Do women in Europe live longer and happier lives than men?

Do women in Europe live longer and happier lives than men? Abstract Background The article examines gender differences in happy life expectancy at age 50 (LE50) and computes the age-specific contributions of mortality and happiness effects to gender differences in happy LE50 in 16 European countries. Methods Abridged life tables and happy LE50 were calculated using conventional life tables and Sullivan’s method. Age-specific death rates were calculated from deaths and population exposures in the Human Mortality Database. Happiness prevalence was estimated using the 2010–11 Survey of Health, Ageing and Retirement in Europe. Happiness was defined using a single question about life satisfaction on a scale of 0–10. A decomposition algorithm was applied to estimate the exact contributions of the differences in mortality and happiness to the overall gender gap in happy LE50. Results Gender differences in happy LE50 favour women in all countries except Portugal (0.43 years in Italy and 3.55 years in Slovenia). Generally, the contribution of the gender gap in happiness prevalence is smaller than the one in mortality. The male advantage in the prevalence of happiness partially offsets the effects of the female advantage in mortality on the total gender gap in happy LE50. Gender differences in unhappy life years make up the greatest share of the gender gap in total LE50 in all countries except Denmark, Germany, Netherlands, Slovenia and Sweden. Conclusion Countries with the largest gender gap in LE are not necessarily the countries with larger differences in happy LE50. The remaining years of life of women are expected to be spent not only in unhealthy but also in unhappy state. Introduction In developed countries, the female advantage in life expectancy (LE) has been one of the most consistent empirical findings over the past several decades,1–3 although the magnitude of gender differences in LE varies substantially across European nations.4 At the same time, gender differences in healthy LE are less apparent.5 Women at age 50 have been found to have higher LE with and without activity limitations than same-aged men in most EU countries,6 and the gender gap is mostly attributable to better survival among women.7 Compared with women, men have superior physical performance in physical tests,8 fewer difficulties in carrying out activities of daily life9 and fewer other reported health problems.10 Cross-national gender differences in subjective well-being Empirical research on gender differences in subjective well-being has yielded contradictory results. Some studies have demonstrated that women tend to be happier than men across geographic regions, although the size of the female advantage appears to be small.11 Other studies have shown that men are happier or more satisfied with life than women across all ages but that the gender gap widens with age.12 Comparative studies conducted at the population level have generated inconsistent findings on the question of whether national populations reporting higher levels of happiness also have longer and healthier lives.13 For instance, some empirical analyses have indicated that happier persons have lower levels of hypertension14 and are able to manage stress better than their unhappier counterparts.15 Being happy has also been associated with having lower incidence of chronic conditions.16 However, other research has found that happiness is negatively associated with longevity at the national level across 15 European countries.17 Although there is a large body of literature on gender differences in survival, health, healthy LE and well-being, the number of studies focusing on happy LE and its variations by gender is much smaller. At present, there is no consensus on how happiness should be measured.18 Empirical findings suggest that for international comparison, life satisfaction may be a better measure of subjective well-being than general happiness.19 In addition, the analyses where scores for both the measures of life satisfaction and general happiness are available suggest show fairly consistent results similar.18,20,21 In our study, subjective well-being refers to an individual’s happiness, measured through satisfaction with life. Like healthy LE, happy LE is a summary measure of population well-being that combines data on the length of life and a measure of well-being.22 Comparative research has shown that in Europe in early 1990s, levels of happy LE were lowest in eastern European countries, such as Bulgaria and Belarus, and were highest in wealthy North–West EU countries, such as Iceland, the Netherlands, Sweden and Switzerland.20,23 Studies conducted in the USA have demonstrated that at all ages, women have longer happy and unhappy lives than men but that the proportion of the life span spent in a happy state is greater among men than among women.24 Little is known about the directions and the magnitudes of gender differences in happy LE across European countries. We fill this research gap by analyzing the magnitudes and variations of the gender gaps in happy LE across 16 European countries. We also identify the gender-specific differences in the shares of the remaining (un)happy years of life. Finally, our study provides the first evidence about the exact contributions of the female–male gap in mortality and prevalence of happiness to the total gender gap in remaining happy life years at age 50. Methods Data and indicators This study was based on the data collected in the fourth wave (2010–11) of the Survey of Health, Ageing and Retirement in Europe (SHARE) in 16 countries: Austria, Belgium, the Czech Republic, Denmark, Estonia, France, Germany, Hungary, Italy, the Netherlands, Poland, Portugal, Slovenia, Spain, Sweden and Switzerland.25 The SHARE is a multidisciplinary and cross-national panel survey of community-dwelling individuals aged 50 and older. The data collection instruments and study design have been harmonized to facilitate European comparisons of health, family circumstances, socio-economic characteristics and social and family networks across countries. The total sample consists of 56 984 individuals (25 018 men and 31 966 women) aged 50 and older (born in 1960 or earlier). The sample sizes vary by gender and country; the largest samples of both men and women are from Estonia (6758 respondents) and France (5667 respondents), while the smallest total sample is from Germany (1612 respondents). When examining country differences, it is important to keep these varying sample sizes in mind. Participants were asked to evaluate their life satisfaction by responding a single question: ‘On a scale from 0 to 10 where 0 means completely dissatisfied and 10 means completely satisfied, how satisfied are you with your life?’ We dichotomized the responses as follows: those who rated their life satisfaction level as between 8 and 10 were coded as happy, while those who rated their life satisfaction level as between zero and seven were coded as less happy. Analysis The age-specific prevalences of happiness were smoothed using a multivariate regression model with sex, quadratic terms of age and the interaction between age and sex as independent variables.24 The smoothing was applied because of the fluctuations of the age-specific prevalence of life satisfaction in males and females across ages. We used death counts and population exposures from the Human Mortality Database.4 Abridged period life tables for ages 50 and older were calculated by applying a conventional algorithm.26 The happy LE50 was estimated using the Sullivan method,27 a method of dividing life table years lived in an age interval into years lived in happy and unhappy states based on the prevalence of happiness in a specific age group. To analyze whether there was a correlation between LE50 and happy LE50, and between gender differences in LE and happy LE50, we plotted LE against happy LE at age 50 for men and women, and gender differences in LE50 against gender differences in happy LE50. A decomposition method developed by Andreev et al.28 was implemented to identify the exact contributions to the total gap in happy LE50 between women and men of (i) differences in age-specific mortality rates and (ii) differences in age-specific prevalences of happiness. The analyses were conducted using R version 3.3 (http://www.R-project.org). Results Prevalences of happiness by gender and country The results indicate that the smoothed age-specific prevalences of happiness varied from 0.35 to 0.84 (Estonia and Switzerland, respectively) for men and from 0.37 to 0.86 (Estonia and Denmark, respectively) for women in the age group 50–54 and from 0.47 to 0.80 (Estonia and Switzerland, respectively) for men and from 0.42 to 0.77 (Portugal and Switzerland, respectively) for women in the age group 80+ (Supplementary figure S1). In most of the countries, the prevalence of happiness was greater among men than among women across age groups. In Denmark, Estonia and Sweden, we found no gender differences in the smoothed age-specific prevalences of happiness. Gender differences in LE50 and happy life years by country Figure 1 shows the correlation between LE50 and happy LE50 for men and women as well as the correlation between gender differences in LE50 and happy LE50. In all countries, women had higher LE50 than men. The gender differences in LE50 ranged from 3.4 years in Sweden to 7.6 years in Estonia. The gender differences in LE50 were smallest in the Nordic countries, largest in the Central and Eastern European (CEE) countries and of intermediate size in the southern and the western European countries. The happy LE50 varied considerably across countries among both men (from 26.7 years in Switzerland to 9.1 years Estonia) and women (from 28.7 years in Switzerland to 12.1 years in Hungary) (figure 1). Figure 1 View largeDownload slide LE and happy life years at 50 years by gender and gender differences in LE and in happy life years at age 50 in 16 European countries. Source: SHARE 2010–11; HMD 2010. Note: LE50—life expectancy at age 50. Countries: AT: Austria, BE: Belgium; CZ: Czech Republic; DE: Germany; DK: Denmark; ES: Spain; FR: France; GR: Greece, HU: Hungary; IT: Italy; NT: The Netherlands; PL: Poland; PT: Portugal; SE: Sweden; SI: Slovenia and SW: Switzerland. Gender differences in LE and in happy life years at age 50 (right panel). Correlation between LE50 and happiness-adjusted LE50: men = 0.82 (P value < 0.001); women = 0.44 (P value = 0.09) and gender differences = 0.16 (P value = 0.56) Figure 1 View largeDownload slide LE and happy life years at 50 years by gender and gender differences in LE and in happy life years at age 50 in 16 European countries. Source: SHARE 2010–11; HMD 2010. Note: LE50—life expectancy at age 50. Countries: AT: Austria, BE: Belgium; CZ: Czech Republic; DE: Germany; DK: Denmark; ES: Spain; FR: France; GR: Greece, HU: Hungary; IT: Italy; NT: The Netherlands; PL: Poland; PT: Portugal; SE: Sweden; SI: Slovenia and SW: Switzerland. Gender differences in LE and in happy life years at age 50 (right panel). Correlation between LE50 and happiness-adjusted LE50: men = 0.82 (P value < 0.001); women = 0.44 (P value = 0.09) and gender differences = 0.16 (P value = 0.56) The gender gap in happy LE50 was in favour of women in all countries except Portugal. In general, the countries with the largest gender differences in LE50 were not the countries with the largest gender differences in happy LE50 (correlation = 0.16, P values = 0.56) (figure 1). The only exceptions were two CEE countries, Poland and Estonia, which had the largest gender gaps in both LE50 and happy LE50. Two other CEE countries, the Czech Republic and Hungary, as well as Spain and France, had large gender differences in LE50 but smaller gender gaps in happy LE50 (about a year). Denmark was among the countries with the smallest gender gaps in LE50 but it was also among the countries with the largest gender differences in happy LE50. Gender differences in (un)happy life years by country Figure 2 shows the gender differences in LE50 (panel A) divided into the remaining years spent in happy and unhappy states (panel B). The gender gaps in happy LE50 in Denmark—and to a lesser extent in Sweden, the Netherlands and Slovenia—were larger than the gender differences in expected number of years spent in unhappy state at age 50. In all of the other countries, the gender differences in unhappy life years at age 50 were larger than the gender gaps in happy LE50; except in Austria, Switzerland and in Germany, where they were of similar size. Figure 2 View largeDownload slide Gender differences in LE and gender differences in happy and unhappy life years at age 50 in 16 European countries. Source: SHARE 2010–11; HMD 2010. Note: LE50—life expectancy at age 50. F-M Diff.= female–male differences Figure 2 View largeDownload slide Gender differences in LE and gender differences in happy and unhappy life years at age 50 in 16 European countries. Source: SHARE 2010–11; HMD 2010. Note: LE50—life expectancy at age 50. F-M Diff.= female–male differences Contribution to the gender differences in happy life years by country and age groups We further examined the contributions of mortality and the prevalence of high levels of satisfaction with life to the gender gap in happy LE50 for the total sample, and for different age groups. The contributions to the gender differences in happy LE50 made by differences in mortality were positive in all of the countries, reflecting the lower mortality among women than among men (figure 3). The contributions of mortality varied across countries; they were largest in Poland (3.6 years) and were smallest in Portugal (2.4 years). In seven countries (Poland, Austria, Switzerland, Belgium, Estonia, Spain and Slovenia), the mortality contributions were over 3 years. However, these countries presented dissimilarities: they did not all show the lowest gender differences in LE50. Estonia and Austria were among the countries with the largest LE50 gender gaps, while Slovenia and Poland had the lowest. By contrast, happiness effects contributed negatively in most countries, which indicates that men had an advantage in the prevalence of happiness in these countries. Meanwhile, the happiness effects contributed positively (by about half a year) to the total gender differences in happy LE50 in only three countries (Denmark, Estonia and Slovenia), which indicates that women had an advantage in the prevalence of happiness in these countries. Overall, the mortality effects that contributed to the total gender differences in happy LE50 were greater than the happiness effects of the prevalence of high levels of satisfaction with life. The exceptions were Portugal, where the mortality effects were smaller than the happiness effects; and Italy, where mortality and happiness effects were approximately of similar size. Figure 3 View largeDownload slide Contributions of mortality and happiness prevalences effects to gender differences in happy life years, age 50. Source: SHARE 2010–11; HMD 2010. Note: ‘Mortality-effect’ = dark black bar; ‘Happiness-effect’ = light grey bar Figure 3 View largeDownload slide Contributions of mortality and happiness prevalences effects to gender differences in happy life years, age 50. Source: SHARE 2010–11; HMD 2010. Note: ‘Mortality-effect’ = dark black bar; ‘Happiness-effect’ = light grey bar As found in the decomposition of the total gender gap into mortality and happiness effects for all ages combined, the contributions of mortality differences (in black) to the total gender gap in happy LE50 were generally larger than the contributions of differences in the prevalence of happiness in most age groups and countries (figure 4). Only in Austria, Germany and Poland at ages 65+ and in Slovenia and Poland at ages below 65 the mortality effects were smaller than the happiness effects. Figure 4 View largeDownload slide Age-specific contributions of mortality effects and happiness effects to the gender differences in happy life years. Source: SHARE 2010–11; HMD 2010. Note: ‘Mortality-effect’ = dark black bar; ‘Happiness-effect’ = light grey bar Figure 4 View largeDownload slide Age-specific contributions of mortality effects and happiness effects to the gender differences in happy life years. Source: SHARE 2010–11; HMD 2010. Note: ‘Mortality-effect’ = dark black bar; ‘Happiness-effect’ = light grey bar Regarding the contribution of happiness differences to the gender gap in happy LE50 by age groups, we found that these happiness effects contributed negatively to the total gender differences in happy LE50; i.e. the higher prevalence of happiness among men partially offset the effects of lower mortality among women in all age groups in Belgium, the Czech Republic, France, Hungary, Italy, the Netherlands, Portugal, Spain, Sweden and Switzerland; at ages 65+ in Austria, Poland and Germany and at ages 75+ in Slovenia. We also observed that happiness contributed positively to the total gender gap in happy LE50 among the youngest age groups in Austria, Denmark, Estonia, Germany, Poland and Slovenia. Overall, the female advantage in happy LE at 65+ is reduced due to men reporting higher levels of happiness; while at ages 50–65 in the latter six countries the advantage is due to the combination of lower mortality and higher prevalence of happiness among women. Discussion This study is among the first to examine gender differences in happy LE for 16 European countries and to estimate the contributions of differences in mortality and differences in the prevalence of happiness to the total gender gaps in happy LE50. Our findings confirm that based on SHARE data women have an advantage not only in LE50 but also in happy LE50 in all countries except Portugal. Despite this advantage over men, the larger share of the remaining years of life of women is expected to be spent in an unhappy state. This first analysis of gender difference in happy LE across EU countries therefore contributes to the existing literature that the remaining years of life of women tend to be spent not only in unhealthy but also in unhappy states. The results further suggest that the countries with the highest LE50 are not necessarily the countries with the highest happy LE50; and that the countries with the largest gender gaps in LE50 are not the countries with the greatest gender differences in happy LE50. In Sweden, Denmark, the Netherlands and Slovenia, the female advantage in overall LE50 is mainly due to their higher expected number of happy life years than for males. However, in the remaining European countries considered in our study, the female advantage in LE50 is largely due to a higher number of unhappy life years. Importantly, we found that in almost all of the analyzed countries, the mortality effects contribute positively to the total gender differences in happy LE50 and are larger than the happiness effects. The effects of lower mortality among women are offset by the lower prevalences of happiness among women in all of the countries studied. Comparative research in developed countries has indicated that even though aggregate-level gender differences in happiness worldwide favour women, in Europe, mean levels of happiness are higher among women than among men in western European countries only.11 Although national income and high levels of public expenditure were found to be associated with a short-term increase in happiness,29 over the long-term there was no relationship between a country’s income rise and an increase in happiness.30 Comparative research also indicates that gender inequality is associated with life satisfaction.31 However, other studies have shown that most measures of gender inequality are unrelated to gender differences in subjective well-being.32,33 In-depth multilevel studies are needed to investigate the contributions of socio-economic measures at the national level to the cross-country differences in gender gap in happiness and happy LE50. Generally, the literature has shown that higher levels of life satisfaction and happiness are associated with living a longer and healthier life.34,35 Individuals with poor self-rated health, physical disabilities, depressive symptoms and other common health conditions tend to report having lower happiness levels than others.36 Female disadvantages in health may underlie the longer lives in an unhappy state experienced by women. Although we have not tested this hypothesis in this study, our findings and previous research evidence on gender differences in health across European countries do not suggest that gender differences in health and happiness are highly correlated. Spain, France and Italy, which have among the highest values for LE50, are also the countries with the highest numbers of years spent in an unhappy state. However, it is only in France, which is among the countries with the highest levels of female disadvantage in terms of unhappy life years, that poor self-rated health has been found to be lower for women than men.10 Our findings have some limitations, which should be taken into account in interpreting the results. Household response rates across countries in wave 4 varied from 41% in the Netherlands to 97% in Austria; the corresponding individual response rates across countries ranged from 36% in the Netherlands to 89% in Austria.37 Happier people may be more willing to participate in the survey, especially in countries with lower participation rates, and there may also be gender-specific patterns in participation rates.38 However, the countries which in our analysis show a positive contribution by the prevalence of happiness to the gender gap in happy LE, i.e. Denmark and Slovenia, are countries with response rates (52 and 57% for household response rates and 46 and 44% for individual response rates, respectively) which are close to the average across all SHARE countries (62 and 52%, respectively). Furthermore, responses to such survey questions may be culturally influenced and may differ by gender.39,40 Although it is commonly believed that women are more likely than men to report being ill, and particularly to report having psychosomatic symptoms of stress and malaise-type symptoms, the research evidence on gender differences in the reporting of illnesses has been contradictory.40 Still, a portion of the observed gender differences in happy LE50 may be related to differences in survey participation and reporting styles between men and women and across cultures.39 Our work provides empirical evidence on an interesting and relevant aspect of the health literature for contemporary societies, where LE is high and continues to increase. Particularly, it sheds additional light on how differently men and women across different nations live these added years of life in terms of happiness. The four main contributions of this article are the following. First, compared with men, women not only live longer but also spend more years in an unhappy state. Second, we have found that in most countries, the male advantage in the prevalence of happiness partially offsets the effects of the female advantage in mortality on the total gender gap in happy LE, and especially at older ages. Third, across age groups, we find, in six countries, a reversal of the prevalence of happiness around retirement ages, suggesting that conditions after retirement may play a role in explaining differences between men and women in the levels of happiness. Lastly, the countries with the largest gender gap in LE are not necessarily the countries with larger differences in happy LE50. Further research is needed to fully explain the interplay of factors that determine the international patterns of gender differentials in subjective well-being at older ages, and in particular to fully address the role of contextual factors in an international comparison. National health policies should view happiness as an important determinant of health and well-being at old age, especially among women. Acknowledgements This article uses data from SHARE Wave 4 (DOI: 10.6103/SHARE.w4.600); see Börsch-Supan et al. (2013) for methodological details. Funding The SHARE data collection has been primarily funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812) and FP7 (SHARE-PREP: N°211909, SHARE-LEAP: N°227822, SHARE M4: N°261982). Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the US National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C) and from various national funding sources is gratefully acknowledged (see www.share-project.org). This work has been supported by the 2014 SGR 768 grant—AGAUR, Generalitat de Catalunya and by the Max Planck Society within the framework of the project ‘On the edge of societies: New vulnerable populations, emerging challenges for social policies and future demands for social innovation. The experience of the Baltic Sea States’ (2016–21). It was presented at the scientific REVES meeting in Santiago de Chile, 17–19 May 2017. Conflicts of interest: None declared. Key points Women have an advantage in happy LE50 in all countries but Portugal. Women’s advantage in happy LE50 is almost entirely explained by their lower mortality. In the majority of countries, the prevalence of happiness is lower among women than among men, and contributes negatively to the gender gap in happy LE50. A reversal of the prevalence of happiness around retirement ages is found in six countries, suggesting that post-retirement conditions may play a role in explaining differences between genders in the levels of happiness. In 11 European countries, the overall longevity advantage of women is associated with a longer life spent in an unhappy state. References 1 Verbrugge LM , Wingard DL , Features Submission HC . Sex differentials in health and mortality . Women Health 1987 ; 12 : 103 – 45 . Google Scholar Crossref Search ADS PubMed 2 Barford A , Dorling D , Smith GD , Shaw M . Life expectancy: women now on top everywhere . BMJ 2006 ; 332 : 808 . Google Scholar Crossref Search ADS PubMed 3 Oksuzyan A , Juel K , Vaupel JW , Christensen K . Men: good health and high mortality. Sex differences in health and aging . Aging Clin Exp Res 2008 ; 20 : 91 . Google Scholar Crossref Search ADS PubMed 4 HMD . Human Mortality Database. 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This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The European Journal of Public Health Oxford University Press

Do women in Europe live longer and happier lives than men?

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Oxford University Press
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© The Author(s) 2018. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
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1101-1262
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1464-360X
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10.1093/eurpub/cky070
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Abstract

Abstract Background The article examines gender differences in happy life expectancy at age 50 (LE50) and computes the age-specific contributions of mortality and happiness effects to gender differences in happy LE50 in 16 European countries. Methods Abridged life tables and happy LE50 were calculated using conventional life tables and Sullivan’s method. Age-specific death rates were calculated from deaths and population exposures in the Human Mortality Database. Happiness prevalence was estimated using the 2010–11 Survey of Health, Ageing and Retirement in Europe. Happiness was defined using a single question about life satisfaction on a scale of 0–10. A decomposition algorithm was applied to estimate the exact contributions of the differences in mortality and happiness to the overall gender gap in happy LE50. Results Gender differences in happy LE50 favour women in all countries except Portugal (0.43 years in Italy and 3.55 years in Slovenia). Generally, the contribution of the gender gap in happiness prevalence is smaller than the one in mortality. The male advantage in the prevalence of happiness partially offsets the effects of the female advantage in mortality on the total gender gap in happy LE50. Gender differences in unhappy life years make up the greatest share of the gender gap in total LE50 in all countries except Denmark, Germany, Netherlands, Slovenia and Sweden. Conclusion Countries with the largest gender gap in LE are not necessarily the countries with larger differences in happy LE50. The remaining years of life of women are expected to be spent not only in unhealthy but also in unhappy state. Introduction In developed countries, the female advantage in life expectancy (LE) has been one of the most consistent empirical findings over the past several decades,1–3 although the magnitude of gender differences in LE varies substantially across European nations.4 At the same time, gender differences in healthy LE are less apparent.5 Women at age 50 have been found to have higher LE with and without activity limitations than same-aged men in most EU countries,6 and the gender gap is mostly attributable to better survival among women.7 Compared with women, men have superior physical performance in physical tests,8 fewer difficulties in carrying out activities of daily life9 and fewer other reported health problems.10 Cross-national gender differences in subjective well-being Empirical research on gender differences in subjective well-being has yielded contradictory results. Some studies have demonstrated that women tend to be happier than men across geographic regions, although the size of the female advantage appears to be small.11 Other studies have shown that men are happier or more satisfied with life than women across all ages but that the gender gap widens with age.12 Comparative studies conducted at the population level have generated inconsistent findings on the question of whether national populations reporting higher levels of happiness also have longer and healthier lives.13 For instance, some empirical analyses have indicated that happier persons have lower levels of hypertension14 and are able to manage stress better than their unhappier counterparts.15 Being happy has also been associated with having lower incidence of chronic conditions.16 However, other research has found that happiness is negatively associated with longevity at the national level across 15 European countries.17 Although there is a large body of literature on gender differences in survival, health, healthy LE and well-being, the number of studies focusing on happy LE and its variations by gender is much smaller. At present, there is no consensus on how happiness should be measured.18 Empirical findings suggest that for international comparison, life satisfaction may be a better measure of subjective well-being than general happiness.19 In addition, the analyses where scores for both the measures of life satisfaction and general happiness are available suggest show fairly consistent results similar.18,20,21 In our study, subjective well-being refers to an individual’s happiness, measured through satisfaction with life. Like healthy LE, happy LE is a summary measure of population well-being that combines data on the length of life and a measure of well-being.22 Comparative research has shown that in Europe in early 1990s, levels of happy LE were lowest in eastern European countries, such as Bulgaria and Belarus, and were highest in wealthy North–West EU countries, such as Iceland, the Netherlands, Sweden and Switzerland.20,23 Studies conducted in the USA have demonstrated that at all ages, women have longer happy and unhappy lives than men but that the proportion of the life span spent in a happy state is greater among men than among women.24 Little is known about the directions and the magnitudes of gender differences in happy LE across European countries. We fill this research gap by analyzing the magnitudes and variations of the gender gaps in happy LE across 16 European countries. We also identify the gender-specific differences in the shares of the remaining (un)happy years of life. Finally, our study provides the first evidence about the exact contributions of the female–male gap in mortality and prevalence of happiness to the total gender gap in remaining happy life years at age 50. Methods Data and indicators This study was based on the data collected in the fourth wave (2010–11) of the Survey of Health, Ageing and Retirement in Europe (SHARE) in 16 countries: Austria, Belgium, the Czech Republic, Denmark, Estonia, France, Germany, Hungary, Italy, the Netherlands, Poland, Portugal, Slovenia, Spain, Sweden and Switzerland.25 The SHARE is a multidisciplinary and cross-national panel survey of community-dwelling individuals aged 50 and older. The data collection instruments and study design have been harmonized to facilitate European comparisons of health, family circumstances, socio-economic characteristics and social and family networks across countries. The total sample consists of 56 984 individuals (25 018 men and 31 966 women) aged 50 and older (born in 1960 or earlier). The sample sizes vary by gender and country; the largest samples of both men and women are from Estonia (6758 respondents) and France (5667 respondents), while the smallest total sample is from Germany (1612 respondents). When examining country differences, it is important to keep these varying sample sizes in mind. Participants were asked to evaluate their life satisfaction by responding a single question: ‘On a scale from 0 to 10 where 0 means completely dissatisfied and 10 means completely satisfied, how satisfied are you with your life?’ We dichotomized the responses as follows: those who rated their life satisfaction level as between 8 and 10 were coded as happy, while those who rated their life satisfaction level as between zero and seven were coded as less happy. Analysis The age-specific prevalences of happiness were smoothed using a multivariate regression model with sex, quadratic terms of age and the interaction between age and sex as independent variables.24 The smoothing was applied because of the fluctuations of the age-specific prevalence of life satisfaction in males and females across ages. We used death counts and population exposures from the Human Mortality Database.4 Abridged period life tables for ages 50 and older were calculated by applying a conventional algorithm.26 The happy LE50 was estimated using the Sullivan method,27 a method of dividing life table years lived in an age interval into years lived in happy and unhappy states based on the prevalence of happiness in a specific age group. To analyze whether there was a correlation between LE50 and happy LE50, and between gender differences in LE and happy LE50, we plotted LE against happy LE at age 50 for men and women, and gender differences in LE50 against gender differences in happy LE50. A decomposition method developed by Andreev et al.28 was implemented to identify the exact contributions to the total gap in happy LE50 between women and men of (i) differences in age-specific mortality rates and (ii) differences in age-specific prevalences of happiness. The analyses were conducted using R version 3.3 (http://www.R-project.org). Results Prevalences of happiness by gender and country The results indicate that the smoothed age-specific prevalences of happiness varied from 0.35 to 0.84 (Estonia and Switzerland, respectively) for men and from 0.37 to 0.86 (Estonia and Denmark, respectively) for women in the age group 50–54 and from 0.47 to 0.80 (Estonia and Switzerland, respectively) for men and from 0.42 to 0.77 (Portugal and Switzerland, respectively) for women in the age group 80+ (Supplementary figure S1). In most of the countries, the prevalence of happiness was greater among men than among women across age groups. In Denmark, Estonia and Sweden, we found no gender differences in the smoothed age-specific prevalences of happiness. Gender differences in LE50 and happy life years by country Figure 1 shows the correlation between LE50 and happy LE50 for men and women as well as the correlation between gender differences in LE50 and happy LE50. In all countries, women had higher LE50 than men. The gender differences in LE50 ranged from 3.4 years in Sweden to 7.6 years in Estonia. The gender differences in LE50 were smallest in the Nordic countries, largest in the Central and Eastern European (CEE) countries and of intermediate size in the southern and the western European countries. The happy LE50 varied considerably across countries among both men (from 26.7 years in Switzerland to 9.1 years Estonia) and women (from 28.7 years in Switzerland to 12.1 years in Hungary) (figure 1). Figure 1 View largeDownload slide LE and happy life years at 50 years by gender and gender differences in LE and in happy life years at age 50 in 16 European countries. Source: SHARE 2010–11; HMD 2010. Note: LE50—life expectancy at age 50. Countries: AT: Austria, BE: Belgium; CZ: Czech Republic; DE: Germany; DK: Denmark; ES: Spain; FR: France; GR: Greece, HU: Hungary; IT: Italy; NT: The Netherlands; PL: Poland; PT: Portugal; SE: Sweden; SI: Slovenia and SW: Switzerland. Gender differences in LE and in happy life years at age 50 (right panel). Correlation between LE50 and happiness-adjusted LE50: men = 0.82 (P value < 0.001); women = 0.44 (P value = 0.09) and gender differences = 0.16 (P value = 0.56) Figure 1 View largeDownload slide LE and happy life years at 50 years by gender and gender differences in LE and in happy life years at age 50 in 16 European countries. Source: SHARE 2010–11; HMD 2010. Note: LE50—life expectancy at age 50. Countries: AT: Austria, BE: Belgium; CZ: Czech Republic; DE: Germany; DK: Denmark; ES: Spain; FR: France; GR: Greece, HU: Hungary; IT: Italy; NT: The Netherlands; PL: Poland; PT: Portugal; SE: Sweden; SI: Slovenia and SW: Switzerland. Gender differences in LE and in happy life years at age 50 (right panel). Correlation between LE50 and happiness-adjusted LE50: men = 0.82 (P value < 0.001); women = 0.44 (P value = 0.09) and gender differences = 0.16 (P value = 0.56) The gender gap in happy LE50 was in favour of women in all countries except Portugal. In general, the countries with the largest gender differences in LE50 were not the countries with the largest gender differences in happy LE50 (correlation = 0.16, P values = 0.56) (figure 1). The only exceptions were two CEE countries, Poland and Estonia, which had the largest gender gaps in both LE50 and happy LE50. Two other CEE countries, the Czech Republic and Hungary, as well as Spain and France, had large gender differences in LE50 but smaller gender gaps in happy LE50 (about a year). Denmark was among the countries with the smallest gender gaps in LE50 but it was also among the countries with the largest gender differences in happy LE50. Gender differences in (un)happy life years by country Figure 2 shows the gender differences in LE50 (panel A) divided into the remaining years spent in happy and unhappy states (panel B). The gender gaps in happy LE50 in Denmark—and to a lesser extent in Sweden, the Netherlands and Slovenia—were larger than the gender differences in expected number of years spent in unhappy state at age 50. In all of the other countries, the gender differences in unhappy life years at age 50 were larger than the gender gaps in happy LE50; except in Austria, Switzerland and in Germany, where they were of similar size. Figure 2 View largeDownload slide Gender differences in LE and gender differences in happy and unhappy life years at age 50 in 16 European countries. Source: SHARE 2010–11; HMD 2010. Note: LE50—life expectancy at age 50. F-M Diff.= female–male differences Figure 2 View largeDownload slide Gender differences in LE and gender differences in happy and unhappy life years at age 50 in 16 European countries. Source: SHARE 2010–11; HMD 2010. Note: LE50—life expectancy at age 50. F-M Diff.= female–male differences Contribution to the gender differences in happy life years by country and age groups We further examined the contributions of mortality and the prevalence of high levels of satisfaction with life to the gender gap in happy LE50 for the total sample, and for different age groups. The contributions to the gender differences in happy LE50 made by differences in mortality were positive in all of the countries, reflecting the lower mortality among women than among men (figure 3). The contributions of mortality varied across countries; they were largest in Poland (3.6 years) and were smallest in Portugal (2.4 years). In seven countries (Poland, Austria, Switzerland, Belgium, Estonia, Spain and Slovenia), the mortality contributions were over 3 years. However, these countries presented dissimilarities: they did not all show the lowest gender differences in LE50. Estonia and Austria were among the countries with the largest LE50 gender gaps, while Slovenia and Poland had the lowest. By contrast, happiness effects contributed negatively in most countries, which indicates that men had an advantage in the prevalence of happiness in these countries. Meanwhile, the happiness effects contributed positively (by about half a year) to the total gender differences in happy LE50 in only three countries (Denmark, Estonia and Slovenia), which indicates that women had an advantage in the prevalence of happiness in these countries. Overall, the mortality effects that contributed to the total gender differences in happy LE50 were greater than the happiness effects of the prevalence of high levels of satisfaction with life. The exceptions were Portugal, where the mortality effects were smaller than the happiness effects; and Italy, where mortality and happiness effects were approximately of similar size. Figure 3 View largeDownload slide Contributions of mortality and happiness prevalences effects to gender differences in happy life years, age 50. Source: SHARE 2010–11; HMD 2010. Note: ‘Mortality-effect’ = dark black bar; ‘Happiness-effect’ = light grey bar Figure 3 View largeDownload slide Contributions of mortality and happiness prevalences effects to gender differences in happy life years, age 50. Source: SHARE 2010–11; HMD 2010. Note: ‘Mortality-effect’ = dark black bar; ‘Happiness-effect’ = light grey bar As found in the decomposition of the total gender gap into mortality and happiness effects for all ages combined, the contributions of mortality differences (in black) to the total gender gap in happy LE50 were generally larger than the contributions of differences in the prevalence of happiness in most age groups and countries (figure 4). Only in Austria, Germany and Poland at ages 65+ and in Slovenia and Poland at ages below 65 the mortality effects were smaller than the happiness effects. Figure 4 View largeDownload slide Age-specific contributions of mortality effects and happiness effects to the gender differences in happy life years. Source: SHARE 2010–11; HMD 2010. Note: ‘Mortality-effect’ = dark black bar; ‘Happiness-effect’ = light grey bar Figure 4 View largeDownload slide Age-specific contributions of mortality effects and happiness effects to the gender differences in happy life years. Source: SHARE 2010–11; HMD 2010. Note: ‘Mortality-effect’ = dark black bar; ‘Happiness-effect’ = light grey bar Regarding the contribution of happiness differences to the gender gap in happy LE50 by age groups, we found that these happiness effects contributed negatively to the total gender differences in happy LE50; i.e. the higher prevalence of happiness among men partially offset the effects of lower mortality among women in all age groups in Belgium, the Czech Republic, France, Hungary, Italy, the Netherlands, Portugal, Spain, Sweden and Switzerland; at ages 65+ in Austria, Poland and Germany and at ages 75+ in Slovenia. We also observed that happiness contributed positively to the total gender gap in happy LE50 among the youngest age groups in Austria, Denmark, Estonia, Germany, Poland and Slovenia. Overall, the female advantage in happy LE at 65+ is reduced due to men reporting higher levels of happiness; while at ages 50–65 in the latter six countries the advantage is due to the combination of lower mortality and higher prevalence of happiness among women. Discussion This study is among the first to examine gender differences in happy LE for 16 European countries and to estimate the contributions of differences in mortality and differences in the prevalence of happiness to the total gender gaps in happy LE50. Our findings confirm that based on SHARE data women have an advantage not only in LE50 but also in happy LE50 in all countries except Portugal. Despite this advantage over men, the larger share of the remaining years of life of women is expected to be spent in an unhappy state. This first analysis of gender difference in happy LE across EU countries therefore contributes to the existing literature that the remaining years of life of women tend to be spent not only in unhealthy but also in unhappy states. The results further suggest that the countries with the highest LE50 are not necessarily the countries with the highest happy LE50; and that the countries with the largest gender gaps in LE50 are not the countries with the greatest gender differences in happy LE50. In Sweden, Denmark, the Netherlands and Slovenia, the female advantage in overall LE50 is mainly due to their higher expected number of happy life years than for males. However, in the remaining European countries considered in our study, the female advantage in LE50 is largely due to a higher number of unhappy life years. Importantly, we found that in almost all of the analyzed countries, the mortality effects contribute positively to the total gender differences in happy LE50 and are larger than the happiness effects. The effects of lower mortality among women are offset by the lower prevalences of happiness among women in all of the countries studied. Comparative research in developed countries has indicated that even though aggregate-level gender differences in happiness worldwide favour women, in Europe, mean levels of happiness are higher among women than among men in western European countries only.11 Although national income and high levels of public expenditure were found to be associated with a short-term increase in happiness,29 over the long-term there was no relationship between a country’s income rise and an increase in happiness.30 Comparative research also indicates that gender inequality is associated with life satisfaction.31 However, other studies have shown that most measures of gender inequality are unrelated to gender differences in subjective well-being.32,33 In-depth multilevel studies are needed to investigate the contributions of socio-economic measures at the national level to the cross-country differences in gender gap in happiness and happy LE50. Generally, the literature has shown that higher levels of life satisfaction and happiness are associated with living a longer and healthier life.34,35 Individuals with poor self-rated health, physical disabilities, depressive symptoms and other common health conditions tend to report having lower happiness levels than others.36 Female disadvantages in health may underlie the longer lives in an unhappy state experienced by women. Although we have not tested this hypothesis in this study, our findings and previous research evidence on gender differences in health across European countries do not suggest that gender differences in health and happiness are highly correlated. Spain, France and Italy, which have among the highest values for LE50, are also the countries with the highest numbers of years spent in an unhappy state. However, it is only in France, which is among the countries with the highest levels of female disadvantage in terms of unhappy life years, that poor self-rated health has been found to be lower for women than men.10 Our findings have some limitations, which should be taken into account in interpreting the results. Household response rates across countries in wave 4 varied from 41% in the Netherlands to 97% in Austria; the corresponding individual response rates across countries ranged from 36% in the Netherlands to 89% in Austria.37 Happier people may be more willing to participate in the survey, especially in countries with lower participation rates, and there may also be gender-specific patterns in participation rates.38 However, the countries which in our analysis show a positive contribution by the prevalence of happiness to the gender gap in happy LE, i.e. Denmark and Slovenia, are countries with response rates (52 and 57% for household response rates and 46 and 44% for individual response rates, respectively) which are close to the average across all SHARE countries (62 and 52%, respectively). Furthermore, responses to such survey questions may be culturally influenced and may differ by gender.39,40 Although it is commonly believed that women are more likely than men to report being ill, and particularly to report having psychosomatic symptoms of stress and malaise-type symptoms, the research evidence on gender differences in the reporting of illnesses has been contradictory.40 Still, a portion of the observed gender differences in happy LE50 may be related to differences in survey participation and reporting styles between men and women and across cultures.39 Our work provides empirical evidence on an interesting and relevant aspect of the health literature for contemporary societies, where LE is high and continues to increase. Particularly, it sheds additional light on how differently men and women across different nations live these added years of life in terms of happiness. The four main contributions of this article are the following. First, compared with men, women not only live longer but also spend more years in an unhappy state. Second, we have found that in most countries, the male advantage in the prevalence of happiness partially offsets the effects of the female advantage in mortality on the total gender gap in happy LE, and especially at older ages. Third, across age groups, we find, in six countries, a reversal of the prevalence of happiness around retirement ages, suggesting that conditions after retirement may play a role in explaining differences between men and women in the levels of happiness. Lastly, the countries with the largest gender gap in LE are not necessarily the countries with larger differences in happy LE50. Further research is needed to fully explain the interplay of factors that determine the international patterns of gender differentials in subjective well-being at older ages, and in particular to fully address the role of contextual factors in an international comparison. National health policies should view happiness as an important determinant of health and well-being at old age, especially among women. Acknowledgements This article uses data from SHARE Wave 4 (DOI: 10.6103/SHARE.w4.600); see Börsch-Supan et al. (2013) for methodological details. Funding The SHARE data collection has been primarily funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812) and FP7 (SHARE-PREP: N°211909, SHARE-LEAP: N°227822, SHARE M4: N°261982). Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the US National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C) and from various national funding sources is gratefully acknowledged (see www.share-project.org). This work has been supported by the 2014 SGR 768 grant—AGAUR, Generalitat de Catalunya and by the Max Planck Society within the framework of the project ‘On the edge of societies: New vulnerable populations, emerging challenges for social policies and future demands for social innovation. The experience of the Baltic Sea States’ (2016–21). It was presented at the scientific REVES meeting in Santiago de Chile, 17–19 May 2017. Conflicts of interest: None declared. Key points Women have an advantage in happy LE50 in all countries but Portugal. Women’s advantage in happy LE50 is almost entirely explained by their lower mortality. In the majority of countries, the prevalence of happiness is lower among women than among men, and contributes negatively to the gender gap in happy LE50. A reversal of the prevalence of happiness around retirement ages is found in six countries, suggesting that post-retirement conditions may play a role in explaining differences between genders in the levels of happiness. In 11 European countries, the overall longevity advantage of women is associated with a longer life spent in an unhappy state. References 1 Verbrugge LM , Wingard DL , Features Submission HC . Sex differentials in health and mortality . Women Health 1987 ; 12 : 103 – 45 . Google Scholar Crossref Search ADS PubMed 2 Barford A , Dorling D , Smith GD , Shaw M . Life expectancy: women now on top everywhere . BMJ 2006 ; 332 : 808 . Google Scholar Crossref Search ADS PubMed 3 Oksuzyan A , Juel K , Vaupel JW , Christensen K . Men: good health and high mortality. Sex differences in health and aging . Aging Clin Exp Res 2008 ; 20 : 91 . Google Scholar Crossref Search ADS PubMed 4 HMD . Human Mortality Database. 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This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Journal

The European Journal of Public HealthOxford University Press

Published: Oct 1, 2018

References

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