Gender and health inequalities in CONSTANCES: social determinants of the male-female differences in healthy ageing – GINCO

The analysis of gender differences in healthy ageing in 5 steps

We use data from the CONSTANCE cohort. We will focus on the over 45s, the age at which functional health indicators are available. The sample was drawn from the health insurance database and individuals were invited to visit a health insurance examination centre.

1. We will establish gender differences in diseases and disabilities using indicators of prevalence, disability-free life expectancy and incidence (re-interview) and analyse the differences using multivariate models (risk factors, social indicators) and decomposition techniques. We will focus on musculoskeletal, anxiety-depressive and cardiovascular diseases, which are assumed to be strongly related to social risk factors.

2. In relation to diseases, women and men differ in their biological functioning with respect to risk factors. Exposures throughout their careers affect this biological functioning, among other things by reacting to strains (economic, organisational, relational) that stress cardiovascular functions in particular. From blood and urine samples, biological indicators will be constructed by identifying the appropriate thresholds, and will be linked to chronic diseases and disabilities.

3. We will seek to identify critical situations and exposure pathways, possibly gendered. Professional careers expose women and men differently to health risks: harmful working conditions and career characteristics (low-skilled, discontinuous, low progression). The aim will be to construct typologies of career paths and social situations associating careers and family histories. We will analyse chronic diseases, disabilities and biomarkers in the light of these typologies and gender differences.

4. We will evaluate a possible protective effect of family policies on the health of women and men. Family policies in particular (maternity and parental leave, childcare, single parent benefits) play a crucial role in women's living conditions, return to work and career paths. While studies have pointed to a negative effect on careers, we wish to measure the effect on health. We will use a quasi-experimental method already tested on the CONSTANCES data.

5. We will have a group discussion on the measurement of critical social situations, to complement the classic indicators (profession, diplomas, household structure), at the crossroads of the professional and family spheres, sources of organisational and economic tensions. We will propose ways to develop questionnaires in order to improve data collection on these themes.

• Coordination INED team
-Organisation of project meetings (Paris and visio - 12/10/2020; Paris and visio - 21/10/21); of a data workshop (Toulouse and visio - 16/02/2022)
-Opening of the bilingual project website (https://ginco.site.ined.fr/)

• Axis 1. INED - Differences in disease and disability.
-Recruitment in October 2021 of Mira Rahal for a thesis co-supervised by Emmanuelle Cambois and Pierre-Yves Geoffard (PSE), financed by the GENDHI project and her work is at the articulation of the two projects. She is currently in charge of the construction of health indicators to compare the health status of women and men

• Axis 2. INSERM-CHU Toulouse, «Biomarkers and health«.
-Hélène Colineaux (public health doctor & member of their team) was recruited for a thesis on gender and biomarkers directed by Michelle Kelly-Irving and Benoit Lapage. She is funded by the GINCO project. She conducted a literature review to build a framework for analysis (submitted article), and began to take ownership of the data. She explored the biological data and constructed different indicators of the allostatic load score: she is testing its properties in relation to other variables.

• Axis 3. INED «health and trajectories«.
Constance Beaufils (PhD student co-supervised by Emmanuelle Cambois) has received GINCO funding to complete her PhD by working on the construction of career indicators in CONSTANCES. She (1) explored career data, reconstructed careers, created indicators and typologies; (2) explored occupational exposures, created exposure indicators. For her thesis, she analysed women's occupational inactivity pathways in relation to aggregate health indicators (one thesis chapter, two papers and one article in preparation) as well as the links between occupational exposures, women's inactivity pathways and health (one thesis chapter planned, one paper).

• Axis 4. Harvard/LSHT/Unil «Quasi-experimental« approach to the effect of EPA on careers/health
-Organisation of the work schedule.
-Hosting (2 months) at the LSHT of Constance Beaufils -April-May 2022
-Working meeting at LSHT planned for April 2022
-Recruitment of a post-doc for 18 months planned at the end of 2022 or beginning of 2023

• Axis 5. INED «measurement of social configurations / family-work«.
-As a continuation of a «cousin« project WELLWAYS, now completed, Anna Barbuscia, post-doctoral fellow, has initiated an analysis of «unplanned« births. She is currently collaborating on the GINCO project, for which she is refining the identification of births in the cohort, in order to reconstruct the reproductive history, based on the «Women« questionnaire and events between the follow-up waves.

If some of the critical social categories that we will identify are still more frequent among women today, they could be redistributed over the generations as family configurations and career paths change. These categories will then renew our understanding of social inequalities in health more generally. Our project aims to enrich knowledge on the impact of life courses linked in part to gendered social organisation and on the benefits for health of social policies in this area.

none at this stage

BACKGROUND: Women's longevity is an important health issue: if they live longer than men do, their additional life years are mainly years of poor health and disability. These health situations affect the quality of life and usually require a high level of care. In this context, this gender gap questions both its causes and the circumstances in which these disabilities are experienced. It was shown that some of these differences are due to social determinants that are unevenly distributed between men and women, in relation to their different professional, social or family life course experiences. Yet, the literature provides a rich but fragmented overview of the exposure paths within these life course experiences to explain the gender health differences.

OBJECTIVES. Our project proposes to develop a holistic approach to these differences, implemented using a new database, the CONSTANCES cohort. It allows constructing specific indicators to reflect the different health dimensions, from the biological functioning to disabilities, which could be emblematic of these gender differences. The objective is to highlight where the differences are located, and then to highlight exposure paths across the life course that could explain them. We intend to identify social determinants at the crossroads of professional, social and family life course; we assume that some circumstances (living conditions, jobs, family situation) can modify these exposure paths and modulate health risks. In total, the project intends to explain health differences between women and men, but also within women and men populations.

METHODS. The project is based on five tasks built around CONSTANCES data. We will work on the sample of 45 years of age or older (n=81,400 people at the end of 2018). Different methods will be used 1) To specify gender differences in relation to a number of diseases and disabilities (based on prevalence, disability-free life expectancies); 2) To qualify differences in biological functioning and provide, in relation to Task 1, a clinical and functional picture to analyse the gender health differences. 3) To shed light on the exposure paths contributing to the gender health differences established in Tasks 1-2, linked to critical situations within professional, family and social histories (based on composite indicator of stressful exposures; analyses using multivariate and nested models; pathway typologies and sequence analyses; structural equations; path analyses). 4) To adopt a quasi-experimental approach to analyse whether the reform of parental leave (APE) in France - which increased periods of inactivity with a mixed effect on mothers' careers - had a long-term effect on their health (based on method of double differences). 5) To carry out a collective reflection on the limits of measures of critical social and family situations in surveys.

PERSPECTIVES. Our project involves five teams from France and abroad, gathering researchers who have been working for a long time in the field of life courses and/or social determinants of health. Our project will build on this expertise and this new health data: we intend to shed light on the issue of gender differences in health by taking into account exposures related to gendered life courses. More generally, this project aims to broaden the scope of the social determinants of health at the intersection of the professional and family spheres; one approach being also to consider the impact of public policies. In doing so, this project also aims to broaden the scope of levers for action to improve the health status of the general population and, potentially, reduce health differences between population groups.