Not good for the heart Thanasis Zovoilis/Getty

Housework takes a heavy toll. Women may be more likely to die after a heart attack than men because they do more housework, childcare and looking after relatives.

Women who have heart disease tend to have worse symptoms and are more likely to die from the condition than men. Until now, it has been hard to distinguish whether this might be due to differences in biology or lifestyle. But a new method for teasing apart physiological and social factors has shown that caring for children and performing household chores account for more of this difference than biological factors do.

Worldwide, heart diseases kill more men and women than anything else. Doctors have long observed that acute coronary syndrome (ACS) – an umbrella term that covers many heart disorders including heart attacks and angina – affects women more severely. They have worse symptoms, poorer recoveries and are more likely to die from it.


To understand why, Colleen Norris at the University of Alberta in Edmonton, Canada, and her colleagues have been following the progress of men and women diagnosed with ACS.

Housework heartache

The team analysed data from about a thousand people in Canada who were treated for ACS before they were 55 – the age at which differences between men and women’s health outcomes from the condition are starkest.

They then looked at how each person was doing a year after starting treatment, and used a statistical programme to compare this with their biological sex, medical factors like blood pressure, plus 31 traits or attributes such as salary size and time spent doing housework that have been historically linked to a male or female gender.

As well as showing that the women were in worse health a year after diagnosis, the analysis identified seven factors that seemed to play a role in determining how well a person was likely to recover. People who experienced more stress at home and spent more time doing housework fared less well, as did people who had lower personal incomes, or were a household’s primary earner.

Those whose personality traits and social behaviours ranked as less masculine or more feminine based on answers to questions adapted from a standard questionnaire developed in the 1970s also suffered worse health.

Back to work

With the exception of being a household’s primary earner, it was the women in the study who tended to fulfil most of these criteria. Data from Statistics Canada suggests that women spend about 65 per cent more time doing unpaid domestic chores than men, including housework and maintenance work around the home and garden. On average, women spend nearly 14 hours on such work a week, while men spend only about 8 hours on the same. It’s a pattern seen elsewhere – on any day, 20 per cent of US men do housework, compared with 49 per cent of women, while in the UK, women carry out 70 per cent of household chores.

Norris has also found that women are more likely to look after other members of the family, even when they themselves are unwell. “We have noticed that women who have bypass surgery tend to go right back into their caregiver roles, while men were more likely to have someone to look after them,” says Norris, who presented the team’s findings on gender and cardiovascular health at the Canadian Women’s Heart Health Summit in Ottawa, Canada, earlier this month.

Similar trends are seen in other countries. One Finnish study, for example, has found that men are more likely to survive a heart attack if they are married, but the opposite is true for women – single women recover better than those who are married.

Norris hopes her tool – the combination of a newly compiled questionnaire with a statistical analysis – can be used to investigate the importance of people’s roles and responsibilities in other diseases, and to improve healthcare for women.

“The tool is the first of its kind, and will influence cardiovascular health significantly,” says Rachel Dreyer at Yale School of Medicine. “The fact that there is little data on gender-related differences on coronary heart disease in 2016 is very concerning, because it is the leading cause of death in women.”

Read more: Women live longer than men but suffer more years of poor health