The Male-Female Health-Mortality Paradox

Abstract

Definition The male-female health-mortality paradox results from the fact that females live longer than males, but spend a higher proportion of their total life expectancy in poorer health states. The phenomenon is depicted in the schematic Fig. 1, where the grey shaded area represents the proportion of total life expectancy spent in poor health, for females and males, respectively, on panels a and b. It is clear that the grey shaded areas, representative of poor life expectancy, are larger for women than for men. The sum of the white area and the grey shaded area is equal to the total life expectancy. Since health is an important predictor of death, the fact that women live longer in spite of a higher proportion of their lives spent in unhealthy state puzzles researchers. Some other terms used to describe the phenomenon are: "gender and health paradox," "morbidity paradox," "morbidity-mortality paradox," or "male-female health-survival paradox." Overview The differences in life expectancy between women and men remained more or less constant until the first half of the twentieth century, with a female advantage of around 2-3 years, and started to increase thereafter. This increase of the gap coincided with a rise among men in cardiovascu-lar diseases, cancer, and accidents and a fall in maternal mortality and in causes of death related to pregnancy among women. Since the beginning of the 1980s, the gap between women and men in overall life expectancy has been slowly narrowing in the developed world. This does not apply to the oldest-old where the differences between the sexes continue to rise until today. In light of this universal observable male excess mortality, it is surprising that studies on gender differences in morbidity report that women are in worse health than men (among many others, Case and Paxson 2005; Deeg and Kriegsman 2003), and that women spend a higher proportion of their total life expectancy in poor health and with limitations (Crimmins et al. 2002; Robine et al. 2001). Researchers have most commonly addressed this paradox by focusing either on male excess mortality or on female excess morbidity. Another complementary approach has been to attribute at least a part of the paradox to method-ological artifacts that arise due to the survey framework and the behavior dynamics between respondents and interviewers.