Is the educational health gap increasing for women? Results from Catalonia (Spain)

250 words) Background: Health expectancies vary worldwide according to socioeconomic status (SES). The lower SES usually show health disadvantage and the higher SES a health advantage compared to the average. The educational level of individuals is strongly linked to their SES. Objective: We propose to identify the evolution of SES differentials in health by gender, paying special attention to the trends for the least advantaged low educated females. We focus on the adult Catalan population (Spain) aged 55 or older. Methods: We measured SES through education. We used individual cross-sectional data obtained in 1994 and in 2012 from the Catalan Health Survey. We examined three comprehensive health indicators to disentangle the health and disability statuses in order to document social differences in health. We applied logistic models for each indicator, controlling for sociodemographic characteristics, health coverage and lifestyle. Results: Low educated males and females experienced an increase in the prevalence of functional and ADL limitations. We found an increment in the likelihood of bad health and functional limitations for the low educated between 1994 and 2012. The prevalences of smoking increased for low and middle educated females, whereas low educated males suffered a 4.1% increment of sedentarism. Having smoked in the past and leading a sedentary lifestyle increased the likelihood of bad and functional limitations. In general, double health coverage reduced the effect on reporting more health problems. Our predicted probabilities show that low educated women were more likely to self-perceive their health as bad and report functional limitations than any other group in both periods. Conclusions: Lower educated females are the most disfavored group in terms of health and personal autonomy. The gender gap between low educated men and women has reduced for self-perceiving bad health and for functional limitations between 1994 and 2012. Adopting a healthy lifestyle promotes well-being and personal autonomy. Health policies should continue to take into account that the population with lower SES is more likely to suffer from poor health and disability as they age, being the females a particularly fragile group.