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

Journal Article (Journal Article)

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.

Full Text

Duke Authors

Cited Authors

  • Kulminski, AM; Culminskaya, IV; Ukraintseva, SV; Arbeev, KG; Land, KC; Yashin, AI

Published Date

  • December 2008

Published In

Volume / Issue

  • 43 / 12

Start / End Page

  • 1052 - 1057

PubMed ID

  • 18835429

Pubmed Central ID

  • PMC2703431

Electronic International Standard Serial Number (EISSN)

  • 1873-6815

International Standard Serial Number (ISSN)

  • 0531-5565

Digital Object Identifier (DOI)

  • 10.1016/j.exger.2008.09.007


  • eng