Sex-specific health deterioration and mortality: the morbidity-mortality paradox over age and time.

Pubmed ID: 18835429

Pubmed Central ID: PMC2703431

Journal: Experimental gerontology

Publication Date: Dec. 1, 2008

MeSH Terms: Humans, Male, Female, Aged, Middle Aged, Sex Factors, Chronic Disease, Mortality, Health Behavior, Health Status

Grants: R01 AG028259, R01 AG027019, 5P01-AG-008761, P01 AG008761, R01 AG027019-03, R01 AG030612, P01 AG008761-19, R01 AG028259-04, 1R01 AG028259, 1R01-AG-027019, 5R01-AG-030612, R01 AG030612-02, P30 AG034424, R03 HD050374

Authors: Yashin AI, Arbeev KG, Ukraintseva SV, Kulminski AM, Culminskaya IV, Land KC

Cite As: Kulminski AM, Culminskaya IV, Ukraintseva SV, Arbeev KG, Land KC, Yashin AI. Sex-specific health deterioration and mortality: the morbidity-mortality paradox over age and time. Exp Gerontol 2008 Dec;43(12):1052-7. Epub 2008 Sep 20.

Studies:

Abstract

The traditional sex morbidity-mortality paradox that females have worse health but better survival than males is based on studies of major health traits. We applied a cumulative deficits approach to study this paradox, selecting 34 minor health deficits consistently measured in the 9th (1964) and 14th (1974) Framingham Heart and 5th (1991-1995) Offspring Study exams focusing on the 55-78 age range. We constructed four deficit indices (DIs) using all 34 deficits as well as subsets of these deficits characterizing males' (DI(M)) and females' (DI(F)) health disadvantages, and no relative sex-disadvantages. The DI(34)-specific age patterns are sex-insensitive within the 55-74 age range. The DI(34), however, tends to selectively increase the risk of death for males. The DI(F)-associated health dimension supports the traditional morbidity paradox, whereas the DI(M)-associated dimension supports the inverse paradox, wherein males have worse health but better survival than females. The traditional paradox became less pronounced, whereas the inverse paradox became more pronounced from the 1960s to the 1990 s. The sex-specific excess in minor health deficits may vary according to particular set of deficits, thus providing evidence for traditional and inverse morbidity paradoxes. The time-trends suggest the presence of a strong exogenous effect modifier affecting the rate of health deterioration and mortality risk.