Gender Differences in Quality of Dying and Death among Older Adults: A Cross-sectional Study in China

Background The aging of China is deepening year by year, and improving the quality of dying and death (QODD) is increasingly becoming an urgent and realistic need. This study explores the gender differences in the quality of dying and death and its influencing factors among Chinese elderly people, aiming to provide assistance to the relevant authorities in formulating end-of-life care policies for the elderly, and to adapt to the needs of an aging society. Methods Based on the data of the Chinese Longitudinal Health Longevity Survey (CLHLS) during 2008–2018, a total of 7,341 respondents were included. Chi-square test and logistic regression analysis were used to analyze the quality of dying and death among Chinese elderly people and its influencing factors. In addition, Fairlie decomposition analysis was performed to quantify the contribution level of different influencing factors. Results The proportion of high QODD among female elderly (63.80%) was significantly higher than male elderly (56.00%), which was statistically significant. Logistic regression showed that age, residence, home facilities score, place of death, medical costs, got timely treatment, number of chronic diseases and unconsciousness were the factors influencing QODD among male elderly. Meanwhile, residence, marital status, home facilities score, place of death, got timely treatment, bedridden, suffered from serious illness, unconsciousness and drinking were the factors influencing QODD among female elderly. Fairlie decomposition showed that 52.11% of the QODD differences between the elderly of different sexes were related to gender differences, and 47.89% were related to other personal characteristics. Conclusion Chinese men have a poorer QODD compared to women. The main factors contributing to this difference were age, the number of chronic diseases, suffered from serious illness, unconsciousness, place of death, residence and home facilities scores. To ensure successful aging, the relevant departments should focus on these factors and work towards reducing the gender differences in QODD.