Exploring Syndemics in Older People Through a Gendered Lens: A Cross-Sectional Study using Linked Healthcare, Societal, and Health Monitor Data

Objective: Sex differences in health condition clustering are often explored biologically, overlooking how gendered lives shape these patterns. We examine the role of gender in syndemics to understand health disparities in older people, where multimorbidity is more common and gendered life impacts shape health. Methods: We conducted a cross-sectional study using linked data (n=4,689) from Dutch general practitioners, the Health Monitor, and Statistics Netherlands for individuals aged ≥65. Health condition combinations were examined by sex, with additive and multiplicative interactions on healthcare utilization assessed using regression. A gender index capturing roles, relations, and institutionalized factors was developed. Univariable regression assessed associations of sex and gender index with excess healthcare utilization within health condition combinations; multivariable analyses evaluated whether sex differences persisted after adjusting for gender index. Results: Sex-specific health condition combinations emerged: cardiovascular–hypertension predominated in males (11.7%), hypertension–musculoskeletal predominated in females (13.2%). Several combinations showed interactions indicating adverse effects on healthcare utilization. Gender index was associated with higher healthcare utilization; sex was rarely significant. In the hypertension–diabetes combination—the only case with a univariate sex effect—the sex effect disappeared in multivariable models where the gender index remained significant (OR=4.74, 95%CI 1.22–19.62). Conclusion: This study shows that syndemics in older people are shaped not only by sex but also by gendered lives involving caregiving roles, economic patterns, and institutional structures. Recognizing gender as a dynamic factor reveals hidden disparities, underscoring the need for gender‑informed research and policy to improve equity and inclusivity in healthcare systems.