Social vulnerability increases the risk of death differently in men and women: longitudinal analysis over 15 years in the Paquid Study

BACKGROUND AND OBJECTIVES: Social vulnerability (SV) is a multidimensional construct associated with adverse health outcomes, including mortality. However, little is known about how SV differentially affects older men and women. RESEARCH DESIGN AND METHODS: We analyzed data from 3695 community-dwelling older adults from the Paquid cohort, followed for 15 years. SV was assessed using a 26-item SV Index (SVI), categorized into low, moderate, and high levels. Delayed-entry Cox models stratified by gender were used to estimate mortality risk, adjusting for disability, history of ischemic heart disease, dyspnea, diabetes, and cognitive impairment. Associations between SV subdimensions and mortality were also examined separately by gender. RESULTS: Women accumulated more social deficits than men (40 % vs. 21 % with high SV). High SV was associated with a 21-25 % increased mortality risk in both genders. However, moderate SV is significantly associated with an increased mortality risk only in men (adjusted Hazard Ratio = 1.25, 95 % CI: 1.09-1.44 vs. aHR = 0.96, 95 % CI: 0.81-1.13 in women). Among subdimensions, low socioeconomic status and poor leisure activity engagement were the strongest mortality predictors in men-even at moderate levels (result marginally significant for leisure activities, p = 0.073). In women, poor engagement in leisure activities and negative psychological experience were the main predictors of mortality; low socioeconomic status (SES) showed a trend-level association (p = 0.045). DISCUSSION AND IMPLICATIONS: Despite greater SV, women seem to withstand moderate social deficits better than men. These findings highlight the need for further studies to explain gender differences and develop gender-sensitive public health interventions.