title: Gender differences of symptom reporting and medical health care utilization in the German population.
abstract: OBJECTIVE
  Gender differences in morbidity have been widely confirmed in representative health surveys in North America and Europe. Significantly more women than men suffer from somatic complaints. It is less clear whether differences in symptom reporting provide an impact on health care utilization and to which degree psychosocial factors exhibit confounding influence.
  
  
  METHODS
  We analyzed data from a representative health examination survey in Germany with 7466 participants in the age range of 25 to 69 years.
  
  
  RESULTS
  The analysis confirmed an overall excess in female symptom reporting, both in the total sample (n = 7460; p < or = 0.001) and in the healthy subsample (n = 906, p < or = 0.01). Also, female utilization of medical services was higher (p < or = 0.0001). A simultaneous age related increase in the prevalence of symptom reporting in both groups peaked in the age group of 55-59 years followed by a subsequent slight decrease in higher age groups whereas utilization steadily increased over the adult life span in both sexes. As expected, more medical utilization was associated with higher symptom reporting levels. Nevertheless, females constantly exhibited more medical utilization than males in all symptom reporting groups. Age and marital status had no univariate influence on symptom reporting whereas low social class status (p = 0.001), poor perceived/self assessed health (p < 0.0001), and high levels of chronic distress (p < 0.0001) were associated with more symptom reporting. In multivariate analysis, the female gender lost its significance on heightened symptom reporting. Poor perceived/self assessed health had the most pronounced impact on symptom count (F-value 59.1; p < 0.001).
  
  
  CONCLUSIONS
  The present study confirms a female excess of symptom reporting and utilization of medical services. Nevertheless, symptom reporting and utilization are not closely related. The gender gap in symptom reporting may be largely explained by low social class status, high levels of chronic distress and poor perceived/self assessed health.
authors.affiliation: Institut und Poliklinik für Psychosomatische Medizin, Med. Psychologie und Psychotherapie des Klinikums Rechts der Isar der Technischen Universität München, Germany. kh.ladwig@lrz.tv-muenchen.de
authors.forename: K H
authors.initials: KH
authors.lastname: Ladwig
authors.forename: B
authors.initials: B
authors.lastname: Marten-Mittag
authors.forename: B
authors.initials: B
authors.lastname: Formanek
authors.forename: G
authors.initials: G
authors.lastname: Dammann
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D005260:Female; D005858:Germany / Q000453:epidemiology; D006296:Health Services / Q000706:statistics & numerical data*; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012737:Sex Factors; D012803:Sick Role; D012923:Social Class; D013001:Somatoform Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology