Male-female Health-survival Paradox Research Articles

Sex Differences in Comorbidity and Frailty in Europe.

To examine sex differences in prevalent comorbidity and frailty across age and European regions. This is a cross-sectional study based on 113,299 Europeans aged 50+ participating in the Survey of Health, Ageing and Retirement in Europe from 2004-2005 to 2015. Sex differences in the Comorbidity Index and the Frailty Phenotype were investigated using ordinal logistic regressions. European women had generally higher odds of prevalent comorbidity (OR 1.11, 95% CI 1.07-1.15) and frailty (OR 1.56, 95% CI 1.51-1.62). Sex differences increased with advancing age. No overall sex difference in comorbidity was found in Western Europe, but women had more comorbidity than men in Eastern (OR 1.30, 95% CI 1.18-1.44), Southern (OR 1.23, 95% CI 1.15-1.30), and Northern (OR 1.08, 95% CI 1.01-1.16) Europe. Women were frailer than men in all regions, with the largest sex difference in Southern Europe (OR 1.84, 95% CI 1.72-1.96). European women are frailer and have slightly more comorbidity than European men lending support for the male-female health survival paradox.

Genetic Associations with Longevity Are Stronger in Females than in Males - A Bio-Demographic Analysis Contributing to a Research Basis for Precision Healthcare

Background: The male-female health-survival paradox that women live significantly longer, but have lower physical performance and more adverse health outcomes at older ages than men, is a phenomenon observed everywhere in the world. This study aims to provide an understanding of the male-female health-survival paradox, through investigating whether genetic associations with longevity are stronger in males or females. Methods: We conducted logistic regression and bio-demographic analyses, using the genome-wide association study (GWAS) datasets including 2,178 centenarians and 2,299 middle-aged controls of Chinese Longitudinal Healthy Longevity Study. Findings: We found that averages of probabilities of longevity, associated with each of the six mutually exclusive groups of 11 male-specific and 11 female-specific top loci (P<10-5), 35 male-specific and 25 female-specific strong loci (10-5≤P<10-4), 191 male-specific and 311 female-specific moderate loci (10-4≤P<10-3), are all significantly higher in females than in males by margins of 13.8% to 25.8%. Our analyses demonstrate that the female vs. male ratios of relative benefit for longevity due to each of the six exclusive groups of sex-specific loci associated with longevity at tiered significance levels are all substantially in favor of females. These empirical findings and additional analyses of both sex-specific and not-sex-specific loci all indicate and reconfirm that genetic associations with longevity are substantially stronger in females than in males. Interpretation: The findings of this study may be interpreted in the context of human genetic evolution in which females may gain and accumulate advantages in genetic constitution to meet their reproductive and offspring-caring duties as mothers and grandmothers. Funding Statement: The funding agencies provided financial support to the data and DNA samples collections and analyses, but they did not play any role in writing, interpreting the results and submission for consideration of publication of this manuscript. The authors were not paid by anyone to write this article. Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: The Research Ethics Committees of Peking University and Duke University granted approval for the Protection of Human Subjects for the Chinese Longitudinal Healthy Longevity Survey, including collection of the data and DNA samples used for present study. The survey respondents gave informed consent before participation.

Sex differences in healthy life expectancy among nonagenarians: A multistate survival model using data from the Vitality 90+ study.

Little is known about sex differences in healthy life expectancy among the oldest old, the fastest growing segment of the older population. This study examines sex differences in total, healthy and unhealthy life expectancy among nonagenarians. Longitudinal data of 884 older adults aged 90 and over participating in the Vitality 90+ study (Tampere, Finland) were used, including 2501 observations (health or death states) from 5 measurement waves between 2001 and 2014. Using the MSM and ELECT packages in R, multistate survival models were performed to estimate the transition probabilities of older adults through the different health states and to calculate life expectancies. The analyses were done separately for two health indicators (disability and multimorbidity) to see whether patterns were consistent. Women had higher total life expectancies than men (about 8 months), but also higher unhealthy life expectancies. Men had a higher disability-free life expectancy between the age of 90 and 95 compared to women. For multimorbidity, no sex differences in healthy life expectancy were found. This study showed that the male-female health-survival paradox remains at very old age. Women aged 90+ live longer than men, and spend more time in poor health.

Intralocus sexual conflict can resolve the male-female health-survival paradox

At any given age, men are more likely to die than women, but women have poorer health at older ages. This is referred to as the “male-female, health-survival paradox”, which is not fully understood. Here, we provide a general solution to the paradox that relies on intralocus sexual conflict, where alleles segregating in the population have late-acting positive effects on male fitness, but negative effects on female health. Using an evolutionary modelling framework, we show that male-benefit, female-detriment alleles can spread if they are expressed after female reproduction stops. We provide support for our conflict based solution using experimental Drosophila data. Our results show that selecting for increased late-life male reproductive effort can increase male fitness but have a detrimental effect on female fitness. Furthermore, we show that late-life male fertility is negatively genetically correlated with female health. Our study suggests that intralocus sexual conflict could resolve the health-survival paradox.

21THE MALE-FEMALE HEALTH-SURVIVAL PARADOX IN HOSPITALISED OLDER ADULTS

Abstract Objectives To determine whether the ‘male-female health-survival paradox’ is present in older hospitalised adults and to examine whether sex differences in the ‘lethality’ of acute medical conditions influence the relationship between sex and mortality. Study design and outcome measures This study was a secondary analysis of prospective cohort data collected from 1418 Australian inpatients aged 70 years and over. Frailty was measured using a 39-variable Frailty Index (FI-AC). Analyses examined the relationship between sex, age, FI-AC and 28-day mortality. Survival models were adjusted for ‘lethality’ of acute conditions (high versus low mortality risk). Results The FI-AC had a normal distribution in both sexes (female mean = 0.34 (±0.13); male mean = 0.31 (± 0.15)). When adjusted for age, females had similar FI-AC scores to males (β coefficient = 0.014, 95% confidence interval (CI) = 0.00-0.028, p = 0.056). There were 80 deaths in the sample, with females facing a significantly lower mortality risk than males of the same FI-AC and age (HR = 0.39, 95% CI = 0.25–0.63, p Conclusion The male-female health-survival paradox was not demonstrated in this study of older inpatients. Whilst females faced a significantly lower risk of near-term mortality, the sexes were found to have similar levels of frailty on admission to hospital. The sex mortality gap was not explained by sex differences in the ‘lethality’ of acute medical conditions.

Gender effect on well-being of the oldest old: a survey of nonagenarians living in Tuscany: the Mugello study.

The population of industrialized nations is progressively aging, with Italy having one of the most elderly populations in the world. Natural aging may be associated with physical and cognitive impairments, often straining public resources. The present study aims to investigate the influence of gender on wellness of the nonagenarians. We evaluated quality of life among nonagenarians living in the Mugello area, an Italian location with a large population of individuals > 90years, using the Health Survey Scoring SF-12. The 15-item Geriatric Depression Scale and Basic and Instrumental Activity of Daily Living scales were also assessed. The Mini-Mental State Examination was used to evaluate the cognitive status. In the current survey, women outnumbered men 2.7:1 confirming their higher longevity. However, on the basis of SF-12 scores, nonagenarian women felt worse than men, both physically (mean: women = 41.8 vs men = 44.4, p = 0.004) and mentally (mean: women = 46.7 vs men =48.5, p = 0.034), and their depression rates were higher: considering a General Depression Scale score ≥ 5 as a possible depression status; 37.5% of men reported depression vs. 48.5% of women (p = 0.021). Significant differences were observed also in daily activities, both basic (median: woman = 3 vs men = 5, p < 0.001) and instrumental (median woman = 1 vs me = 3, p < 0.001). Despite prior reports showing that women perform better than men in aging, our study confirms data reported in most national and European surveys: women live longer than men, but with poorer quality of life. The current study confirms the phenomenon known as the "male-female health-survival paradox."

The male-female health-survival paradox in hospitalised older adults

ObjectivesTo determine whether the ‘male-female health-survival paradox’ is present in older hospitalised adults and to examine whether sex differences in the ‘lethality’ of acute medical conditions influence the relationship between sex and mortality. Study design and outcome measuresThis study was a secondary analysis of prospective cohort data collected from 1418 Australian inpatients aged 70 years and over. Frailty was measured using a 39-variable Frailty Index (FI-AC). Analyses examined the relationship between sex, age, FI-AC and 28-day mortality. Survival models were adjusted for ‘lethality’ of acute conditions (high versus low mortality risk). ResultsThe FI-AC had a normal distribution in both sexes (female mean=0.34 (±0.13); male mean=0.31 (±0.15)). When adjusted for age, females had similar FI-AC scores to males (β coefficient=0.014, 95% confidence interval (CI)=0.00-0.028, p=0.056). There were 80 deaths in the sample, with females facing a significantly lower mortality risk than males of the same FI-AC and age (HR=0.39, 95% CI=0.25–0.63, p<0.001). Females were less likely than males to be admitted with a high-risk acute condition. Even so, this did not significantly reduce their survival advantage (HR=0.46, 95% CI=0.29-0.73, p=0.001). ConclusionThe male-female health-survival paradox was not demonstrated in this study of older inpatients. Whilst females faced a significantly lower risk of near-term mortality, the sexes were found to have similar levels of frailty on admission to hospital. The sex mortality gap was not explained by sex differences in the ‘lethality’ of acute medical conditions.

Men Sustain Higher Dysregulation Levels Than Women Without Becoming Frail.

The aging process differs in important ways between the sexes, with women living longer but at higher risk for frailty (the male-female health-survival paradox). The underlying biological mechanisms remain poorly understood, but may relate to sex differences in physiological dysregulation patterns. Here, using biomarkers from two longitudinal cohort studies (InCHIANTI and BLSA) and one cross-sectional survey (NHANES), we assess sex differences in trajectories of dysregulation globally and for five physiological systems: oxygen transport, electrolytes, hematopoiesis, lipids, and liver/kidney function. We found higher dysregulation levels in men, both globally and in the oxygen transport and hematopoietic systems (p < .001 for all), though differences for other systems were mixed (electrolytes) or absent (lipids and liver/kidney). There was no clear evidence for sex differences in rates of change in dysregulation with age. Although risk of frailty and mortality increase with dysregulation, there was no evidence for differences in these effects between sexes. These findings imply that the greater susceptibility of women to frailty is not simply due to a tolerance for higher dysregulation; rather, it may actually be men that have a greater tolerance for dysregulation, creating a male-female dysregulation-frailty paradox. However, the precise physiological mechanisms underlying the sex differences appear to be diffuse and hard to pin down.

Sex Differences in Biological Markers of Health in the Study of Stress, Aging and Health in Russia.

BackgroundThe apparent contradiction that women live longer but have worse health than men, the so called male-female health-survival paradox, is very pronounced in Russia. The present study investigates whether men in Moscow are healthier than women at the level of biomarkers, and whether the associations between biomarkers and subjective health have sex-specific patterns.MaterialsPreviously collected data in the study of Stress, Aging, and Health in Russia (SAHR, n = 1800) were used to examine sex differences in biomarkers and their associations with physical functioning and self-rated health.ResultsThe present study found mixed directions and magnitudes for sex differences in biomarkers. Women were significantly disadvantaged with regard to obesity and waist circumference, whereas men had a tendency toward higher prevalence of electrocardiographic abnormalities. No sex differences were indicated in the prevalence of immunological biomarkers, and mixed patterns were found for lipid profiles. Many biomarkers were associated with physical functioning and general health. Obesity and waist circumference were related to lower physical functioning among females only, while major Q-wave abnormalities with high probabilities of myocardial infarction and atrial fibrillation or atrial flutter were associated with physical functioning and self-rated health among males only.ConclusionNo clear patterns of sex differences in prevalence of high-risk levels of biomarkers suggest that the male-female health-survival paradox is weaker at the level of health biomarkers. We found some evidence that certain biomarkers reflecting pathophysiological changes in the organism that do not possess acute health risks, but over many years may lead to physical disability, are associated with physical functioning and self-rated health in women, whereas others reflecting more serious life-threatening pathophysiological changes are associated with physical functioning and self-rated health in men.

Developmental timing of the male-female health-survival paradox.

A sample of 200,000 men and women was used to examine the paradoxical observation that in old age there are more women than men but the men are in better health. Insofar as subsequent one-year survivability can be used as an index of health, the paradox was partially supported. After 99 years of age, there was a period of time when men's health compared to women's was improving relative to what it was previously. But there was never a time when it was actually better. The possibilities remain that earlier reports of the paradox might be the result of (a) sample limitations, (b) a focus on types of health that are unrelated to subsequent survival, or (c) local behaviors or conditions, such as smoking or air pollution, that can influence the health of men and women differently.

Sex differences in health and mortality in Moscow and Denmark

In high income countries females outlive men, although they generally report worse health, the so-called male-female health-survival paradox. Russia has one of the world's largest sex difference in life expectancy with a male disadvantage of more than 10 years. We compare components of the paradox between Denmark and Moscow by examining sex differences in mortality and several health measures. The Human Mortality Database and the Russian Fertility and Mortality Database were used to examine sex differences in all-cause death rates in Denmark, Russia, and Moscow in 2007-2008. Self-reported health data were obtained from the Study of Middle-Aged Danish Twins (n = 4,314), the Longitudinal Study of Aging Danish Twins (n = 4,731), and the study of Stress, Aging, and Health in Russia (n = 1,800). In both Moscow and Denmark there was a consistent female advantage at ages 55-89 years in survival and a male advantage in self-rated health, physical functioning, and depression symptomatology. Only on cognitive tests males performed similarly to or worse than women. Nevertheless, Muscovite males had more than twice higher mortality at ages 55-69 years compared to Muscovite women, almost double the ratio in Denmark. The present study showed that despite similar directions of sex differences in health and mortality in Moscow and Denmark, the male-female health-survival paradox is very pronounced in Moscow suggesting a stronger sex-specific disconnect between health indicators and mortality among middle-aged and young-old Muscovites.

Gender differences in healthy life expectancy among Brazilian elderly.

BackgroundThis study examined gender differences in healthy life expectancy (HLE) and unhealthy life expectancy (UHLE) among people aged 60 years or older living in a large Brazilian city.MethodsBased on Chiang method, abridged life tables were constructed for men and for women. To calculate HLE, the Sullivan method was applied. Estimates of the prevalence of self-rated health and self-reported functional disability (global, mild/moderate, and severe) were obtained from a population-based household survey carried out in 2008, which involved non-institutionalized individuals.ResultsFindings showed that women live longer and these extra years would be spent in good self-rated health. For example, women aged 60 would live, on average, 4 more years in good health in comparison to men. In terms of global limitations and mild/moderate limitations, no gender differences were detected for HLE. However, UHLE was statistically higher among women than among men at all ages in the global limitations and mild/moderate limitations (except for the age 80). Women at age 60, for instance, could expect to live 3.1 years longer with mild/moderate limitations compared to men. Gender differences were identified for severe limitations for either HLE or UHLE. In comparison to men, women at age 60, for example, would expect to live 2.5 and 2.0 more years without and with severe limitations.ConclusionsBy showing that the advantage of longer life expectancy among women is not necessarily accompanied by worse health conditions, these findings add some evidence to the debate about male-female health-survival paradox. Policy efforts are necessary to reduce gender differences in the quantity and quality of years to be lived, providing equal opportunities to women and men live longer with quality of life, autonomy, and independence.

The male–female health-survival paradox and sex differences in cohort life expectancy in Utah, Denmark, and Sweden 1850–1910

PurposeIn Utah, the prevalence of unhealthy male risk behaviors are lower than in most other male populations, whereas women experience higher mortality risk because of higher fertility rates. Therefore, we hypothesize that the Utah sex differential in mortality would be small and less than in Sweden and Denmark. MethodsLife tables from Utah, Denmark, and Sweden were used to calculate cohort life expectancies for men and women born in 1850–1910. ResultsThe sex difference in cohort life expectancy was similar or larger in Utah when compared with Denmark and Sweden. The change over time in the sex differences in cohort life expectancy was approximately 2 years smaller for active Mormons in Utah than for other groups suggesting lifestyle as an important component for the overall change seen in cohort life expectancy. Sex differences in cohort life expectancy at the age of 50 years were similar for individuals actively affiliated with the Church of Jesus Christ of Latter-day Saints and for Denmark and Sweden. ConclusionsThe hypothesis that a smaller sex difference in cohort life expectancies in Utah would be detected in relation to Denmark and Sweden was not supported. In Utah, the male–female differences in life expectancy remain substantial pointing toward biological mechanisms or other unmeasured risk factors.

The Male–Female Health–Survival Paradox: A Survey and Register Study of the Impact of Sex-Specific Selection and Information Bias

This study examined whether the health-survival paradox could be due partially to sex-specific selection and information bias in surveys. The study is based on the linkage of three population-based surveys of 15,330 Danes aged 46-102 years with health registers covering the total Danish population regarding hospitalizations within the last 2 years and prescription medicine within 6 months before the baseline surveys. Men had higher participation rates than women at all ages. Hospitalized women and women taking medications had higher participation rate compared with nonhospitalized women (difference=0.7%-3.0%) and female nonusers (difference=0.8%-7.6%), respectively, whereas no consistent pattern was found among men according to hospitalization or medication use status. Men used fewer medications than women, but they underreported medication use to a similar degree as did women. Hospitalized women, as well as women using prescription medicine, were slightly overrepresented in the surveys. Hence, the study found some evidence that selection bias in surveys may contribute to the explanation of the health-survival paradox, but its contribution is likely to be small. However, there was no evidence for sex-specific reporting of medication use among study participants.

Human Biodemography: Some challenges and possibilities

This opinion report - in a series on the future of biodemography - focuses on promising areas that I think will be valuable to develop in the future in order to get a better understanding of the determinants of the health and well-being of elderly peop

Men: good health and high mortality. Sex differences in health and aging

This review examines sex differences in health and survival, with a focus on the Nordic countries. There is a remarkable discrepancy between the health and survival of the sexes: men are physically stronger and have fewer disabilities, but have substantially higher mortality at all ages compared with women: the so-called male-female health-survival paradox. A number of proposed explanations for this paradox are rooted in biological, social, and psychological interpretations. It is likely to be due to multiple causes that include fundamental biological differences between the sexes such as genetic factors, immune system responses, hormones, and disease patterns. Behavioral differences such as risk-taking and reluctance to seek and comply with medical treatment may also play a role. Another consideration is that part of the difference may be due to methodological challenges, such as selective non-participation and under-reporting of health problems, and delayed seeking of treatment by men. The Nordic countries provide a unique opportunity for such studies, as they have good-quality data in their national health registers, which cover the whole population, and a long tradition of high participation rates in surveys.