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. 2025 Aug 12;25(1):616.
doi: 10.1186/s12877-025-06297-7.

Sex differences in the prevalence and determinants of death anxiety among community-dwelling older adults in China: a cross-sectional study

Hui Zhang  1 , Zhonghao Xu  1 , Xiaoyan Zhai  1 , Peina Hu  1 , Qingshu Song  1 , Huaye Li  1 , Chang Fu  2
Affiliations

Sex differences in the prevalence and determinants of death anxiety among community-dwelling older adults in China: a cross-sectional study

Hui Zhang et al. BMC Geriatr. .

Abstract

Background: Death anxiety levels among older adults may differ by sex and are influenced by distinct factors. This study examined the levels of death anxiety and its determinants among older Chinese adults, with a focus on sex differences.

Methods: A multistage sampling method was used to recruit 559 older adults aged 60 years and above who completed a questionnaire survey. Death anxiety was assessed using the Templer Death Anxiety Scale (T-DAS). Factors influencing death anxiety were identified using a multiple linear regression model.

Results: The average death anxiety scores among men and women were 5.48 ± 3.64 and 6.70 ± 3.70, respectively. Among both men and women, residence [men: rural area (β = 1.087, p = 0.018); women: rural area (β = 2.176, p < 0.001)], the number of outpatient visits in the past year [men: 1 (β = 1.906, p < 0.001), ≥ 2 (β = 2.027, p < 0.001); women:1 (β = 1.612, p = 0.001), ≥ 2 (β = 2.160, p < 0.001)], satisfaction with family relationships [men: satisfied ( β= -1.994, p = 0.001); women: satisfied (β = -1.728, p < 0.001)], and the experience of having seen articles or programmes related to the topic of death in the media [men: yes (β = 1.938, p < 0.001); women: yes (β = 0.911, p = 0.048)] were associated with death anxiety score. Per capita monthly income of the household (1,001 to 3,000 Chinese Yuan: β = 1.188, p = 0.025), and the number of hospitalisations in the past year (≥ 2: β = 1.237, p = 0.046) were associated with death anxiety score only among men. Conversely, educational level (junior high school and above: β = -1.436, p = 0.012) was associated with death anxiety score only among women.

Conclusions: Older women exhibited significantly higher death anxiety levels than men. Determinants of death anxiety varied by sex. Therefore, these factors should be considered in future interventional measures.

Keywords: Death anxiety; Determinants; Older adults; Sex difference.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Ethical Review Committee of Binzhou Medical University (approval number: 2024-L037). Considering participants’ voluntary willingness to engage in the study, the confidentiality of their information, and the unique circumstances of each individual, this study did not record participants’ personal identifiers such as names and all the participant provided oral informed consent before participation. As the data does not involve biological samples, the oral informed consent form has been approved and endorsed by the ethical review committee. All the ethical standards were strictly adhered to throughout the entire research project. The study was conducted according to the principles of the Declaration of Helsinki. All methods adhered to relevant guidelines and regulations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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