Will your child take care of you in your old age? Unequal caregiving received by older parents from adult children in Sweden.

Intergenerational family care provided to older parents by adult children is growing and differs based on gender and socioeconomic status. Few studies consider these elements in relation to both the parent and their adult child, and little is known about the number of care tasks received even though those providing intensive levels of care are at risk of experiencing adverse consequences in their lives. This study uses data from the nationally representative 2011 Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) and includes child-specific information from parents aged 76 years and above. Analyses used ordinal logistic regression and are presented as average marginal effects and predictive margins. Results show that parents in need of care report that one-third of all adult children in the sample provide care to three out of five of them. The care is most often non-intensive, yet nearly one in ten of all children provide more intensive care of two or more tasks. When adjusting for dyad characteristics as well as geographic proximity, results show adult-child gender differences where parents receive more care from manual-working-class daughters than manual-working-class sons. Overall, manual-working-class daughters are most commonly reported as carers among adult children, and they are particularly overrepresented in providing intensive care. We conclude that gender and socioeconomic inequalities exist among care receivers' adult children, even in a strong welfare state such as Sweden. Knowledge about levels and patterns of intergenerational care have important implications for how to reduce unequal caregiving.

Regional variations in excessive polypharmacy and potentially inappropriate drug use among older adults in Sweden: Trends from 2006 to 2020.

Introduction: Potentially inappropriate drug use (PID) is common among older adults. Cross-sectional data suggest that there are marked regional variations in PID in Sweden. There is, however, a lack of knowledge about how the regional variations have changed over time. Objectives: This study aimed to investigate the regional differences in the prevalence of PID in Sweden, 2006-2020. Methods: In this repeated cross-sectional study, we included all older adults (≥75 years) registered in Sweden, yearly from 2006 to 2020. We used nationwide data from the Swedish Prescribed Drug Register linked at the individual level to the Swedish Total Population Register. We selected three indicators of PID according to the Swedish national "Quality indicators for good drug therapy in the elderly": 1) Excessive polypharmacy (use of ≥10 drugs); 2) Concurrent use of three or more psychotropic drugs; 3) Use of "drugs that should be avoided in older adults unless specific reasons exist." The prevalence of these indicators was calculated for each of Sweden's 21 regions, yearly from 2006 to 2020. The annual coefficient of variation (CV) was calculated for each indicator by dividing the standard deviation of the regions by the national average, to measure relative variability. Results: In the population of about 800,000 older adults per year, the national prevalence of "drugs that should be avoided in older adults," was reduced by 59% from 2006 to 2020. There was a slight decline in the use of three or more psychotropics, while the prevalence of excessive polypharmacy increased. The CV for excessive polypharmacy was 14% in 2006 and 9% in 2020 compared to 18% and 14% for "use of three or more psychotropics", and stable at around 10% for 'drugs that should be avoided in older adults.' Conclusions: The regional variation in potentially inappropriate drug use decreased or were stable from 2006 to 2020. The regional differences were largest for the use of three or more psychotropics. We found a general tendency that regions with a good performance at the start of the period performed well across the entire period. Future studies should investigate the reasons for regional variation and explore strategies to reduce unwarranted differences.

Increasing inequalities in disability-free life expectancy among older adults in Sweden 2002-2014.

BACKGROUND: In an aging society with increasing old age life expectancy, it has become increasingly important to monitor the health development in the population. This paper combines information on mortality and disability and explores educational inequalities in disability-free life expectancy in the aging population in Sweden, and to what extent these inequalities have increased or decreased over time. METHODS: A random sample of the Swedish population aged 77 years and above (n=2895) provided information about disability in the population in the years 2002, 2004, 2011 and 2014. The prevalence of disability was assessed by five items of personal activities of daily living and incorporated in period life tables for the corresponding years, using the Sullivan method. The analyses were stratified by sex and educational attainment. Estimates at ages 77 and 85 years are presented. RESULTS: Disability-free life expectancy at age 77 years increased more than total life expectancy for all except men with lower education. Women with higher education had a 2.7-year increase and women with lower education a 1.6-year increase. The corresponding numbers for men were 2.0 and 0.8 years. The educational gap in disability-free life expectancy increased by 1.2 years at age 77 years for both men and women. CONCLUSIONS: While most of the increase in life expectancy was years free from disability, men with lower education had an increase of years with disability. The educational differences prevailed and increased over the period as the gains in disability-free life expectancy were smaller among those with lower education.

Physical functioning as a predictor of retirement: Has its importance changed over a thirty-year period in Sweden?

Many countries, including Sweden, are implementing policies aimed at delaying retirement and encouraging older workers to remain on the labour market for longer. During recent decades, there have been several major reforms to the pension and social security systems in Sweden. Moreover, the nature of occupations has shifted towards more non-manual and sedentary activities, older women are today almost as active in the labour market as men in Sweden, and physical functioning has improved over time. In this study, we investigate whether the importance of physical functioning as a predictor for retirement has changed over time, for women and men, respectively. We used four waves of nationally representative data from The Swedish Level of Living Survey from 1981, 1991, 2000, and 2010, together with income register data. We found that greater severity of musculoskeletal pain and mobility limitations increased the likelihood of retirement in all waves. Results from logistic regression models with average marginal effects and predictive margins showed that there is a trend towards physical functioning becoming less important for retirement towards the end of the study period, especially for women, when controlling for occupational-based social class, age, adverse physical working conditions, and job demands. People, especially women, reporting impaired physical functioning did not retire to the same extent as in previous decades. This indicates that people stayed longer in the labour market despite impaired physical functioning, which may have repercussions on well-being and quality of life. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-022-00725-y.

Trends in the shape of the income-mortality association in Sweden between 1995 and 2017: a repeated cross-sectional population register study.

OBJECTIVE: We investigate recent trends in income inequalities in mortality and the shape of the association in Sweden. We consider all-cause, preventable and non-preventable mortality for three age groups (30-64, 65-79 and 80+ years). DESIGN AND SETTING: Repeated cross-sectional design using Swedish total population register data. PARTICIPANTS: All persons aged 30 years and older living in Sweden 1995-1996, 2005-2006 and 2016-2017 (n=8 084 620). METHODS: Rate differences and rate ratios for all-cause, preventable and non-preventable mortality were calculated per income decile and age group. RESULTS: From 1995 to 2017, relative inequalities in mortality by income increased in Sweden in the age groups 30-64 years and 65-79 years. Absolute inequalities increased in the age group 65-79 years. Among persons aged 80+ years, inequalities were small. The shape of the income-mortality association was curvilinear in the age group 30-64 years; the gradient was stronger below the fourth percentile. In the age group 65-79 years, the shape shifted from linear in 1995-1996 to a more curvilinear shape in 2016-2017. In the oldest age group (80+ years), varied shapes were observed. Inequalities were more pronounced in preventable mortality compared with non-preventable mortality. Income inequalities in preventable and non-preventable mortality increased at similar rates between 1995 and 2017. CONCLUSIONS: The continued increase of relative (ages 30-79 years) and absolute (ages 65-79 years) mortality inequalities in Sweden should be a primary concern for public health policy. The uniform increase of inequalities in preventable and non-preventable mortality suggests that a more complex explanatory model than only social causation is responsible for increased health inequalities.

Heavy alcohol consumption before and after negative life events in late mid-life: longitudinal latent trajectory analyses.

BACKGROUND: People who experience negative life events report more heavy alcohol consumption compared with people without these experiences, but little is known about patterns of change within this group. This study aims to identify trajectories of heavy alcohol consumption before and after experiencing either divorce, or severe illness or death in the family. Furthermore, the aim is to examine characteristics of individuals belonging to each trajectory. METHODS: Longitudinal study of public sector employees from the Finnish Retirement and Aging Study with up to 5 years of annual follow-ups (n=6783; eligible sample n=1393). Divorce and severe illness or death in the family represented negative life events. Heavy alcohol consumption was categorised as >14 units/week. RESULTS: Based on latent trajectory analysis, three trajectories of heavy drinking were identified both for divorce and for severe illness or death in the family: 'No heavy drinking' (82% illness/death, 75% divorce), 'Constant heavy drinking' (10% illness/death, 13% divorce) and 'Decreasing heavy drinking' (7% illness/death, 12% divorce). Constant heavy drinkers surrounding illness or death in the family were more likely to be men, report depression and anxiety and to smoke than those with no heavy drinking. Constant heavy drinkers surrounding divorce were also more likely to be men and to report depression compared with those with no heavy drinking. CONCLUSIONS: Most older workers who experience divorce or severe illness or death in the family have stable drinking patterns regarding heavy alcohol consumption, that is, most do not initiate or stop heavy drinking.

Association between psychosocial working conditions in mid-life and leisure activity in old age.

Aims: Leisure activity helps people engage with life, and it promotes health and well-being as we age. This study investigated whether individuals with active jobs (high psychological demands, high control) in mid-life were more active during leisure time in old age compared with those with less active jobs. Methods: Two individually linked Swedish surveys were used (N=776) with 23 years of follow-up. Data were analysed with logistic regression. Results: Having an active job in mid-life was associated with greater engagement in intellectual/cultural, social and physical activity in old age, even when leisure activity in mid-life was taken into account. Conclusions: The results suggest that active jobs in mid-life may be replaced by active leisure during retirement. Active job conditions may promote engagement in society in old age, which in turn may have positive health consequences.

Trends and gender associations in social exclusion in older adults in Sweden over two decades.

BACKGROUND: Social exclusion in older adults is associated with lower well-being and poorer health. To date there has been little research on whether the level of social exclusion in older adults changes over time, and its association with gender. AIM: To examine trends and gender associations in social exclusion indicators in older adults for the years 1992, 2002 and 2011. METHODS: Three waves of data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), a national survey of adults aged 77 years or older, were analysed: 1992 (n = 537), 2002 (n = 621), and 2011 (n = 904). Summative scales were created for four domains of social exclusion: material resources, social relations and leisure activities, civic participation, and services. Associations between gender and social exclusion within waves were examined as were trends in social exclusion across years. RESULTS: The analyses of trends found significant reductions in exclusion in the domains of material resources and services. Higher levels of exclusion from material resources and civic participation were found in women than men. Within domains, significant trends and gender associations in exclusion were found on several indicators, with indicators showing opposing trends. CONCLUSION: Although levels of social exclusion have reduced in certain domains during the years examined, our results reflect the persistence of social exclusion in the population of older adults. This underlines the continuing importance of a well-developed welfare and social security system to ensure the social inclusion of vulnerable groups such as older adults.

Divergence and Convergence: How Do Income Inequalities in Mortality Change over the Life Course?

BACKGROUND: Do inequalities in health by income increase or decrease with age? The empirical evidence is not conclusive and competing theories arrive at different conclusions. OBJECTIVE: This study examined inequality in mortality by income over the adult life course with longitudinal data on people aged 30-99 between the years 1990 and 2009. Each person was followed for 19 years. METHODS: We used Swedish total population data with 5,011,414 individual observations. We calculated the probability of having died for ages between 31 and 99. This approach to calculating death risk incorporates selective mortality during the follow-up period into the measure. Age and year standardized income positions were calculated for all individuals. Inequality was assessed by comparing the top 10% income group and the bottom 10% income group. Relative inequality was measured by risk ratios (RR) and absolute inequality by percentage point differences. RESULTS: The results showed that the highest relative income inequality in mortality was at age 56 for men (RR: 4.7) and at age 40 for women (RR: 4.1) with differing patterns across the younger age categories between the sexes. The highest absolute income inequality in mortality was found at age 78 for men (19% difference) and at age 89 for women (14% difference) with similar patterns for both sexes. Both measures of inequality decreased after the peak, with small or no inequalities above age 95. Income inequality in mortality remained in advanced age, with larger absolute inequalities in older ages and larger relative inequalities in younger ages. CONCLUSION: The results for absolute and relative measures of inequality differed substantially; this highlights the importance of discussing and making an active choice of inequality measure. To explain and understand the patterns of inequality in mortality over the adult life course, we conclude that the "age-as-leveler" and "cumulative disadvantage" theories are best applied to an absolute measure of inequality.

Income trajectories prior to alcohol-attributable death in Finland and Sweden.

BACKGROUND AND AIMS: Mortality from alcohol-attributable causes is patterned by income. We study the income trajectories 17-19 years prior to death in order to determine: (1) whether income levels and trajectories differ between those who die of alcohol-attributable causes, survivors with similar socio-demographic characteristics, all survivors and those dying of other causes; (2) whether the income trajectories of these groups differ by education; and (3) whether there are differences in income trajectories between Finland and Sweden-two countries with differing levels of alcohol-attributable mortality but similar welfare-provision systems. DESIGN: Retrospective cohort study using individual-level longitudinal register data including information on income, cause of death and socio-economic status. SETTING: Finland and Sweden. PARTICIPANTS: The subjects comprised an 11% sample of the Finnish population in 2006-07 and the total population of Sweden aged 45-64 years in 2007-08. MEASUREMENTS: Median household income trajectories by educational group were calculated by cause of death and population alive during the respective years. Additionally, propensity score matching was used to match the surviving population to those dying from alcohol-attributable causes with regard to socio-demographic characteristics. FINDINGS: The median income 17-19 years prior to death from alcohol-attributable causes was 92% (Finland) and 91% (Sweden) of survivor income: 1 year prior to death, the respective figures were 47% and 57%. The trajectories differed substantially. Those dying of alcohol-attributable causes had lower and decreasing incomes for substantially longer periods than survivors and people dying from other causes. These differences were more modest among the highly educated individuals. The baseline socio-demographic characteristics of those dying of alcohol causes did not explain the different trajectories. CONCLUSIONS: In Finland and Sweden, income appears to decline substantially before alcohol-attributable death. Highly educated individuals may be able to buffer the negative effects of extensive alcohol use on their income level. Income trajectories are similar in Finland and Sweden, despite marked differences in the level of alcohol-attributable mortality.

Social class and infirmity. The role of social class over the life-course.

In an aging society, it is important to promote the compression of poor health. To do so, we need to know more about how life-course trajectories influence late-life health and health inequalities. In this study, we used a life-course perspective to examine how health and health inequalities in late-midlife and in late-life are influenced by socioeconomic position at different stages of the life course. We used a representative sample of the Swedish population born between 1925 and 1934 derived from the Swedish Level of Living Survey (LNU) and the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) to investigate the impact of socioeconomic position during childhood (social class of origin) and of socioeconomic position in young adulthood (social class of entry) and late-midlife (social class of destination) on infirmity in late-midlife (age 60) and late-life (age 80). The results of structural equation modelling showed that poor social class of origin had no direct effect on late-midlife and late-life infirmity, but the overall indirect effect through chains of risks was significant. Thus, late-midlife and late-life health inequalities are the result of complex pathways through different social and material conditions that are unevenly distributed over the life course. Our findings suggest that policies that break the chain of disadvantage may help reduce health inequalities in late-midlife and in late-life.

Why is the gender gap in life expectancy decreasing? The impact of age- and cause-specific mortality in Sweden 1997-2014.

OBJECTIVES: To enhance the understanding of the current increase in life expectancy and decreasing gender gap in life expectancy. METHODS: We obtained data on underlying cause of death from the National Board of Health and Welfare in Sweden for 1997 and 2014 and used Arriaga's method to decompose life expectancy by age group and 24 causes of death. RESULTS: Decreased mortality from ischemic heart disease had the largest impact on the increased life expectancy of both men and women and on the decreased gender gap in life expectancy. Increased mortality from Alzheimer's disease negatively influenced overall life expectancy, but because of higher female mortality, it also served to decrease the gender gap in life expectancy. The impact of other causes of death, particularly smoking-related causes, decreased in men but increased in women, also reducing the gap in life expectancy. CONCLUSIONS: This study shows that a focus on overall changes in life expectancies may hide important differences in age- and cause-specific mortality. It also emphasizes the importance of addressing modifiable lifestyle factors to reduce avoidable mortality.

Smoking and Physical Inactivity as Predictors of Mobility Impairment During Late Life: Exploring Differential Vulnerability Across Education Level in Sweden.

Objectives: To test whether older adults from high and low educational groups are differentially vulnerable to the impact of smoking and physical inactivity on the progression of mobility impairment during old age. Methods: A nationally representative sample of older Swedish adults (n = 1,311), aged 57-76 years at baseline (1991), were followed for up to 23 years (2014). Multilevel regression was used to estimate individual trajectories of mobility impairment over the study period and to test for differences in the progression of mobility impairment on the basis of smoking status, physical activity status, and level of education. Results: Compared to nonsmokers, heavy smokers had higher levels and steeper increases in mobility impairment with advancing age. However, there were only small and statistically nonsignificant differences in the impact of heavy smoking on mobility impairment in high versus low education groups. A similar pattern of results was found for physical inactivity. Discussion: Differential vulnerability to unhealthy behaviors may vary across populations, age, time-periods, and health outcomes. In this study of older adults in Sweden, low and high education groups did not differ significantly in their associations between heavy smoking or physical inactivity, and the progression of mobility impairment.

Who Lives Alone During Old Age? Trends in the Social and Functional Disadvantages of Sweden's Solitary Living Older Adults.

This study identifies specific social and functional disadvantages associated with living alone during old age in Sweden and assesses whether these associations have changed during recent decades. Data came from repeated cross-sectional surveys of Swedish adults aged 77+ during 1992-2014. Findings indicate that several types of disadvantage are consistently associated with the probability of living alone including financial insecurity and having never married for women and having never married and mobility impairment for men. Also for older men, low education has become an increasing strong determinant of living alone. These findings suggest that older adults who live alone are a subgroup that is particularly, and in some cases increasingly, vulnerable with respect to social and functional status. This has important policy implications related to addressing the needs of this growing subgroup as well as methodological implications for studies on the health effects of living alone.

Do socioeconomic inequalities in pain, psychological distress and oral health increase or decrease over the life course? Evidence from Sweden over 43 years of follow-up.

BACKGROUND: Inequalities over the life course may increase due to accumulation of disadvantage or may decrease because ageing can work as a leveller. We report how absolute and relative socioeconomic inequalities in musculoskeletal pain, oral health and psychological distress evolve with ageing. METHODS: Data were combined from two nationally representative Swedish panel studies: the Swedish Level-of-Living Survey and the Swedish Panel Study of Living Conditions of the Oldest Old. Individuals were followed up to 43 years in six waves (1968, 1974, 1981, 1991/1992, 2000/2002, 2010/2011) from five cohorts: 1906-1915 (n=899), 1925-1934 (n=906), 1944-1953 (n=1154), 1957-1966 (n=923) and 1970-1981 (n=1199). The participants were 15-62 years at baseline. Three self-reported outcomes were measured as dichotomous variables: teeth not in good conditions, psychological distress and musculoskeletal pain. The fixed-income groups were: (A) never poor and (B) poor at least once in life. The relationship between ageing and the outcomes was smoothed with locally weighted ordinary least squares, and the relative and absolute gaps were calculated with Poisson regression using generalised estimating equations. RESULTS: All outcomes were associated with ageing, birth cohort, sex and being poor at least once in live. Absolute inequalities increased up to the age of 45-64 years, and then they decreased. Relative inequalities were large already in individuals aged 15-25 years, showing a declining trend over the life course. Selective mortality did not change the results. The socioeconomic gap was larger for current poverty than for being poor at least once in life. CONCLUSION: Inequalities persist into very old age, though they are more salient in midlife for all three outcomes observed.

Mortality by country of birth in the Nordic countries - a systematic review of the literature.

BACKGROUND: Immigration to the Nordic countries has increased in the last decades and foreign-born inhabitants now constitute a considerable part of the region's population. Several studies suggest poorer self-reported health among foreign-born compared to natives, while results on mortality and life expectancy are inconclusive. To date, few studies have summarized knowledge on mortality differentials by country of birth. This article aims to systematically review previous results on all-cause and cause-specific mortality by country of birth in the Nordic countries. METHODS: The methodology was conducted and documented systematically and transparently using a narrative approach. We identified 43 relevant studies out of 6059 potentially relevant studies in August 2016, 35 of which used Swedish data, 8 Danish and 1 Norwegian. RESULTS: Our findings from fully-adjusted models on Swedish data support claims of excess mortality risks in specific categories of foreign-born. Most notably, immigrants from other Nordic countries, especially Finland, experience increased risk of mortality from all causes, and specifically by suicide, breast and gynaecological cancers, and circulatory diseases. Increased risks in people from Central and Eastern Europe can also be found. On the contrary, decreased risks for people with Southern European and Middle Eastern origins are found for all-cause, suicide, and breast and gynaecological cancer mortality. The few Danish studies are more difficult to compare, with conflicting results arising in the analysis. Finally, results from the one Norwegian study suggest significantly decreased mortality risks among foreign-born, to be explored in further research. CONCLUSIONS: With new studies being published on mortality differentials between native and foreign-born populations in the Nordic countries, specific risk patterns have begun to arise. Regardless, data from most Nordic countries remains limited, as does the information on specific causes of death. The literature should be expanded in upcoming years to capture associations between country of birth and mortality more clearly.

Shape of the association between income and mortality: a cohort study of Denmark, Finland, Norway and Sweden in 1995 and 2003.

OBJECTIVES: Prior work has examined the shape of the income-mortality association, but work has not compared gradients between countries. In this study, we focus on changes over time in the shape of income-mortality gradients for 4 Nordic countries during a period of rising income inequality. Context and time differentials in shape imply that the relationship between income and mortality is not fixed. SETTING: Population-based cohort study of Denmark, Finland, Norway and Sweden. PARTICIPANTS: We collected data on individuals aged 25 or more in 1995 (n=12.98 million individuals, 0.84 million deaths) and 2003 (n=13.08 million individuals, 0.90 million deaths). We then examined the household size equivalised disposable income at the baseline year in relation to the rate of mortality in the following 5 years. RESULTS: A steep income gradient in mortality in men and women across all age groups except the oldest old in Denmark, Finland, Norway and Sweden. From the 1990s to 2000s mortality dropped, but generally more so in the upper part of the income distribution than in the lower part. As a consequence, the shape of the income gradient in mortality changed. The shift in the shape of the association was similar in all 4 countries. CONCLUSIONS: A non-linear gradient exists between income and mortality in most cases and because of a more rapid mortality decline among those with high income the income gradient has become steeper over time.

Work-related stress in midlife and all-cause mortality: can sense of coherence modify this association?

BACKGROUND: Survival reflects the accumulation of multiple influences experienced over the life course. Given the amount of time usually spent at work, the influence of work may be particularly important. We examined the association between work-related stress in midlife and subsequent mortality, investigating whether sense of coherence modified the association. METHODS: Self-reported work-related stress was assessed in 1393 Swedish workers aged 42-65 who participated in the nationally representative Level of Living Survey in 1991. An established psychosocial job exposure matrix was applied to measure occupation-based stress. Sense of coherence was measured as meaningfulness, manageability and comprehensibility. Mortality data were collected from the Swedish National Cause of Death Register. Data were analyzed with hazard regression with Gompertz distributed baseline intensity. RESULTS: After adjustment for socioeconomic position, occupation-based high job strain was associated with higher mortality in the presence of a weak sense of coherence (HR, 3.15; 1.62-6.13), a result that was stronger in women (HR, 4.48; 1.64-12.26) than in men (HR, 2.90; 1.12-7.49). Self-reported passive jobs were associated with higher mortality in the presence of a weak sense of coherence in men (HR, 2.76; 1.16-6.59). The link between work stress and mortality was not significant in the presence of a strong sense of coherence, indicating that a strong sense of coherence buffered the negative effects of work-related stress on mortality. CONCLUSIONS: Modifications to work environments that reduce work-related stress may contribute to better health and longer lives, especially in combination with promoting a sense of coherence among workers.

Trends in health expectancies among the oldest old in Sweden, 1992-2011.

BACKGROUND: Information on the extent to which older people's increasing life expectancy is characterized by good or poor health is important for policy and fiscal planning. This study explores trends in health expectancies among the oldest old in Sweden from 1992 to 2011. METHODS: Cross-sectional health expectancy estimates at age 77 were obtained for 1992, 2002, 2004 and 2011 by Sullivan's method. Health expectancy was assessed by severe disability, mild disability and mobility problems. Changes in health expectancies were decomposed into the contributions attributed to changes of mortality rates, and changes in disability and mobility prevalence. Mortality data were obtained from Statistics Sweden and prevalence data from two nationally representative surveys, the Swedish Panel Study of Living Conditions of the Oldest Old and the Survey of Health, Ageing and Retirement in Europe. RESULTS: Years free from severe disability, mild disability and mobility problems increased in both men and women. Decomposition analysis indicates that the increase was mainly driven by the change in health status rather than change in mortality. In relation to total life expectancy, the general patterns suggest that women had a compression of health problems and men an expansion. CONCLUSION: Men's life expectancy increased more than women's; however, the increased life expectancy among men was mainly characterized by disability and mobility problems. The results suggest that the gender gap in health expectancy is decreasing.