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There are well-documented differences in the health and well-being of males and females. These disparities are not strictly based on biology but develop through gendered experiences over the lifecourse and are influenced by factors such as differences in access to resources and societal gender norms.
A 2017 report from the Milken Institute explored health disparities between females and males across states. The report found that states with lower gender disparities were concentrated in the Northeastern region and tended to have better health outcomes overall. These states also tended to have greater availability of health care resources — suggesting access to care (including preventive care) plays an important role. The report also found that females have a higher prevalence of depression, while males have higher rates of unhealthy behaviors like drinking and smoking.
Because differential experiences accumulate over the life span, gender disparities among male and female seniors were examined for six measures of health, focusing on mental health and unhealthy behaviors. Gender was defined by the original data sources (National Vital Statistics Systems for suicide data, Behavioral Risk Factor Surveillance System for all other measures). Gender disparity ratios were calculated to compare prevalence estimates among male and female seniors, with a ratio of 1.0 indicating no disparity between genders.

Mental Health

Females have a higher prevalence of frequent mental distress and depression, while males have a higher suicide rate.

Frequent Mental Distress

Frequent mental distress is the percentage of adults aged 65 and older reporting 14 or more days of poor mental health in the past 30 days. Frequent mental distress captures those experiencing persistent and likely severe mental health issues. Since 2016, the prevalence of frequent mental distress has been consistently higher among females than males (Figure 27). In this year’s report, frequent mental distress is 1.28 times higher among females (8.7 percent) than males (6.8 percent). In 2019, an estimated 2.4 million female and 1.5 million male seniors reported frequent mental distress. In the past year, frequent mental distress among males increased 15 percent from 5.9 to 6.8 percent and remained stable among females.
Frequent mental distress is significantly higher among female seniors in Iowa, Ohio, Utah, West Virginia and Indiana, compared with male seniors. The highest gender disparity ratio is in Iowa (females at 6.7 percent; males at 3.6 percent) and Ohio (females at 8.7 percent; males at 4.7 percent), where frequent mental distress is around 1.86 times higher among females than males in both states (Figure 28). While these two states have a lower prevalence of frequent mental distress than the U.S. overall, West Virginia has a high gender disparity ratio and an overall prevalence higher than the U.S. This measure is more prevalent among females in the majority of states, however, there are five states in which males have a higher prevalence than females (gender disparity ratio less than 1.0). In Hawaii frequent mental distress is higher among males (7.5 percent) than females (5.3 percent), leading to a gender disparity ratio less than 1.0.

Depression

Depression is significantly higher among females in 34 states compared with males, resulting in a gender disparity ratio greater than 1.0. Seventeen of these states have a lower overall prevalence of depression than the U.S., while 15 have a higher overall prevalence and two have the same overall prevalence as the U.S. Figure 30 shows Alaska has the highest gender disparity ratio, with depression 2.91 times higher among females (19.2 percent) than males (6.6 percent). Ohio, Wyoming and Tennessee follow with females reporting around 2.0times the prevalence of depression compared with males. All states have a gender disparity ratio greater than 1.0. The District of Columbia, however, has a higher prevalence of depression among males (11.1 percent) than females (10.7 percent), leading to a gender disparity ratio less than 1.0.
Depression is significantly higher among females in 34 states compared with males, resulting in a gender disparity ratio greater than 1.0. Seventeen of these states have a lower overall prevalence of depression than the U.S., while 15 have a higher overall prevalence and two have the same overall prevalence as the U.S. Figure 30 shows Alaska has the highest gender disparity ratio, with depression 2.91 times higher among females (19.2 percent) than males (6.6 percent). Ohio, Wyoming and Tennessee follow with females reporting around two times the prevalence of depression compared with males. All states have a gender disparity greater than one. The District of Columbia, however, has a higher prevalence of depression among males (11.1 percent) than females (10.7 percent), leading to a gender disparity ratio less than 1.0.

Suicide

Suicide rates are another indication of the burden of poor mental health among seniors. Males of all ages are generally at a higher risk of death by suicide compared with females, despite females having higher rates of depression and suicidal ideation. Several factors are associated with the elevated risk of death by suicide among males, including a higher use of more lethal methods, such as firearms, compared with females. Data from the Centers for Disease Control and Prevention show that non-Hispanic white males aged 85 and older have the highest suicide rate of any group in the nation.
From 2013 to 2019, the suicide rate among males increased 7 percent from 29.3 to 31.4 deaths per 100,000 males aged 65 and older; among females it increased 16 percent from 4.5 to 5.2 deaths per 100,000 (Figure 31). In 2019, the suicide rate is 6.04 times higher among males (31.4 deaths per 100,000 males aged 65 and older) than females (5.2 deaths per 100,000 females aged 65 and older). In 2019, 1,481 female and 7,079 male seniors died by suicide.
The suicide rate among males is significantly higher compared with females in every state for which data are available for both genders (25 states) (Figure 32). The gender disparity ratios for suicide are the highest of any measure examined in this report, with gender disparity ratios of around four or higher for each state examined. In Ohio, the state with the highest gender disparity ratio, the suicide rate is 9.36 times higher among males (30.9 deaths per 100,000 males aged 65 and older) than females (3.3 deaths per 100,000 females aged 65 and older), despite having an overall suicide rate that is lower than the U.S. rate. In Pennsylvania, the overall suicide rate is higher than the U.S. rate and is 7.84 times higher in males (34.5 deaths per 100,000 males aged 65 and older) than females (4.4 deaths per 100,000 females aged 65 and older).

Unhealthy Behaviors

Females have a higher prevalence of physical inactivity, while males have a higher prevalence of smoking and excessive drinking.

Physical Inactivity

Being physically active can prevent or delay the onset of many chronic diseases. Physical inactivity is the percentage of adults aged 65 and older in fair or better health who report doing no physical activity or exercise other than their regular job in the past 30 days. Physical inactivity is 1.24 times higher among females (32.6 percent) than males (26.2 percent). Between 2016 and 2019 the prevalence of physical inactivity among male and female seniors has remained stable (Figure 33). In 2019 an estimated 5.1 million male and nearly 8 million female seniors report being physically inactive.
In 19 states, the prevalence of physical inactivity among female seniors is significantly higher than male seniors (Figure 34). Six of these states have an overall prevalence less than the U.S. prevalence, while 13 states have an overall prevalence that is greater than the U.S. Massachusetts has the highest gender disparity ratio, with physical inactivity 1.72 times higher among females (41.0 percent) than males (23.9 percent). There are three states with a gender disparity ratio less than 1.0, where males report a higher prevalence of physical inactivity than females.
  • Wisconsin: 28.1 percent of males report being physically inactive, compared with 26.5 percent of females
  • Maine: 29.3 percent of males report being physically inactive, compared with 27.0 percent of females
  • Nevada: 34.0 percent of males report being physically inactive, compared with 28.5 percent of females

Excessive Drinking

Excessive drinking is the percentage of adults aged 65 and older who report chronic or binge drinking. Seniors experience the highest alcohol-attributable death rate, and excessive alcohol use contributes to injuries, chronic diseases, dementia and mood disorders. Excessive drinking is 1.62 times higher among male seniors compared with female seniors. The prevalence has increased 9 percent among females (from 5.3 to 5.8 percent) and 12 percent among males (from 8.4 to 9.4 percent) since 2016 (Figure 35). This year, an estimated 1.5 million females and 2.0 million males reported excessive drinking.
Excessive drinking prevalence is significantly higher among male seniors than female seniors in 23 states (Figure 36). Sixteen of these states have a lower overall prevalence of excessive drinking than the U.S., while seven have a higher overall prevalence than the U.S. Iowa has the highest gender disparity ratio, with male seniors (9.6 percent) reporting 3.0 times the prevalence of excessive drinking than female seniors (3.2 percent). No states have a gender disparity of 1.0 or less, meaning males have a higher prevalence of excessive drinking than females in every state.

Smoking

Individuals who smoke have a greater risk of death from any cause no matter their age. However, smoking cessation, even in older adults, has been shown to improve health outcomes. Smoking is the percentage of adults aged 65 and older who are smokers (report smoking at least 100 cigarettes in their lifetime and currently smoke every or some days). Smoking prevalence is 1.25 times higher among male than female seniors. Since 2013, smoking has gradually decreased 4 percent among female seniors (from 8.3 to 8.0 percent) but increased 3 percent among male seniors (from 9.7 to 10.0 percent) (Figure 37).
Smoking is significantly more prevalent among males in three states (Hawaii, Georgia, and South Carolina) and the District of Columbia. Hawaii has an overall smoking prevalence that is lower than the U.S. prevalence, while Georgia, South Carolina and the District of Columbia have overall prevalences higher than the U.S. Hawaii has the highest gender disparity ratio with smoking prevalence twice as high among males (8.5 percent) than females (4.2 percent) (Figure 38). Ten states have a gender disparity ratio that is less than 1.0, indicating female seniors report a higher prevalence of smoking than male seniors in those states.

Conclusions

Female seniors report a higher prevalence of physical inactivity, frequent mental distress and depression than male seniors. Male seniors have a higher prevalence of smoking and excessive drinking; they also have a higher suicide rate than female seniors.
Gender disparity ratios for the six measures examined vary widely by state. The reason for a large gender disparity ratio for a state may be a particularly high or low prevalence for either gender. A state may also have a small gender disparity ratio due to both genders having a high or low prevalence.
The findings shed light on gender disparities among seniors in the United States. A better understanding of these disparities offers policymakers and community leaders an opportunity to tailor programs that address health challenges facing seniors today, as well as future generations of seniors. This information can be used to target programs and advocate for systems improvements that promote health equity.

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