title: Comparative study of the quality of life associated with menopause in Tunisia and France.
abstract: OBJECTIVE
  Because the experience of menopause varies by ethnic group, society, and social class, we sought to compare quality of life (QoL) at menopause between Tunisian and French women.
  
  
  METHODS
  This secondary analysis of existing data collected in two independent, cross-sectional surveys (the French GAZEL cohort and a representative sample of Tunisian women) compared both samples for six dimensions of the Women's Health Questionnaire while taking into account social and demographic characteristics and menopause status with multivariate logistic models.
  
  
  RESULTS
  Comparison of 1,040 Tunisian women aged 45 to 64 years with 774 French women aged 48 to 53 years showed that Tunisian women had a significantly lower QoL than the French women in every dimension (low QoL for Tunisian vs French, odds ratio [95% CI]: somatic symptoms, 2.1 [1.6-2.7]; depressed mood, 3.6 [2.8-4.7]; anxiety, 2.4 [1.8-3.3]; vasomotor symptoms, 1.7 [1.3-2.3]). QoL was also lower for working-class women, but associations were weaker than for country (low QoL for working class vs middle class, odds ratio [95% CI]: somatic symptoms: 1.9 [1.5-2.4]; depressed mood, 1.5 [1.2-1.8]; anxiety, 1.8 [1.5-2.3]; vasomotor symptoms, 1.7 [1.4-2.2]). Associations between country and QoL were stronger in the working class than in the middle class.
  
  
  CONCLUSIONS
  This epidemiological study comparing France and a North African country sheds light on the major role of country of residence, social class, and their interaction in the experience of menopause. Levels of national wealth, human development, cultural constraints, and social and gender inequality are likely to explain how country and class affect QoL.
authors: Gender, Sexual, and Reproductive Health Team, Center for Research in Epidemiology and Population Health, Institut National de la Santé et de la Recherche Médicale, U1018, le Kremlin-Bicêtre, France.
authors: Farida
authors: F
authors: Ferrand
authors: Selma
authors: S
authors: Hajri
authors: Sarah
authors: S
authors: Benzineb
authors: Dorra Mahfoudh
authors: DM
authors: Draoui
authors: Danielle
authors: D
authors: Hassoun
authors: Daniel
authors: D
authors: Delanoë
authors: Marie
authors: M
authors: Zins
authors: Virginie
authors: V
authors: Ringa
mesh_terms: D001007:Anxiety / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003469:Culture; D003863:Depression / Q000453:epidemiology; D004522:Educational Status; D015444:Exercise; D005260:Female; D005602:France / Q000453:epidemiology; D019584:Hot Flashes / Q000453:epidemiology; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D011788:Quality of Life; D063507:Sexism; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014416:Tunisia / Q000453:epidemiology