)
|
37.4 (6.3)
|
38.9 (5.9)
|
39.3 (5.9)
|
40.7 (5.1)
|
41.0 (5.0)
|
No (g)
|
35.7 (6.1)
|
36.7 (6.1)
|
36.5 (6.3)
|
37.8 (6.5)
|
37.8 (6.7)
|
38.6 (6.5)
|
40.1 (6.4)
|
39.1 (5.3)
|
Wave 6 (2015)
|
|
|
|
|
|
|
|
|
Alla (f)
|
35.3 (7.1)
|
36.4 (6.6)
|
36.7 (6.1)
|
37.0 (6.0)
|
38.7 (6.1)
|
39.3 (5.6)
|
40.4 (5.4)
|
40.6 (5.0)
|
Age groupsa
|
|
|
|
|
|
|
|
|
50-64 (ref.)
|
36.8 (6.3)
|
37.6 (5.8)
|
37.4 (5.9)
|
37.3 (6.4)
|
39.0 (5.9)
|
39.3 (5.4)
|
40.9 (4.9)
|
40.8 (4.9)
|
65-74
|
35.6 (6.8)
|
37.0 (6.3)
|
36.9 (5.6)
|
37.9 (5.5)
|
39.2 (5.6)
|
39.7 (5.7)
|
40.9 (5.0)
|
41.4 (4.6)
|
75-84 (x)
|
33.3 (7.5)
|
34.3 (7.1)
|
35.2 (7.0)
|
35.6 (5.4)
|
37.4 (6.6)
|
38.8 (5.8)
|
39.0 (5.9)
|
39.2 (5.6)
|
Over 85 (x)
|
30.4 (7.1)
|
32.6 (7.9)
|
33.9 (5.3)
|
32.5 (5.3)
|
35.1 (8.1)
|
39.1 (6.0)
|
36.7 (8.3)
|
37.7 (5.4)
|
Education levela
|
|
|
|
|
|
|
|
|
High (ref.)
|
38.6 (5.6)
|
38.3 (5.5)
|
39.2 (4.1)
|
41.3 (3.0)
|
40.1 (7.3)
|
41.7 (3.8)
|
42.1 (4.7)
|
39.8 (4.5)
|
Medium (x)
|
37.5 (5.9)
|
38.3 (5.9)
|
37.2 (5.9)
|
37.4 (5.7)
|
39.2 (5.7)
|
39.6 (5.3)
|
40.7 (5.0)
|
40.9 (4.9)
|
Low (x)
|
34.6 (7.3)
|
35.7 (6.7)
|
35.4 (6.5)
|
35.3 (6.7)
|
37.1 (6.8)
|
37.8 (6.6)
|
39.3 (6.3)
|
39.4 (5.4)
|
Making ends meeta
|
|
|
|
|
|
|
|
|
With difficulty (ref.)
|
33.2 (7.0)
|
34.6 (6.5)
|
35.5 (5.9)
|
35.9 (5.7)
|
34.5 (6.8)
|
35.0 (6.5)
|
37.3 (6.3)
|
36.3 (6.1)
|
Without difficulty (x)
|
37.0 (6.7)
|
37.7 (6.4)
|
37.6 (6.0)
|
37.7 (6.0)
|
39.7 (5.4)
|
40.2 (5.0)
|
40.8 (5.1)
|
40.9 (4.8)
|
External financial assistancea
|
|
|
|
|
|
|
|
|
Yes (ref.)
|
31.8 (8.0)
|
33.3 (7.8)
|
34.6 (5.9)
|
35.3 (5.9)
|
37.1 (6.8)
|
38.1 (6.1)
|
39.2 (6.1)
|
39.7 (5.7)
|
No (x)
|
35.8 (6.8)
|
36.7 (6.4)
|
37.7 (5.9)
|
37.6 (5.9)
|
39.1 (5.8)
|
39.6 (5.4)
|
40.8 (5.1)
|
40.8 (4.8)
|
Born in interview country
|
|
|
|
|
|
|
|
|
Yes (ref.)
|
35.2 (7.1)
|
33.3 (7.8)
|
36.7 (6.1)
|
36.9 (5.9)
|
38.9 (5.9)
|
39.4 (5.5)
|
40.5 (5.3)
|
40.7 (4.9)
|
No (x)
|
36.9 (6.9)
|
36.7 (6.4)
|
36.6 (6.0)
|
38.0 (6.6)
|
37.8 (6.7)
|
38.8 (6.2)
|
39.3 (6.6)
|
38.8 (6.6)
|
Wave 7 (2017)
|
|
|
|
|
|
|
|
|
Alla (f)
|
35.1 (7.1)
|
36.0 (7.2)
|
36.2 (6.6)
|
37.0 (6.5)
|
38.3 (6.4)
|
39.1 (6.19
|
39.9 (5.7)
|
40.0 (5.5)
|
Age groupsa
|
|
|
|
|
|
|
|
|
50-64 (ref.)
|
36.9 (6.1)
|
37.2 (6.6)
|
37.4 (6.3)
|
37.7 (6.8)
|
38.6 (6.1)
|
39.4 (5.8)
|
40.7 (5.1)
|
40.5 (5.39
|
65-74
|
35.4 (6.9)
|
37.0 (6.9)
|
36.4 (6.7)
|
37.5 (5.7)
|
39.0 (6.3)
|
39.3 (5.8)
|
40.8 (5.1)
|
40.9 (4.8)
|
75-84 (y)
|
33.7 (7.3)
|
34.7 (7.4)
|
35.1 (6.0)
|
35.9 (6.7)
|
37.5 (6.4)
|
38.8 (6.0)
|
38.4 (5.6)
|
38.8 (5.9)
|
Over 85 (y)
|
30.8 (7.9)
|
32.0 (7.9)
|
32.2 (7.5)
|
34.4 (7.9)
|
34.5 (8.1)
|
37.1 (7.0)
|
34.4 (8.1)
|
36.9 (6.7)
|
Education levela
|
|
|
|
|
|
|
|
|
High (ref.)
|
34.6 (4.3)
|
40.7 (2.6)
|
39.3 (5.1)
|
40.5 (5.8)
|
40.1 (6.8)
|
41.8 (4.6)
|
39.0 (6.3)
|
39.9 (3.3)
|
Medium (y)
|
37.5 (6.4)
|
37.7 (6.3)
|
36.5 (6.8)
|
37.2 (6.5)
|
38.9 (6.0)
|
39.4 (5.7)
|
40.3 (5.3)
|
40.4 (5.2)
|
Low (y)
|
34.4 (7.2)
|
35.4 (7.4)
|
35.3 (5.9)
|
35.9 (6.6)
|
36.5 (7.3)
|
37.4 (7.4)
|
38.6 (6.5)
|
38.8 (6.2)
|
Making ends meeta
|
|
|
|
|
|
|
|
|
With difficulty (ref.)
|
32.6 (6.7)
|
33.3 (6.9)
|
34.2 (6.5)
|
35.5 (6.7)
|
33.8 (6.9)
|
34.6 (6.9)
|
36.1 (6.0)
|
36.4 (6.1)
|
Without difficulty (y)
|
37.1 (6.8)
|
38.0 (6.8)
|
37.5 (6.3)
|
37.6 (6.4)
|
39.3 (5.9)
|
40.0 (5.5)
|
40.3 (5.5)
|
40.3 (5.3)
|
External financial assistancea
|
|
|
|
|
|
|
|
|
Yes (ref.)
|
32.6 (7.5)
|
34.5 (7.9)
|
33.9 (6.2)
|
35.3 (6.7)
|
36.7 (6.9)
|
37.8 (6.8)
|
39.1 (6.4)
|
39.3 (5.5)
|
No (y)
|
35.4 (7.0)
|
36.1 (7.2)
|
37.2 (6.5)
|
37.6 (6.3)
|
38.8 (6.2)
|
39.4 (5.9)
|
40.2 (5.4)
|
40.2 (5.5)
|
Born in interview country
|
|
|
|
|
|
|
|
|
Yes (ref.)
|
35.1 (7.0)
|
36.0 (7.2)
|
36.2 (6.5)
|
36.7 (6.5)
|
38.5 (6.2)
|
39.2 (6.0)
|
40.0 (5.6)
|
40.1 (5.5)
|
No (y)
|
34.9 (8.3)
|
36.6 (7.5)
|
35.8 (7.2)
|
37.7 (6.2)
|
37.2 (7.2)
|
38.7 (6.6)
|
38.8 (6.9)
|
39.1 (5.7)
|
Abbreviations: Ref.: reference.
a Mean, (standard deviation).
Notes:
European regions: South: Spain, Italy; East: Slovenia, Estonia, Czech Republic; Continental: Austria, Germany, Belgium, France, Luxembourg, Switzerland; North: Denmark, Sweden.
(f) In each of the three waves, differences between pairs of regions (South vs. East; South vs. Continental; South vs. North; East vs. Continental; East vs. North; Continental vs. North) p value < 0.001.
Selected category versus reference category p value < 0.05, (g) in Wave 5, (x) in Wave 6, and (y) in Wave 7.
Relationship between score QoL and covariates differentiated by sex and European region.
In the fifth wave, both male and female respondents from all European regions who lived with a partner obtained a higher QoL score than those who lived alone. The score was always higher for men living with a partner, except in the northern region. The difference was significantly greater between women and men in the southern region.
Self-perceived health was the variable with the greatest differences in QoL scores; women in the southern region scored lower in excellent or very good quality of life compared to women in the northern region, 38.5 (SD 5.4) vs. 42.6 (SD 3.6) (p<0.05), respectively. Women with worse objective health data obtained lower QoL scores than men in all regions, with these sex score differences being greater in the southern and eastern regions of Europe (p<0.05). The presence of depression showed a significant QoL score decrease for both women and men in all regions, with it being more notable among women and in the southern region (p<0.05).
Regarding lifestyle, no significant differences in QoL scores related to smoking habits were found between regions or sexes, except in the continental region and Northern Europe, where nonsmoking men obtained a better QoL score. Regarding alcohol consumption, individuals of both sexes who consumed alcohol moderately (1-4 days/week) obtained the highest scores in all regions. Women who consumed alcohol daily in the eastern region of Europe obtained a higher score, 39.6 (SD 5.7), compared to men, 36.8 (SD 6.5) (p<0.05). For complete data, refer to Table 5.
Table 5. Relationship between score QoL and covariates differentiated by sex and European regions in Wave 5 (2013)
Variables
|
South
Female Male
n= 1499 n= 1271
|
East
Female Male
n= 880 n= 653
|
Continental
Female Male
n= 2383 n= 2060
|
North
Female Male
n= 1474 n= 1273
|
Family Unit a
|
|
|
|
|
Living with a partner (ref.)
|
35,4 (6.3) 36,1 (6,2)
|
37,3 (6,3) 37,5 (6,3)
|
39,3 (5,8) 39,6 (5,8)
|
41,3 (4,6) 41,3 (4,8)
|
Living alone (g)
|
33,6 (7,0) 35,2 (6,4)
|
36,0 (6,1) 36,3 (6,8)
|
36,9 (6,5) 37,4 (6,6)
|
39,0 (6,2) 39,3 (6,0)
|
Employment Statusa
|
|
|
|
|
Retired (ref.)
|
34,1 (6,7) 35,6 (6,4)
|
36,6 (6,2) 37,1 (6,5)
|
38,7 (6,1) 39,2 (5,9)
|
40,4 (5,4) 40,8 (5,1)
|
Employed (g)
|
36,6 (5,8) 37,5 (5,5)
|
37,2 (5,4) 38,9 (6,8)
|
38,6 (5,5) 40,2 (5,4)
|
41,5 (4,4) 41,5 (4,6)
|
Unemployed
|
Nd 32,6 (6,4)
|
Nd 35,6 (5,3)
|
Nd 34,1 (6,8)
|
Nd 37,8 (5,3)
|
Disabled
|
Nd 31,8 (5,7)
|
Nd 31,2 (5,4)
|
27,0 (2,1) 32,8 (6,6)
|
Nd 35,0 (7,2)
|
Household Tasks
|
33,3 (6,9) Nd
|
37,9 (7,1) Nd
|
35,2 (7,1) Nd
|
38,1 (6,2) Nd
|
Number of Children a
|
|
|
|
|
No children (ref.)
|
34,8 (6,9) 34,8 (7,0)
|
36,4 (7,2) 36,2 (6,6)
|
38,9 (5,9) 38,7 (6,6)
|
39,4 (6,0) 39,3 (5,7)
|
1-2
|
35,3 (6,3) 36,6 (6,1)
|
37,0 (6,4) 37,4 (6,4)
|
38,5 (6,2) 39,4 (5,6)
|
40,5 (5,3) 41,0 (5,3)
|
3 or more
|
31,5 (6,6) 36,0 (6,1)
|
35,1 (5,8) 36,4 (5,1)
|
38,7 (5,5) 32,5 (4,0)
|
39,9 (4,7) 41,8 (4,0)
|
Number of Grandchildren a
|
|
|
|
|
No grandchildren (ref.)
|
35,7 (6,4) 36,2 (6,2)
|
38,0 (6,0) 37,8 (6,3)
|
39,0 (6,0) 39,4 (5,9)
|
40,6 (5,0) 40,6 (5,2)
|
1-2
|
35,3 (6,4) 36,4 (6,1)
|
37,3 (5,9) 38,2 (5,9)
|
38,8 (5,9) 39,3 (5,9)
|
40,3 (5,4) 40,7 (5,4)
|
3 or more
|
32,7 (6,3) 35,4 (6,7)
|
34,9 (5,1) 37,0 (6,7)
|
37,0 (4,2) 34,9 (6,7)
|
39,7 (5,1) 41,6 (4,6)
|
Self-Perceived Health a
|
|
|
|
|
Excellent/Very Good (ref.)
|
38,5 (5,4) 38,7 (5,7)
|
41,3 (4,5) 41,6 (4,3)
|
41,8 (4,3) 41,9 (4,2)
|
42,6 (3,6) 42,7 (4,1)
|
Good (g)
|
36,5 (5,6) 37,1 (5,3)
|
37,6 (5,7) 38,1 (5,7)
|
39,5 (5,2) 40,0 (5,2)
|
40,0 (4,7) 39,9 (4,7)
|
Regular (g)
|
33,0 (6,2) 33,4 (5,5)
|
35,1 (5,9) 36,2 (6,1)
|
36,5 (6,1) 37,1 (6,0)
|
37,5 (6,0) 38,0 (5,9)
|
Poor (g)
|
27,8 (5,8) 28,7 (6,0)
|
31,2 (5,8) 31,1 (6,7)
|
31,7 (7,7) 31,5 (7,8)
|
32,7 (7,1) 35,2 (6,2)
|
Chronic Illnesses a
|
|
|
|
|
None (ref.)
|
36,2 (6,2) 37,0 (6,1)
|
38,8 (5,7) 38,7 (6,4)
|
39,9 (5,5) 40,3 (5,6)
|
41,5 (4,4) 41,6 (4,7)
|
1-2 (g)
|
34,4 (6,5) 35,9 (6,1)
|
36,5 (6,2) 36,9 (6,4)
|
38,6 (5,9) 39,2 (5,8)
|
40,4 (5,4) 40,8 (5,0)
|
3 or more (g)
|
32,5 (7,0) 33,0 (6,3)
|
34,1 (6,3) 36,3 (6,1)
|
35,8 (7,4) 37,1 (6,8)
|
38,8 (5,9) 39,2 (5,7)
|
Activities of Daily Living a
|
|
|
|
|
No limitations (ref.)
|
35,5 (6,3) 36,4 (6,0)
|
37,3 (6,1) 37,9 (6,0)
|
39,2 (5,8) 39,6 (5,8)
|
40,9 (4,9) 41,1 (4,9)
|
With limitations (g)
|
29,2 (6,5) 29,7 (6,6)
|
31,8 (5,9) 31,6 (7,6)
|
33,4 (6,6) 34,2 (7,1)
|
35,6 (7,4) 37,7 (6,2)
|
Mobility Difficulty a
|
|
|
|
|
No difficulty (ref.)
|
36,8 (5,8) 37,1 (5,8)
|
38,6 (5,7) 38,6 (5,9)
|
39,9 (5,4) 40,2 (5,3)
|
41,4 (4,6) 41,4 (4,7)
|
Much difficulty (g)
|
28,0 (5,7) 28,3 (6,1)
|
31,6 (5,9) 30,4 (7,5)
|
31,9 (7,1) 32,5 (7,6)
|
34,5 (7,6) 36,0 (7,4)
|
Physical Activity a
|
|
|
|
|
Active (ref.)
|
37,2 (5,8) 37,7 (5,7)
|
38,8 (5,8) 38,9 (5,7)
|
39,8 (5,3) 40,0 (4,9)
|
41,4 (4,6) 41,7 (4,4)
|
Inactive (g)
|
33,9 (6,6) 34,8 (6,3)
|
35,2 (6,2) 35,4 (6,6)
|
37,5 (6,7) 38,0 (6,8)
|
39,5 (5,8) 39,2 (5,9)
|
Depression Scale (EURO-D) a
|
|
|
|
|
Low depression (ref.)
|
37,7 (4,9) 37,5 (5,2)
|
38,6 (5,4) 38,6 (5,4)
|
40,4 (5,0) 40,5 (4,9)
|
41,9 (4,2) 41,6 (4,4)
|
High depression (g)
|
25,4 (4,4) 34,8 (6,3)
|
27,8 (6,1) 25,4 (6,8)
|
28,9 (6,9) 26,7 (7,2)
|
31,0 (5,2) 26,5 (7,1)
|
Doctor Visits per Year a
|
|
|
|
|
1 to 5 (ref.)
|
36,3 (6,1) 36,9 (6,0)
|
38,5 (6,0) 38,6 (6,0)
|
39,8 (5,4) 40,2 (5,4)
|
41,1 (4,8) 41,2 (4,7)
|
6 to 10 (g)
|
33,4 (6,4) 34,5 (5,8)
|
35,0 (5,7) 35,6 (5,7)
|
38,6 (5,9) 38,7 (5,8)
|
39,4 (6,2) 39,2 (5,7)
|
11 or more (g)
|
30,9 (7,0) 32,5 (6,3)
|
31,9 (5,5) 34,1 (7,2)
|
35,8 (7,1) 36,0 (7,4)
|
37,7 (5,3) 39,8 (6,1)
|
Hospital Admission a
|
|
|
|
|
Yes (ref.)
|
31,6 (7,3) 33,5 (7,0)
|
34,6 (6,4) 35,7 (7,4)
|
37,1 (6,6) 37,8 (7,2)
|
38,9 (5,5) 39,4 (6,2)
|
No (g)
|
35,3 (6,4) 36,2 (6,1)
|
37,2 (6,2) 37,6 (6,2)
|
39,1 (5,9) 39,5 (5,6)
|
40,9 (5,1) 41,1 (4,9)
|
Daily Smoking a
|
|
|
|
|
Yes (ref.)
|
35,1 (7,0) 35,8 (6,3)
|
37,5 (6,4) 37,2 (6,6)
|
38,4 (6,3) 38,9 (6,3)
|
40,6 (5,2) 40,7 (5,0)
|
No
|
34,9 (6,4) 36,2 (6,1)
|
36,6 (6,2) 37,5 (6,2)
|
39,0 (5,9) 39,7 (5,5)
|
40,8 (5,1) 41,2 (5,0)
|
Daily Drinking a
|
|
|
|
|
Doesn't drink (ref.)
|
34,6 (6,6) 35,4 (6,5)
|
36,7 (6,3) 36,8 (6,5)
|
38,0 (6,4) 38,1 (6,6)
|
39,8 (5,5) 39,9 (5,5)
|
1-4 days/week (g)
|
36,6 (5,9) 36,8 (6,4)
|
36,4 (5,9) 37,2 (6,2)
|
40,1 (5,2) 40,2 (5,3)
|
41,4 (4,3) 41,1 (4,8)
|
Every day
|
35,7 (6,4) 36,4 (5,7)
|
39,6 (5,7) 38,6 (6,2)
|
38,7 (6,2) 39,1 (6,0)
|
41,0 (5,8) 41,8 (4,7)
|
Body Mass Index (BMI) a
|
|
|
|
|
Normal (ref.)
|
36,1 (6,2) 36,3 (6,4)
|
38,2 (6,1) 37,3 (6,8)
|
39,5 (5,6) 39,8 (5,9)
|
41,1 (5,0) 41,4 (4,6)
|
Underweight
|
34,6 (6,7) 31,6 (5,9)
|
36,3 (5,5) 31,0 (4,2)
|
38,4 (6,1) 34,9 (8,1)
|
39,6 (5,2) 40,5 (2,1)
|
Overweight
|
34,1 (6,6) 36,2 (6,1)
|
36,9 (6,2) 37,5 (6,4)
|
38,9 (5,8) 39,3 (5,8)
|
40,8 (4,9) 40,9 (5,1)
|
Obesity (g)
|
33,7 (6,8) 34,8 (6,1)
|
35,4 (6,2) 37,2 (6,0)
|
37,2 (6,5) 38,3 (6,3)
|
38,9 (5,7) 39,8 (5,5)
|
Abbreviations: Ref.: reference.
a Mean, (standard deviation).
Notes:
Selected category versus reference category p value < 0.05 (g)
Multivariate analysis of QoL evolution in relation to SDHs, European region, and consecutive waves
The multivariate analysis examined the relationship between the CASP-12 scores across all waves as the dependent variable and the SDH, European region, and consecutive wave variables. The analysis was adjusted for significant sociodemographic and clinical covariates.
Women experienced a significant decrease in QoL score from wave 5 to wave 7 compared to men (β: -0.196, 95% CI: -0.345; -0.047 vs. β: 0.038, 95% CI: -0.122; 0.197). The interaction between sex and consecutive waves achieved a significance of 0.019, indicating that the decrease in QoL score was more pronounced among women than among men over time.
Regarding age, both women and men in older age groups reported worse QoL than those in younger age groups. However, the difference was more pronounced among women than among men (β: -1.611, 95% CI: -2.083; -1.140 vs. β: -1.051, 95% CI: -1.558; -0.545).
During follow-up, participants of both sexes without economic difficulties obtained a higher QoL score than those who reported difficulties. This difference was greater among women than among men (β: 2.417, 95% CI: 2.234; 2.601 vs. β: 2.038, 95% CI: 1.833; 2.243), with a p for interaction of 0.0057.
Participants of both sexes with a high level of education achieved a better QoL score than those with a low level of education during follow-up. This difference was more significant among men than among women (β: 0.455, 95% CI: 0.193; 0.717 vs. β: 0.252, 95% CI: 0.003; 0.501), indicating that educational level had a greater influence on QoL among men than among women over time.
Differences in QoL scores were observed among interviewees of both sexes according to their region of residence. These differences were more pronounced among women and between the southern and northern regions (β: 2.709, 95% CI: 2.403; 3.015) than among men (β: 2.224, 95% CI: 1.896; 2.551), with a p for interaction of 0.009. Living in a rural area was a protective factor in QoL evolution for women compared to men. No significant association was found between place of residence and QoL among men. For complete data, refer to Table 6.
Table 6. Multivariate analysis of social determinants of health by sex, European region, and consecutive waves.
|
|
|
IC 95%
|
|
|
|
IC 95%
|
|
|
Coef. β Female
|
SD
|
Lower
|
Upper
|
Sig. Female
|
Coef. β Male
|
SD
|
Lower
|
Upper
|
Sig.
Male
|
p interaction
|
Wave 5 Ref.
|
|
|
|
|
Wave 6
|
-0,027
|
0,075
|
-0,173
|
0,119
|
NS
|
0,067
|
0,08
|
-0,089
|
0,223
|
NS
|
0,4387
|
Wave 7
|
-0,196
|
0,076
|
-0,345
|
-0,047
|
|
0,038
|
0,082
|
-0,122
|
0,197
|
NS
|
0,0193
|
Age groups
|
|
|
|
|
|
|
|
|
|
|
|
50-64 Ref.
|
|
|
|
|
|
|
|
|
|
|
|
65-74
|
-0,225
|
0,135
|
-0,49
|
0,041
|
NS
|
0,11
|
0,139
|
-0,162
|
0,382
|
NS
|
0,6971
|
75-84
|
-0,695
|
0,168
|
-1,023
|
-0,366
|
|
-0,286
|
0,172
|
-0,623
|
0,05
|
NS
|
0,7048
|
> 85
|
-1,611
|
0,241
|
-2,083
|
-1,14
|
|
-1,051
|
0,259
|
-1,558
|
-0,545
|
|
0,508
|
Education level
|
|
|
|
|
|
|
|
|
|
|
|
Low Ref.
|
|
|
|
|
|
|
|
|
|
|
|
Medium
|
0,162
|
0,112
|
-0,057
|
0,381
|
NS
|
0,281
|
0,121
|
0,045
|
0,517
|
|
0,8964
|
High
|
0,252
|
0,127
|
0,003
|
0,501
|
|
0,455
|
0,134
|
0,193
|
0,717
|
|
0,8542
|
Making ends meet
|
|
|
|
|
With difficulty Ref.
|
|
|
|
|
|
|
|
|
|
|
|
Without difficulty
|
2,417
|
0,093
|
2,234
|
2,601
|
|
2,038
|
0,104
|
1,833
|
2,243
|
|
0,0057
|
External financial assistance
|
|
|
|
|
|
|
|
|
|
|
|
No Ref.
|
|
|
|
|
|
|
|
|
|
|
|
Yes
|
-0,296
|
0,099
|
-0,49
|
-0,103
|
|
-0,489
|
0,11
|
-0,705
|
-0,274
|
|
0,1176
|
European region
|
|
|
|
|
South Ref.
|
|
|
|
|
|
|
|
|
|
|
|
Continental
|
2,319
|
0,137
|
2,05
|
2,587
|
|
2,083
|
0,15
|
1,79
|
2,376
|
|
0,122
|
North
|
2,709
|
0,156
|
2,403
|
3,015
|
|
2,224
|
0,167
|
1,896
|
2,551
|
|
0,0099
|
East
|
1,134
|
0,171
|
0,798
|
1,469
|
|
0,937
|
0,192
|
0,561
|
1,314
|
|
0,3688
|
Area of residence
|
|
|
|
|
|
|
|
|
|
|
|
Large city/town Ref.
|
|
|
|
|
|
|
|
|
|
|
|
Small/rural town
|
0,247
|
0,097
|
0,056
|
0,438
|
|
0,131
|
0,105
|
-0,074
|
0,337
|
NS
|
0,4052
|
Suburbs of a major city
|
0,199
|
0,16
|
-0,114
|
0,513
|
NS
|
-0,094
|
0,174
|
-0,435
|
0,248
|
NS
|
0,1055
|
Abbreviations: Ref.: reference.