Masculine gender affects sex differences in the prevalence of chronic health problems - The Doetinchem Cohort Study

•Both sex and gender are relevant for health and health research.•Gender affects sex differences in chronic health problems.•A more “masculine” gender seems beneficial for health in both men and women.•Gender deserves more attention in large-scale health survey analysis. Both (biological) sex and (socio-cultural) gender are relevant for health but inlarge-scale studies specific gender measures are lacking.Using a masculine gender-score based on 'traditionalmasculine-connotated aspects of everyday life’, we explored how masculinity may affect sex differences in the prevalence of chronic health problems. We used cross-sectional data (2008–2012) fromthe Doetinchem CohortStudy to calculate a masculine gender-score (range 0–19) using information on work, informal care, lifestyle and emotions. The sample consistedof 1900 menand2117 women (age:40–80). Multivariable logistic regressions including age and SES were used to examine the role of masculine gender on sex differences in the prevalence of diabetes, coronary heart disease, CVA, arthritis, chronic pain and migraine.Menhad higher masculine gender-scores than women (12.2 vs 9.1). For both sexes, a higher masculine gender-score was associated with lower prevalence of chronic health problems. Diabetes,CHD, andCVAwere more prevalent in men, and gender-adjustment resulted in greater sex differences: e.g. for diabetes the ORsexchanged from1.21 (95 %CI 0.93–1.58) to 1.60 (95 %CI 1.18–2.17). Arthritis, chronic pain, and migraine were more prevalent in women, and gender-adjustment resulted in smaller sex differences: e.g. for chronic pain the ORsexchanged from 0.53 (95 %CI 0.45–0.60) to 0.73 (95 %CI 0.63–0.86).Gender measured as ‘everyday masculinity’ is associated with lower prevalence of chronic health problems in both men and women. Our findings also suggest that the commonly found sex differences in the prevalence of chronic health problems have a large gender component.