Abstract

The aim: To determine gender differences in the dynamics of attitudes towards the cardiovascular prevention in an open population of 25-64 years over a long-term period - 29 years in Russia / Siberia (Novosibirsk).

Methods: Within the framework of the screening in 1988-89 under the WHO MONICA-psychosocial (MOPSY) program (n=1676, 49.5% males, mean age 44.1±0.4 years), MOPSY screening in 1994-95 (n=1527, 43% males, mean age 44.85 ± 0.4 years), in 2003-2005 under the international project HAPIEE (n=1650, 34,9% males, mean age 54,25±0,2 years), in 2013-2016 (n=975, 43,8% males, mean age 34,5±0,4 years) and 2016-2017 гг.( n=663, 41,3% years 51,95±0,32 years) within the framework of the budgetary theme No. АААА-А17-117112850280-2, random representative samples of men and women in one of districts in Novosibirsk were examined. Attitude towards preventive methods and health care utilization were assessed using the questionnaire "Knowledge and attitude towards own's health".

Results: About 100% male and female population aged of 25-64 years considered it probable "to develop a serious illness within the next 5-10 years" in 1988. This proportion has not changed significantly by 2017. In 1988, men more often than women certainly believed that they would avoid serious illness if they took action on their own health. In subsequent years of observation these sex differences in responses were erased. Belief in the power of medicine to prevent all or most of the heart disease was present among young men in 2013 and 2017. In comparison with them, women are more balanced about the preventive possibilities of medicine.

Despite the fact that 100% of men and women in the open population 25-64 years find "preventive health screening" useful, only 6.8% of males and 3% of females were regularly checked by a doctor in 1988. In 2016-2017, the frequency of regular health checks exceeded the 10% in middle-aged groups.

An equal proportion of men and women - 67% sought medical help only in case of chest pain, and 11-12% would not go to a doctor even with intense pain; by 2017, their share had decreased to 6.5%.

Conclusions: Among those who consider it likely to have a serious illness, only one of ten is regularly checked by a doctor. At the same time, men are more likely than women to shift responsibility for their health to the preventive capabilities of medicine.

Keywords: awareness, cardiovascular prevention, sex differences, population, healthcare utilization

Keywords: awareness, cardiovascular prevention, sex differences, population, healthcare utilization

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Introduction

Gender differences in prevention are due to many factors. For example, in the way men and women perceive and report their diseases and symptoms. There may be misperceptions of health risks and misperceptions about the benefits of certain medical procedures, unconscious and cultural biases. Gender bias in medicine also leads to gender inequalities in access to and use of health services. A number of diseases, for example, depression, is considered as a diagnosis associated with the female sex [1]; thus, health care providers may not consider depression when assessing males. This can lead to differences in health care utilization by men and women. Differences in the use of preventive measures and the use of care can arise due to the fact that men neglect their health and do not seek medical help until their health condition worsens [2]. Because men seek medical attention at a later stage, their treatment is more expensive. But the study of self-rated health in a number of countries shows that health deteriorates more with age in women compared with men [3].

Gender differences in the use of health care can be explained by the fact that women tend to experience life-threatening diseases somewhat later than men [2]. And, probably, this is associated with an underestimation of their risk compared to men and a delay in seeking consultation at the clinic, for example, in the case of myocardial infarction [4]. However, most of studies indicate a 30% difference in the frequency of seeking medical help / consultation. The largest gender gap in primary care is observed among people of working age 18-60 years old. And among those who receive drug therapy gender differences in accessibility are minimal [5]. But we should not ignore the fact that men do not experience such dramatic changes as women do during menopause [2]. More frequent contacts of women with health services can contribute to the emergence of gender differences, as they are more informed and aware of the diagnoses and symptoms made by the doctor [3]. Our research complements these prior scientific reports. Evaluating a large number of people from the general population participating in screening over the years but with a common design, increases the generalizability and relevance required for epidemiological protocols based on research principles. Thus, the aim of our study was to study gender differences in the dynamics of attitudes towards cardiovascular prevention in population aged of 25-64 years over a long-term period - 29 years.

Methods

The results of our study were obtained on the basis of a survey of the male and female population living in one of the districts of Novosibirsk. The examinations were carried out within the framework of screenings 1988-89, 1994-95, 2003-2005, 2013-2016 and 2016-2017.

Under the II screening of the WHO program «Multinational Monitoring of Trends and Determinants of Cardiovascular Disease - Optional Psychosocial Sybstudy» (MONICA-MOPSY) representative sample of residents aged 25–64 years was examined in 1988-1989 (n=1676, 49.5% males, mean age 44.1±0.4 years, response rate - 69.8%) [6]. in frame of MOPSY screening in 1994-1995 representative sample of residents aged 25–64 years was examined (n=1527, 43% males, mean age − 44.85±0.4 years, response rate – 77.3%).

In the course of another international project HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) persons aged 45-64 were examined in 2003-2005 (n=1650, 34.9% males, mean age 54.25±0.2 years, response rate – 66.5%) [7]. In the framework of the screening studies a random representative sample survey of the population aged 25-44 years conducted in 2013-2016 by the budget scientific research theme, Gov.Task № 01201282292 (n=975, 43.8% males, mean age 34.5±0.4 years, response rate – 71.5%). Within the framework of the budget theme No. AAAA-A17-117112850280- survey of persons aged 35-64 was carried out in 2016-2017 (n=663, 41.3% males, mean age 51.95±0.32 years, response rate – 73.6%). The study included residents of the same district of Novosibirsk as in 1994-95, 2003-2005 and 2013-2016. All samples were formed on the basis of electoral lists of citizens using a table of random numbers. A random mechanical selection procedure was used. The general survey was carried out according to the standard methods accepted in epidemiology and included in the MONICA program [6]. The methods were strictly standardized and complied with the requirements of the MONICA project protocol. Validation and processing of material according to the WHO MONICA-psychosocial program was carried out at the Information Collection Center of the MEDIS Institute in Munich, Germany (Institut für Medizinische Informatik und Systemforschung). Quality control was carried out in MONICA quality control centers: Dundee (Scotland), Prague (Czech Republic), Budapest (Hungary). The presented results were considered satisfactory. The screening survey program included registration of socio-demographic data according to the standard epidemiological protocol of the WHO MONICA-psychosocial program: identification number, place of residence, full name, date of birth, date of registration, gender, marital status, educational level, professional status. Indicators of awareness about own health and methods of cardiovascular prevention, medical care utilization were studied using the “Knowledge and Attitude to Own’s Health” scale proposed by the MOPSY protocol and adapted to the studied population [8]. The subjects were asked to answer the questions of the scale themselves according to the instructions placed on the scale. Individuals who did not complete the questionnaire were not included in the analysis. Statistical analysis was performed using the SPSS software package version 11.5. The study participants were standardized by age groups in the analysis. To compare the indicators between screenings, the corresponding age groups were used. To check the statistical significance of differences between groups, we used: the chi-square test (χ2). As a criterion of statistical significance the value of the chi-square was taken into account at a certain number of degrees of freedom. The reliability of analysis was accepted at a significance level of p<0.05.

Results

To the question: "Do you think that a healthy person of your age can get sick with a serious illness within the next 5-10 years?" almost 100% of males and females aged 25-64 answered “highly possible” and “possible” in 1988. The proportion of people who considered the possibility of getting sick «highly possible» was higher among women (34.3% and 39% for men and women; p = 0.067). This gender difference was stronger in the youngest group of 25-34 years (28.4% and 35.9%, respectively; p = 0.057) and the middle-age group 45-54 years old (37.9% and 44.3%; ns), although was not statistically significant. The proportion of those convinced that "a person of their age will get sick in the next 5-10 years" increased with age among both sexes. The proportion of older participants who noted a high likelihood of "getting sick within the next 5-10 years" was higher among men than women in 2003; these differences were statistically significant in the 55-64 age group (p <0.05). The same trend persisted in 2016-17: 43% and 30.1% for men and women aged of 55-64 years (p <0.05). In the younger age groups, there was a certain parity in opinions with the exception of 2013-2017 when women aged of 35-44 years noted a high probability of getting sick more often than men.

In 1988, men were more categorical in their statements to the question: "Is a healthy person of your age able to avoid serious diseases if he takes actions in advance?". They answered "yes, definitely": 52.8% and 43.8% for men and women aged of 25-64 years (p <0.01). In subsequent years of observation, these sex differences in responses were erased. But in 2013 and 2017, the frequency of categorical answers “yes, it is certainly possible to avoid diseases” increased, especially in younger age groups, approaching 60-70% without significant gender differences.Gender differences in the structure of opinions were found when answering the question: "Is modern medicine capable to prevent heart disease?" In 1988, the proportion of women was higher among the answers “it depends on the disease”: 51.4% and 58.6% for men and women aged of 25-64 years (p <0.05). The belief in the ability of medicine to prevent heart disease was higher among the male population, especially in the younger age group: 33.3% and 24.7% for men and women aged of 25-34 years (combined answers are “yes, all heart diseases”, “yes, most of diseases "; p <0.001). In the dynamics, there was an increase in such beliefs among the population. Two-thirds of men and 50% of women aged of 25-34y and 35-44y believed that medicine could prevent “all or most of the heart diseases” in 2013 and 2017. At the same time, there was a decrease in opinions about the ability of medicine to prevent "only some diseases" or "none" in these age groups; the frequency of such responses did not exceed 10-12%.

Attitude towards own’s health 25-34 years 35-44 years 45-54 years 55-64 years 25-64 years
M F M F M F M F M F
N % N % N % N % N % N % N % N % N % N %
Do you believe that a healthy person of your age can get a serious illness within the next 5-10 years?
1. Highly possible 1988 58 28.4 66 35.9 61 30.8 71 33.8 66 37.9 81 44.3 60 39.7 60 44.4 252 34.3 281 39.0
2. Possible 142 69.6 118 64.1 132 66.7 137 65.2 104 59.8 100 54.6 91 60.3 74 54.8 469 69.9 434 60.2
3. Incredible 4 2 0 0 5 2.5 2 1.0 4 2.3 2 1.1 0 0 1 0.7 13 1.8 6 0.8
Total 204 100 184 100 198 100 210 100 174 100 183 100 151 100 135 100 734 100 721 100
χ2=5.716 df=2 p=0.057 n.s. n.s. n.s. χ2=5.398 df=2 p=0.067
1. Highly possible 2003 118 38.8 210 37.9 129 47.4 197 37.9 247 42.9 407 37.9
2. Possible 182 59.9 336 60.6 141 51.8 317 61.0 323 56.1 653 60.8
3. Incredible 4 1.3 8 1.4 2 0.7 6 1.2 6 1.0 14 1.3
Total 304 100 554 100 272 100 520 100 576 100 1074 100
n.s. χ2=6.830 df=2 p<0.05 n.s.
1. Highly possible 2013 51 31.1 66 31.0 71 27.2 132 39.4 122 28.7 198 36.1
2. Possible 105 64.0 133 62.4 181 69.3 198 59.1 286 67.3 331 60.4
3. Incredible 8 4.9 14 6.6 9 3.4 5 1.5 17 4.0 19 3.5
Total 164 100 213 100 261 100 335 100 425 100 548 100
n.s. χ2=11.120 df=2 p<0.01 χ2=5.990 df=2 p=0.05
1. Highly possible 2017 22 31.0 31 31.6 34 41.5 39 28.3 52 43.0 46 30.1 108 39.4 116 29.8
2. Possible 47 66.2 65 66.3 48 58.5 98 71.0 69 57.0 102 66.7 164 59.9 265 68.1
3. Incredible 2 2.8 2 2.0 0 0 1 0.7 0 0 5 3.3 2 0.7 8 2.1
Total 71 100 98 100 82 100 138 100 121 100 153 100 274 100 389 100
n.s. n.s. χ2=8.109 df=2 p<0.05 χ2=7.956 df=2 p<0.05
Table 1. Gender differences in awareness and attitude towards own’s health among the population aged of 25-64 years, depending on age
Attitude towards own’s health 25-34 years 35-44 years 45-54 years 55-64 years 25-64 years
M F M F M F M F M F
N % N % N % N % N % N % N % N % N % N %
Is a healthy person of your age able to avoid serious diseases if he takes actions in advance?
1. Yes, definitely 1988 112 54.9 85 46.2 114 57 95 44.8 86 49.4 76 41.3 78 50.9 58 42.3 390 52.8 318 43.8
2. May be 86 42.2 96 52.2 82 41.8 114 53.8 80 46.0 99 53.8 71 46.4 73 53.3 327 44.3 387 53.3
3. Incredible 6 2.9 3 1.6 4 2 3 1.4 8 4.6 9 4.9 4 2.6 6 4.4 21 2.9 21 2.9
Total 204 100 184 100 200 100 212 100 174 100 184 100 153 100 137 100 738 100 726 100
n.s. χ2=6.751 df=2 p<0.05 n.s. n.s. χ2=12.267 df=2 p<0.01
1. Yes, definitely 2003 161 53.0 261 47.1 112 41.2 205 39.4 273 47.4 466 43.4
2. May be 139 45.7 273 49.3 152 55.9 299 57.5 291 50.5 572 53.3
3. Incredible 4 1.3 20 3.6 8 2.9 16 3.1 12 2.1 36 3.4
Total 304 100 554 100 272 100 520 100 576 100 1074 100
χ2=5.575 df=2 p=0.062 n.s. n.s.
1. Yes, definitely 2013 119 72.6 150 70.4 176 67.7 227 67.8 295 69.6 377 68.8
2. May be 44 26.8 62 29.1 80 30.8 105 31.3 124 29.2 167 30.5
3. Incredible 1 .6 1 .5 4 1.5 3 .9 5 1.2 4 .7
Total 164 100 213 100 260 100 335 100 424 100 548 100
n.s. n.s. n.s.
1. Yes, definitely 2017 43 60.6 59 60.2 49 59.8 79 57.2 59 48.8 77 50.3 151 55.1 215 55.3
2. May be 28 39.4 38 38.8 33 40.2 57 41.3 62 51.2 75 49.0 123 44.9 170 43.7
3. Incredible 0 0 1 1.0 0 0 2 1.4 0 0 1 0.7 0 0 4 1.0
Total 71 100 98 100 82 100 138 100 121 100 153 100 274 100 389 100
n.s. n.s. n.s. n.s.
Table 2. Gender differences in awareness and attitude towards own’s health among the population aged of 25-64 years, depending on age
Attitude towards own’s health 25-34 years 35-44 years 45-54 years 55-64 years 25-64 years
M F M F M F M F M F
N % N % N % N % N % N % N % N % N % N %
Is modern medicine capable to prevent heart disease
1. Yes, all of heart diseases 1988 8 3.9 4 2.2 11 5.5 5 2.4 9 5.3 9 4.9 19 12.4 14 10.2 47 6.4 33 4.6
2. Yes, most of heart diseases 60 29.4 41 22.5 46 23 38 18.0 29 17.0 27 14.8 29 19.0 19 13.9 166 22.6 125 17.3
3. It depends on the disease 101 49.5 102 56.0 103 51.5 129 61.1 98 57.3 109 59.6 72 47.1 78 56.9 378 51.4 423 58.6
4. Some of them, only 33 16.2 33 18.1 33 16.5 34 16.1 31 18.1 31 16.9 29 19.0 21 15.3 127 17.3 122 16.9
5. None 2 1 2 1.1 7 3.5 5 2.4 4 2.3 7 3.8 4 2.6 5 3.6 17 2.3 19 2.6
Total 204 100 182 100 200 100 211 100 171 100 183 100 153 100 137 100 735 100 722 100
χ2=68.064 df=4 p<0.001 χ2=9.017 df=4 p=0.061 n.s. n.s. χ2=10.851 df=4 p<0.05
1. Yes, all of heart diseases 2003 34 11.2 65 11.7 28 10.3 70 13.5 62 10.8 135 12.6
2. Yes, most of heart diseases 80 26.3 120 21.7 42 15.4 78 15.0 122 21.2 198 18.4
3. It depends on the disease 148 48.7 276 49.8 160 58.8 275 52.9 308 53.5 551 51.3
4. Some of them, only 41 13. 5 84 15. 2 35 12. 9 87 16. 7 76 13. 2 171 15. 9
5. None 1 0.3 9 1.6 7 2.6 10 1.9 8 1.4 19 1.8
Total 304 100 554 100 272 100 520 100 576 100 1074 100
n.s. n.s. n.s.
1. Yes, all of heart diseases 2013 22 13.4 32 15.0 44 16.9 42 12.5 66 15.5 74 13.5
2. Yes, most of heart diseases 89 54.3 81 38.0 104 39.8 135 40.3 193 45.4 216 39.4
3. It depends on the disease 46 28.0 90 42.3 84 32.2 124 37.0 130 30.6 214 39.1
4. Some of them, only 7 4.3 10 4.7 28 10.7 30 9.0 35 8.2 40 7.3
5. None 0 0 0 0 1 .4 4 1.2 1 .2 4 .7
Total 164 100 213 100 261 100 335 100 425 100 548 100
χ2=10.807 df=4 p<0.05 n.s. χ2=8.990 df=4 p=0.061
1. Yes, all of heart diseases 2017 15 21.1 14 14.3 12 14.6 19 13.8 27 22.3 26 17.0 54 19.7 59 15.2
2. Yes, most of heart diseases 37 52.1 40 40.8 17 20.7 42 30.4 18 14.9 43 28.1 72 26.3 125 32.1
3. It depends on the disease 19 26.8 35 35.7 37 45.1 60 43.5 53 43.8 75 49.0 109 39.8 170 43.7
4. Some of them, only 0 0 9 9.2 8 9.8 17 12.3 23 19.0 9 5.9 31 11.3 35 9.0
5. None

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Copyright © 2021 Valery Gafarov Dmitriy Panov Elena Gromova Eldar Krymov Igor Gagulin Almira Gafarova this is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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How to Cite
Gafarov, V., Panov, D., Gromova, E., Krymov, E., Gagulin, I., & Gafarova, A. (2021). Gender Differences in the Dynamics of Attitudes towards the Prevention of Cardiovascular Diseases in Population Aged 25-64 Years from 1988 To 2017. International Journal of Medical Science and Clinical Invention, 8(03), 5258–5271. https://doi.org/10.18535/ijmsci/v8i03.02
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