Sensory impairments and depressive symptoms in Europe: a cross-national cohort study.

OBJECTIVES: To investigate the associations between sensory impairments and the development of depressive symptoms across sex, age, and European regions, and to examine the mediating role of cognitive function, activities of daily living (ADL), and physical activity. METHOD: A cohort study including 56,847 Europeans aged 50+ participating in at least two waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). Associations were analyzed using mixed effects logistic regression models considering several confounders. RESULTS: Overall, 17.8% developed depressive symptoms. Compared to participants with good vision and hearing, those with vision impairment (VI) (odds ratio (OR) = 1.35, 95% confidence interval (CI) 1.27-1.44), hearing impairment (HI) OR = 1.32, 95% CI 1.21-1.43, and dual sensory impairment (DSI, i.e. VI and HI) (OR = 1.93, 95% CI 1.75-2.13) had increased odds of depressive symptoms. The associations were consistent across sex and European regions but became stronger with advancing age among men. Dose-response relationships were found for all associations. Mediation analyses revealed that preventing cognitive decline, ADL limitations, and physical inactivity would eliminate 15.0%, 11.5%, and 21.4% of the total effect for VI, HI, and DSI, respectively. CONCLUSION: Our findings emphasize the importance of preventing sensory impairments to avoid depressive symptoms.

Salutogenic health measures: Psychometric properties of the Danish versions of the Flourish Index and the Secure Flourish Index.

Measurement of human flourishing represents a salutogenic approach to epidemiological and behavioral research emphasizing factors contributing to "good lives" rather than pathology. The objective of this study was to translate and psychometrically test the 10-item Flourish Index (FI) and 12-item Secure Flourish Index (SFI) in a convenience sample of Danish adults. A total of 325 participants completed a cross-sectional survey, with 148 of those participants completing the survey a second time (retest). Confirmatory factor analysis in a structural equation modelling framework was used to establish structural validity by comparing four different pre-specified models of the indexes. Additionally, internal consistency, convergent and incremental validity, and retest reliability were examined. The FI models exhibited superior structural validity compared with similar models of the SFI, although all models had good fits. Internal consistencies with McDonald's omega were 0.89 and 0.87 for the FI and SFI, respectively. The five (FI) or six (SFI) domains were happiness & life satisfaction, mental & physical health, meaning & purpose, character & virtue, close social relationships, and financial & material stability (λ4 = 0.51-0.91). Convergent and incremental validity tests supported predefined hypotheses. Retest analyses with the FI and SFI showed a high degree of retest reliability. Based on the psychometric evidence reported in this study, the Danish Flourish Index and Secure Flourish Index seem suitable for use with healthy adult Danes. The authors hope that this psychometric evaluation of the FI and SFI will stimulate research on patterns, health and economic outcomes, and predictors of human flourishing in Denmark.

Barriers for continuous medical education: cross-sectional questionnaire study among danish general practitioners.

BACKGROUND: General practitioners' (GPs') participation in continuous medical education (CME) is essential for patientcare, wellbeing of the GPs, and healthcare expenditures. A quarter of the Danish GPs did not use their reimbursement for CME in 2022. Knowledge of barriers for participating in CME is limited. AIM: To analyse GPs' barriers for participation in CME and patterns in perceived barriers. DESIGN & SETTING: The study population comprised all 3257 GPs in Denmark, who in May 2023 were registered as entitled to reimbursement for CME. METHOD: The response rate was 1303/3257 (40%). Based on a question about use of CME, the respondents were divided into frequent, partial, and seldom users. Partial and seldom users answered questions about barriers related to CME (n=726). The presence of barriers was quantified, and a Latent class analysis (LCA) was used to stratify GPs according to their barrier patterns. RESULTS: Most frequent barriers were: Too busy (68%), fully booked courses (47%), and no substitute (41%). Based on the LCA, we found three distinctive patterns, clustering around: GPs from clinics with no tradition for CME (17%), GPs who used time on professional work outside clinic (teaching, organisational work) (43%), and GPs who were personally or professionally affected (40%). Singled-handed and male GPs were slightly overrepresented among seldom-users. CONCLUSIONS: We have identified barriers for CME. We found three different profiles of GPs who perceived different patterns of barriers. Identified patters in barriers should be considered in future CME initiatives.

Assessment of quality of life for frail, elderly patients post-ICU discharge: a protocol for a scoping review.

INTRODUCTION: Rises in average life expectancy, increased comorbidities and frailty among older patients lead to higher admission rates to intensive care units (ICU). During an ICU stay, loss of physical and cognitive functions may occur, causing prolonged rehabilitation. Some functions may be lost permanently, affecting quality of life (QoL). There is a lack of understanding regarding how many variables are relevant to health-related outcomes and which outcomes are significant for the QoL of frail, elderly patients following discharge from the ICU. Therefore, this scoping review aims to identify reported variables for health-related outcomes and explore perspectives regarding QoL for this patient group. METHODS AND ANALYSIS: The Joanna Briggs Institute guidelines for scoping reviews will be employed and original, peer-reviewed studies in English and Scandinavian languages published from 2013 to 2023 will be included. The search will be conducted from July 2023 to December 2023, according to the inclusion criteria in Embase, MEDLINE, PsycINFO and CINAHL. References to identified studies will be hand-searched, along with backward and forward citation searching for systematic reviews. A librarian will support and qualify the search strategy. Two reviewers will independently screen eligible studies and perform data extraction according to predefined headings. In the event of disagreements, a third reviewer will adjudicate until consensus is achieved. Results will be presented narratively and in table form and discussed in relation to relevant literature. ETHICS AND DISSEMINATION: Ethical approval is unnecessary, as the review synthesises existing research. The results will be disseminated through a peer-reviewed publication in a scientific journal.

Sex differences in vision and hearing impairments across age and European regions : Findings from SHARE.

AIM: Although sensory impairments are common conditions among older people, research often fails to consider the role of sex. We examined sex differences in vision impairment and hearing impairment across age and European regions. METHODS: We conducted a cross-sectional study based on a pooled sample of 65,656 females and 54,881 males aged 50 years and older participating in the Survey of Health, Ageing and Retirement in Europe (SHARE) from 2004-2020. Logistic regression models with robust standard errors providing odds ratios (OR) and 95% confidence intervals (CI) were used to examine associations. RESULTS: European females had generally higher odds of vision impairment (OR 1.16, 95% CI 1.12-1.21) but lower odds of hearing impairment than European males (OR 0.70, 95% CI 0.67-0.73). The female disadvantage in vision increased with advancing age, whereas the female advantage in hearing decreased. No overall sex difference in vision was found in northern Europe, but females had more vision impairments than males in southern (OR 1.23, 95% CI 1.14-1.32), western (OR 1.14, 95% CI 1.08-1.21) and eastern (OR 1.10, 95% CI 1.02-1.20) Europe. Females were healthier than males in terms of hearing in all regions, with the largest female advantage in northern Europe (OR 0.58, 95% CI 0.53-0.64). CONCLUSION: Our findings demonstrate an overall consistent pattern of sex differences in sensory impairments across Europe showing an increasing female disadvantage in vision and a decreasing female advantage in hearing with advancing age.

Cognitive function among religious and non-religious Europeans: a cross-national cohort study.

OBJECTIVES: To examine the associations between several measures and categories of religiosity and cognitive function across sex and European regions. METHODS: We conducted a longitudinal study including 17,756 Europeans aged 50 and older who participated in the Survey of Health, Ageing and Retirement in Europe wave 1. Participants were followed for up to 15 years. Associations were analyzed using linear mixed effects models adjusted for several potential confounders. RESULTS: Religious service attendance was consistently associated with better cognitive function (coefficient: 1.04, 95% CI 0.71; 1.37) across sex and European regions. Praying was also associated with better cognitive function but only among men (coefficient: 0.55, 95% CI 0.15; 0.96). However, individuals who received religious education from their parents had poorer cognitive function (coefficient: -0.59, 95% CI -0.93; -0.25). The association persisted in women and among both sexes in Western Europe. Comparing different religious categories to the non-religious, participants who were religious in childhood showed an inverse association with cognitive function, while persistently religious men exhibited better cognitive function. CONCLUSIONS: Our findings indicate that religious service attendance and, to a certain extent, prayer is associated with better cognitive function. However, receiving religious education in childhood may be linked to lower cognitive function.

The role of modifiable risk factors in incident cancer in transport, rescue, and security industries.

PURPOSE: Examine the risk for site-specific incident cancer across representative transport, rescue, and security industries. METHODS: This Danish nationwide register-based study included all 302,789 workers from transport, rescue and security industries in 2001-2015 and 2,230,877 individuals aged 18-64 years from a total sample of the economically active population for comparison. We used Cox models to estimate the hazard ratios (HRs) of incident cancers. We categorized site-specific cancers by using population-attributable fraction (PAF) estimates from the previous literature. RESULTS: During an average follow-up of 13.4 years, 22,116 incident cancer cases were recorded in these industries. Compared with the reference population, the age-adjusted cancer incidence with a high PAF was higher among men in seafaring (HR 1.28; 95% CI 1.14-1.43), and land transport (HR 1.32; 95% CI: 1.26-1.37), and among women in seafaring (HR 1.26; 95% CI: 1.01-1.57), land transport (HR 1.21; 95% CI: 1.12-1.32), aviation (HR 1.22; 95% CI: 1.05-1.41), and police force (HR 1.21; 95% CI: 1.04-1.40). Overall, tobacco and physical inactivity were the most significant risk factors of cancer. CONCLUSIONS: Regardless of considerable disparities in incident cancer attributable to modifiable risk factors across industries, the total incident cancer rate was elevated in all industries in both sexes.

Effect of religious service attendance on mortality and hospitalisations among Danish men and women: longitudinal findings from REGLINK-SHAREDK.

Research suggests a protective effect of religious service attendance on various health outcomes. However, most research has been done in religious societies, raising the question of whether these associations are also prominent in secular cultures. Here we examine mortality and hospitalisations by religious service attendance among men and women in a secular society. We performed a cohort study including 2987 Danes aged 40+ interviewed in SHARE from 2004 to 2007 and followed up in the Danish registries until 2018. We used Cox regressions and negative binomial regressions to examine associations, including interactions with sex and adjusting for age, wave, socioeconomic factors, lifestyle factors, body mass index, and history of diseases. Overall, 5.0% of men and 6.6% of women reported that they had taken part in a religious organisation within the last month. Among 848 deaths, we found lower mortality for people who attended religious services (hazard ratio (HR) 0.70; 95% CI 0.50-0.99). There was evidence for an association among women (HR 0.56; 95% CI 0.35-0.89), but not among men (HR 0.95; 95% CI 0.59-1.53). In contrast, regarding hospital admissions (n = 12,010), we found lower hospitalisation rates among men who attended religious services (incidence rate ratio (IRR) 0.67; 95% CI 0.45-0.98), whereas no association was found among women (IRR 0.95; 95% CI 0.70-1.29). Sensitivity analyses with E-values were moderately robust. Our results contribute to the limited literature on possible health benefits of religious service attendance in secular societies, demonstrating lower mortality among women and fewer hospitalisations among men.

Sex differences in quality of life and depressive symptoms among middle-aged and elderly Europeans: results from the SHARE survey.

OBJECTIVES: We examine sex differences in quality of life (QoL) and depressive symptoms across age and European regions. METHODS: We performed a large cross-sectional study based on 64,552 women and 53,647 men aged 50+ who participated in the Survey of Health, Ageing and Retirement in Europe (SHARE) from 2004-2020. Linear and logistic regression models were used to examine associations with QoL (CASP-12) and depressive symptoms (EURO-D). RESULTS: Women reported slightly lower QoL (coefficient -0.78, 95% CI -0.92; -0.65) and more depressive symptoms (odds ratio (OR) 2.23, 95% CI 2.13; 2.34) than men. Sex differences in QoL increased with advancing age, whereas sex differences in depressive symptoms were stable across age groups. No overall sex difference in QoL was found in Northern Europe, but women had lower QoL than men in Western (coefficient -0.49, 95% CI -0.69; -0.29), Southern (coefficient -1.35, 95% CI -1.61; -1.09) and Eastern (coefficient -0.72, 95% CI -1.05; -0.39) Europe. However, sex differences varied within the specific CASP-12 items, with women having overall lower control and autonomy, but more self-realisation, than men. Women reported more depressive symptoms than men in all regions, with the largest overall sex difference in Southern Europe (OR 2.62, 95% CI 2.40; 2.86). A female disadvantage was found for most of the EURO-D items, with the largest sex differences for 'tearfulness', 'depression' and 'sleep'. CONCLUSION: Middle-aged and elderly European women report lower QoL and more depressive symptoms than European men, lending support for the male-female health survival paradox.

Prayer frequency and COVID-19 vaccine hesitancy among older adults in Europe.

AIM: Differences in levels of vaccine uptake have emerged across Europe, and this may partly be explained by religious beliefs. Our aim is to study the association between religiosity, measured by prayer frequency, and vaccine hesitancy, and to examine how this association varies across European countries and regions. METHODS: This study was based on 42,583 adults aged 50 years and above from 27 European countries in the Survey of Health, Ageing and Retirement in Europe (SHARE), waves 1-8, and the 2nd SHARE COVID-19 Survey. Logistic regression models were used to investigate the associations. RESULTS: Participants were more likely to be vaccine-hesitant when praying 'weekly or less' (odds ratio (OR) 1.32 95 % confidence interval (CI) 1.23-1.42) or daily (OR 1.78 95 % CI 1.65-1.92). Praying 'weekly or less' was associated with increased vaccine hesitancy in Southern Europe (OR 1.48 95 % CI 1.17-1.87) and Central and Eastern (OR 1.35 95 % CI 1.24-1.47) Europe, while daily praying was associated with vaccine hesitancy in Western (OR 1.77 95 % CI 1.51-2.08), Southern (OR 1.30 95 % CI 1.03-1.64), Central and Eastern (OR 1.89 95 % CI 1.73-2.06) and Northern (OR 2.75 95 % CI 1.54-4.89) Europe. CONCLUSIONS: These findings provide support for an association between daily prayer frequency and COVID-19 vaccine hesitancy, with a consistent pattern across European regions.

Modifiable risk factors and cancer mortality in transport, rescue, and security industries.

PURPOSE: We investigated the risk of mortality from cancers attributable to modifiable risk factors across representative transport, rescue, and security industries. METHODS: We used nationwide Danish registries to identify all 307,605 workers from these industries from 2001 through 2015 and 2,278,363 other economically active individuals aged 18-64 years at the baseline for comparison. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) for site-specific cancer deaths were calculated using Cox regression. Site-specific cancers were categorized by using population-attributable fraction (PAF) estimates derived from the previous literature. RESULTS: During an average follow-up of 12.8 years, 5977 cancer deaths were registered in these industries. Cancer mortality with a high proportion of avoidable deaths (i.e., high PAF) was elevated in male seafarers (1.37; 1.16-1.62), in men of land transport (1.44; 1.35-1.52), in women of land transport (1.51; 1.29-1.77), and in women of defense forces (1.43; 1.13-1.81). In contrast, cancer mortality with a high PAF was reduced in men of police force (0.63; 0.51-0.78). The total cancer mortality was higher in seafarers (1.24; 1.12-1.37), workers in land transport (1.31; 1.27-1.36), and workers in defense forces (1.14; 1.07-1.22). CONCLUSIONS: We observed considerable cancer mortality disparities associated with modifiable risk factors across transport, rescue, and security industries.

Cancer-Related Reductions in Survival: Extent and Duration Evaluated Using a Large Cohort Study of Twins, 1943-2011.

BACKGROUND: The time during which there is an increased risk of death for cancer survivors was evaluated in a large twin study, which allows for matching on shared components such as age, genes, and socioeconomic factors in childhood. METHODS: By use of data from Danish registers, time to death from initial cancer was studied prospectively in twins in two different settings. The twins were diagnosed with at least one cancer in the period 1943 to 2011. Setting I included 5,680 same-sex twin pairs aged 6 and over, while Setting II included 3,218 twin individuals from age 70 and over. The study provides comparisons within twin pairs and across birth cohorts, age at diagnoses, and time at diagnosis. RESULTS: In 2001 to 2011, the 5-year mortality risk for a twin surviving cancer after the age of 70 was twofold that of the co-twin, regardless of sex and zygosity, and it was 1.5-fold if the twin survived the initial 9 months. After 5 to 6 years, the mortality risk corresponded to that of the co-twin. In previous decades, the excess hazard risk was considerably higher for both older and younger cohorts. There were no indications of change in relative survival across old birth cohorts. CONCLUSIONS: This large twin study suggested that for a cancer-treatment survivor diagnosed at age 70 or later, the additional mortality risk was largely absent 5 years later, by which time the survival relative to the co-twin was 60%. IMPACT: Elevated mortality risk after cancer is offset after 5 to 6 years.

Longitudinal changes in mental health following the COVID-19 lockdown: Results from the Survey of Health, Ageing, and Retirement in Europe.

BACKGROUND: To limit the spread of the coronavirus disease 2019 (COVID-19) pandemic, different restriction measures were implemented aiming to ensure social distancing and isolation. However, it is well known that such measures may lead to adverse effects on mental health. METHODS: Data from 36,478 adults aged 50+ from the Survey of Health, Ageing and Retirement in Europe was used to investigate the longitudinal changes in mental health from pre-COVID-19 to during the pandemic (summer 2020), considering national restriction levels across 26 European countries and Israel. Multilevel logistic regression models were used to assess changes in feeling 'sad or depressed', sleeping problems, and loneliness. RESULTS: Compared with the mental health status before the COVID-19 outbreak, participants had a lower risk of feeling "sad or depressed" (-14.4%) and having sleeping problems (-9.9%), while the risk of feeling lonely slightly increased (1.2%). However, for individuals in countries with high restriction levels, the risk of feeling "sad or depressed" was attenuated and the risk of loneliness was greater compared to countries with low restriction levels. CONCLUSION: Older people felt less depressed and had fewer sleeping problems during the pandemic as compared to before the pandemic, while the risk of loneliness increased slightly. Stricter policy measures attenuated the otherwise positive impact on mental health. Future studies are needed to investigate the long-term effects of COVID-19 on mental health.

Development in life expectancy with good and poor cognitive function in the elderly European Population from 2004-05 to 2015.

BACKGROUND: Living not just longer, but also cognitively healthier, and more independent lives is essential if European countries are to cope with the financial challenges that the shifting age composition of Europe's population presents. Here we investigate the change in life expectancy (LE) spent with good and poor cognitive function among older adults across Europe. METHODS: LE with good/poor cognitive function was estimated by the Sullivan Method. Cross-sectional data on cognitive functioning was obtained from 23,213 (wave 1, 2004-05) and 40,874 (wave 6, 2015) 50+-year-olds of the Survey of Health, Ageing and Retirement in Europe (SHARE). Information on mortality was obtained from the Eurostat Database. Results for 70+-year-olds were emphasized. RESULTS: LE with good cognitive function increased with 1.6 years from 10.7 years (95% CI: 10.6-10.9) in 2004-05 to 12.4 years (95% CI: 12.3-12.5) in 2015 for 70+-year-olds. Disparity was observed across sex and region. In 2004-05, a 70+-year-old woman could expect to spend 30.9% (95% CI: 29.4-32.4) of her remaining LE with poor cognitive function compared to 27.7% (95% CI: 26.0 -29.4) for men. In 2015, women (24.4% (95% CI: 23.4-25.3)) had considerably caught up with men (24.8% (95% CI:23.7.25.8)), shifting the pattern in favor of women. In 2004-05 and 2015, Northern Europeans had the lowest LE with poor cognitive function while Southern Europeans had the highest, but made the most improvement during the period. CONCLUSIONS: Overall we find that LE with poor cognitive function has been compressed in the European population of 70+-year-olds.

Spousal order of migration, gender, and hospitalization among immigrants in Denmark.

Background: Certain migration contexts that may help clarify immigrants' health needs are understudied, including the order in which married individuals migrate. Research shows that men, who are healthier than women across most populations, often migrate to a host country before women. Using Danish register data, we investigate descriptive patterns in the order that married men and women arrive in Denmark, as well as whether migration order is related to overnight hospitalizations. Methods: The study base includes married immigrants who lived in Denmark between January 1, 1980 and December 31, 2014 (N = 13,680). We use event history models to examine the influence of spousal migration order on hospitalizations. Results: The order that married individuals arrive in Denmark is indeed highly gendered, with men tending to arrive first, and varies by country of origin. Risk of hospitalization after age 50 does not depend on whether an individual migrated before, after, or at the same time as their spouse among either men or women. However, among those aged 18+, men migrating before their wives are more likely to experience hospitalizations within the first 5 years of arrival. Conclusions: These findings provide the first key insights about gendered migration patterns in Denmark. Although spousal order of migration is not related to overnight hospitalization among women, our findings provide preliminary evidence that men age 18+ who are first to arrive experience more hospitalization events in the following 5 years. Future research should explore additional outcomes and whether other gendered migration contexts are related to immigrants' health.

Is Religiousness Associated with Better Lifestyle and Health Among Danes? Findings from SHARE.

Evidence of a possible association between religion and health in secular societies is sparse. We therefore conducted a nationwide study using data from 1596 Danes aged 50 + who participated in the Survey of Health, Ageing and Retirement in Europe (SHARE) wave 1 (2004-2005) and were followed up between 2006 and 2015, to investigate the association between religiousness and health including a lifestyle index. Results from the longitudinal models adjusted for age and gender showed that being religiously educated by parents, taking part in a religious organization, and praying were factors associated with fewer risk factors of unhealthy lifestyle. Furthermore, being religiously educated was associated with lower odds of self-rated poor health and depressive symptoms. Results were overall consistent across the cross-sectional and longitudinal models and persisted after further adjustment for education and marital status. These findings provide support for a positive relationship between religiousness and health among Danes, particularly for those being religiously educated by their parents.

Risk of major chronic diseases in transport, rescue and security industries: a longitudinal register-based study.

OBJECTIVE: To investigate the risk of hospitalisation for major chronic diseases across representative transport, rescue and security industries. METHODS: We performed a register-based study of 624 571 workers from six industries in Denmark between 2000 and 2005, followed up hospitalisation for chronic diseases up to 17 years, and compared with a 20% random sample of the economically active population. RESULTS: HR from the Cox regression models showed that seafarers had higher risk of lung cancer (men: 1.54, 95% CI 1.31 to 1.81; women: 1.63, 95% CI 1.13 to 2.36), and male seafarers had higher risk of diabetes (1.32, 95% CI 1.21 to 1.43) and oral cancer (1.51, 95% CI 1.21 to 1.88). Men and women in land transport had increased risk of diabetes (men: 1.68, 95% CI 1.63 to 1.73; women 1.55, 95% CI 1.40 to 1.71) and chronic respiratory disease (men: 1.21, 95% CI 1.16 to 1.25; women 1.42, 95% CI 1.32 to 1.53). Among women, a higher risk of gastrointestinal cancer was observed in aviation (1.53, 95% CI 1.23 to 1.89) and police force (1.29, 95% CI 1.01 to 1.65), oral cancer in defence forces (1.83, 95% CI 1.20 to 2.79), and chronic respiratory disease in rescue service (1.47, 95% CI 1.21 to 1.77), while men in defence forces, police force and rescue service had mainly lower risk of these chronic diseases. CONCLUSIONS: We observed considerable health disparities from chronic diseases across transport, rescue and security industries, with workers in seafaring and land transport generally bearing the greatest relative burden.

Burden and prevalence of risk factors for severe COVID-19 in the ageing European population - a SHARE-based analysis.

Aim: International health authorities suggest that individuals aged 65 years and above and people with underlying comorbidities such as hypertension, chronic lung disease, cardiovascular disease, cancer, diabetes, and obesity are at increased risk of severe Coronavirus Disease 2019 (COVID-19); however, the prevalence of risk factors is unknown in many countries. Therefore, we aimed to describe the distribution of these risk factors across Europe. Subject and methods: Prevalence of risk factors for severe COVID-19 was identified based on interviews from 73,274 Europeans aged 50+ participating in the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2017. Burden of disease was estimated using population data from Eurostat. Results: A total of 75.3% of the study population (corresponding to approx. 60 million European men and 71 million women) had at least one risk factor for severe COVID-19, 45.9% (approx. 36 million men and 43 million women) had at least two factors, and 21.2% (approx. 17 million men and 20 million women) had at least three risk factors. The prevalence of underlying medical conditions ranged from 4.5% for cancer to 41.4% for hypertension, and the region-specific prevalence of having at least three risk factors ranged from 18.9% in Northern Europe to 24.6% in Eastern Europe. Conclusions: Information about the prevalence of risk factors might help authorities to identify the most vulnerable subpopulations with multiple risk factors of severe COVID-19 and thus to decide appropriate strategies to mitigate the pandemic. Supplementary Information: The online version contains supplementary material available at 10.1007/s10389-021-01537-7.

Sex differences in activity and health changes following COVID-19 in Europe-results from the SHARE COVID-19 survey.

While a female advantage in the overall survival from the coronavirus disease 2019 (COVID-19) has been demonstrated, potential sex differences in health changes are not investigated. In a sample of 21 395 men and 29 139 women aged 50+ from the SHARE COVID-19 survey, we investigated sex differences in social activities, self-rated health and mental health following the COVID-19 outbreak. We found considerable sex differences in all European regions with women experiencing larger negative changes across all social activities and health measures than men lending support for the male-female health-survival paradox.

The Reciprocal Relationship between Socioeconomic Status and Health and the Influence of Sex: A European SHARE-Analysis Based on Structural Equation Modeling.

It is well recognized that socioeconomic status (SES) is an important determinant of health, but many studies fail to address the possibility of reverse causation. We aim to investigate the reciprocal relationship between trajectories of SES and health, and how these associations differ by sex. We performed a longitudinal study including 29,824 men and 37,263 women aged 50+ participating in at least two consecutive waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). Using structural equation modeling, we found that baseline household income and wealth led to improvements in cognitive function, grip strength, quality of life and depressive symptoms, and a better initial health led to higher income and wealth for both sexes. However, the results indicated that the relative effect of cognitive function and grip strength on SES trajectories was overall greater than the corresponding effect of SES on health changes, particularly regarding income among women, but for quality of life and depressive symptoms, the reverse was indicated, though most pronounced for the associations with wealth. The reciprocal associations between SES and physical function were stronger for men than for women, whereas most associations with cognitive function and mental health were similar between sexes. This study demonstrates that both social causation and health selection contribute to social inequalities in health, but the influence of each direction and the importance of sex differences may vary according to the health outcomes investigated.