II. An Examination of the Relation Between Symptoms, Disability, and Serious Illness, in Two Homogeneous Groups of Men and Women

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Abstract
One hundred and sixteen men and 96 women, comparable in age, ethnic and social background, occupation, social and economic position, exposure to infection and trauma, place of domicile, and method of observation were studied over a 25-year period (including 5 years of prospective observation), with regard to the nature and duration of every episode of disabling illness that occurred among them. The incidence of disabling illness among women was significantly higher than among men, the difference being accounted for almost entirely by a higher incidence of colds, "grippe", pharyngitis, acute gastroenteritis, dysmenorrhea, muscular pains, minor cuts and bruises, headaches, and minor episodes of tension, anxiety, asthenia, or depression. However, the incidence of serious, life endangering illnesses was somewhat higher among men. An analysis of the risk of death among the 2 groups, based upon expected case fatality rates of the illnesses experienced, led to an estimate that, over a 20-year period, the men experienced a risk of death from illness greater than that of the women, in a ratio of approximately 4 to 3. It seems very likely that the higher incidence of illness reported by the women, the greater amount of disability that they experienced, and the greater number of visits that they made to the doctor, were largely the result of culturally determined differences in the attitudes toward what constitutes illness and what creates an acceptable reason for disability in men and in women.

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