The intersectional impact of sex and social factors on subjective health: analysis of the Canadian longitudinal study on aging (CLSA)

Background Self-rated health (SRH) is a widely validated measure of the general health of older adults. Our aim was to understand what factors shape individual perceptions of health and, in particular, whether those perceptions vary for men and women and across social locations. Methods We used data from the Canadian Longitudinal Study on Aging (CLSA) of community-dwelling adults aged 45 to 85. SRH was measured via a standard single question. Multiple Poisson regression identified individual, behavioural, and social factors related to SRH. Intersections between sex, education, wealth, and rural/urban status, and individual and joint cluster effects on SRH were quantified using multilevel models. Results After adjustment for relevant confounders, women were 43% less likely to report poor SRH. The strongest cluster effect was for groupings by wealth (21%). When wealth clusters were subdivided by sex or education the overall effect on SRH reduced to 15%. The largest variation in SRH (13.6%) was observed for intersections of sex, wealth, and rural/urban status. In contrast, interactions between sex and social factors were not significant, demonstrating that the complex interplay of sex and social location was only revealed when intersectional methods were employed. Conclusions Sex and social factors affected older adults' perceptions of health in complex ways that only became apparent when multilevel analyses were carried out. Utilizing intersectionality analysis is a novel and nuanced approach for disentangling explanations for subjective health outcomes.