Symptom Sensitivity and Sex Differences in Physical Morbidity: A Review of Health Surveys in the United States and the Netherlands

Abstract

Health surveys have found higher female morbidity rates, as reflected by indices such as general health status, number of acute conditions or physical symptoms and medical care utilization. Such findings can lead to the conclusion that women are the "sicker sex" in terms of objective health status. However, the size of the sex difference varies with the different indices used to operationalize the morbidity concept. Apart from sex specific conditions, the female morbidity excess seems most substantial with regard to general health status, acute and mild chronic conditions and physical symptoms. Findings from a large health survey in the Netherlands, presented in this article, confirm this picture. Some major methodological sources of bias, that have been held responsible for part of the sex differences found in health surveys, such as the poor definition of the morbidity concept and aspects of the data collection process, are discussed. One explanation for the higher morbidity of women, i.e., the differential perception of physical symptoms by men and women, is elaborated in more detail. The authors suggest that part of the sex differences found in health surveys can be explained by a higher female symptom sensitivity, defined as a readiness to perceive physical sensations as symptoms of illness. Research supporting this symptom sensitivity hypothesis is reviewed and explanations are given. It is suggested that further research on sex differences in morbidity should control for methodological sources of sex bias and should focus explicitly on differences in the perception of physical symptoms by men and women.

Self-rated health by HIV-infected individuals undergoing antiretroviral therapy in Brazil

“…As in the current study, women in general rank their health more poorly than do men. The main explanation for this lies in gender roles, in which women express pain and discomfort more easily than men 29,30 .…”

Gênero, morbidade, acesso e utilização de serviços de saúde no Brasil

“…Embora possa medir condições crônicas (NCHS, 1995), comparado à auto-avaliação, apresenta maior objetividade e está mais associado a doenças agudas ou episódios agudos de enfermidades crônicas (Gijsbers et al, 1991). Diferentes inquéritos de saúde têm usado períodos diversos de observação (em geral 15 ou 30 dias).…”

Gender differences in health care access indicators in an urban, low-income community

“…8,9,12,19,21 The tendency for women to be more likely to have a usual source of health care may be related to gender differences in health perceptions and attitudes. A number of studies have shown that women report higher rates of illness than do men, [22][23][24][25][26][27][28][29] suggesting that women have a greater need for medical care and, therefore, may be more likely to obtain insurance and establish a regular source of care. Debate exists regarding whether the difference in reported morbidity reflects physiological experiences or gender dissimilarities in perceptions of illness and response to symptoms.…”

“…Debate exists regarding whether the difference in reported morbidity reflects physiological experiences or gender dissimilarities in perceptions of illness and response to symptoms. 23,28,30,31 Some argue that the picture is more complex and note that gender differences in health are not uniformly expressed and can vary by type of health condition and life stage. 32 Regardless of symptom experience, women may be more willing to seek out health care, 26,28 showing significantly greater awareness of their health and a propensity to seek treatment when they are ill. 24 Thus, women may have a stronger inducement for obtaining insurance and a regular health care provider.…”