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Men are more likely to suffer from heart disease, cancer, and stroke more than women do.<ref name=":3" /> These diseases are the main cause of the gender gap in life expectancy.<ref name="doi.org">Hossin, Muhammad Zakir. "The male disadvantage in life expectancy: can we close the gender gap?" International Health, ihaa106, https://doi.org/10.1093/inthealth/ihaa106 Published: 03 February 2021</ref>
Men are more likely to suffer from heart disease, cancer, and stroke more than women do.<ref name=":3" /> These diseases are the main cause of the gender gap in life expectancy.<ref name="doi.org">Hossin, Muhammad Zakir. "The male disadvantage in life expectancy: can we close the gender gap?" International Health, ihaa106, https://doi.org/10.1093/inthealth/ihaa106 Published: 03 February 2021</ref>


Despite men having more fatal conditions such as [[Ischemic Heart Disease|ischemic heart disease]], lung cancer, liver [[cirrhosis]], traffic accidents, and [[suicide]], women have more non-fatal [[acute (medicine)|acute]] and [[chronic condition]]s.<ref name=":3" /><ref>Chloe E. Bird, Patricia P. Rieker. [https://books.google.bs/books?id=3pNpyBMyO_MC&printsec=frontcover&dq=mortality+morbidity+paradox&hl=en&sa=X&ved=0ahUKEwioh4-I4LTgAhXst1kKHbV6CToQ6AEILTAB#v=onepage&q=mortality%20morbidity%20paradox&f=false "Gender and Health: The Effects of Constrained Choices and Social Policies"]. page 1.</ref><ref>{{cite journal |doi=10.1016/0277-9536(95)00335-5 |title=Gender differences in health: Are things really as simple as they seem? |journal=Social Science & Medicine |volume=42 |issue=4 |pages=617–624 |year=1996 |last1=MacIntyre |first1=Sally |last2=Hunt |first2=Kate |last3=Sweeting |first3=Helen |pmid=8643986 }}</ref><ref>{{cite journal |doi=10.1016/j.exger.2008.09.007 |pmid=18835429 |pmc=2703431 |title=Sex-specific health deterioration and mortality: The morbidity–mortality paradox over age and time |journal=Experimental Gerontology |volume=43 |issue=12 |pages=1052–1057 |year=2008 |last1=Kulminski |first1=Alexander M. |last2=Culminskaya |first2=Irina V. |last3=Ukraintseva |first3=Svetlana V. |last4=Arbeev |first4=Konstantin G. |last5=Land |first5=Kenneth C. |last6=Yashin |first6=Anatoli I. }}</ref> The majority of the female survival advantage is accounted for by differences in mortality rates between men and women ages 50–70 due to differing rates of [[cardiovascular disease]]s.<ref>{{cite journal|last1=Beltrán-Sánchez|first1=Hiram|last2=Finch|first2=Caleb E.|last3=Crimmins|first3=Eileen M.|year=2015|title=Twentieth century surge of excess adult male mortality|journal=Proceedings of the National Academy of Sciences|volume=112|issue=29|pages=8993–8998|bibcode=2015PNAS..112.8993B|doi=10.1073/pnas.1421942112|pmc=4517277|pmid=26150507}}</ref> While women report more symptoms and experience higher incidence of musculoskeletal and autoimmune disease, men have earlier and higher rates of cardiovascular diseases, after adjusting the data for the gap in [[life expectancy]].<ref name=":3" /> Other studies report women having higher rates of cardiovascular disease, while not accounting for women having longer life expectancy.<ref>{{Cite journal|date=March 2007|title=Gender differences in cardiovascular disease and comorbid depression|url=https://pubmed.ncbi.nlm.nih.gov/17506227/|journal=Dialogues in Clinical Neuroscience|language=en|volume=9|issue=1|pages=71–83|doi=10.31887/DCNS.2007.9.1/ammoeller|pmc=3181845|pmid=17506227}}</ref> A recent review found that women afflicted with coronary heart disease are generally older and have more cardiovascular risks than men with coronary heart disease. While men have nearly twice the incidence of coronary heart disease and related mortality, women experience more incidence at increasing age.<ref name="sciencedirect.com">{{Cite journal|date=2019-12-01|title=Gender differences in cardiovascular disease|url=https://www.sciencedirect.com/science/article/pii/S2590093519300256|journal=Medicine in Novel Technology and Devices|language=en|volume=4|pages=100025|doi=10.1016/j.medntd.2019.100025|issn=2590-0935}}</ref>
Despite men having more fatal conditions such as [[Ischemic Heart Disease|ischemic heart disease]], lung cancer, liver [[cirrhosis]], traffic accidents, and [[suicide]], women have more non-fatal [[acute (medicine)|acute]] and [[chronic condition]]s.<ref name=":3" /><ref>Chloe E. Bird, Patricia P. Rieker. [https://books.google.bs/books?id=3pNpyBMyO_MC&printsec=frontcover&dq=mortality+morbidity+paradox&hl=en&sa=X&ved=0ahUKEwioh4-I4LTgAhXst1kKHbV6CToQ6AEILTAB#v=onepage&q=mortality%20morbidity%20paradox&f=false "Gender and Health: The Effects of Constrained Choices and Social Policies"]. page 1.</ref><ref>{{cite journal |doi=10.1016/0277-9536(95)00335-5 |title=Gender differences in health: Are things really as simple as they seem? |journal=Social Science & Medicine |volume=42 |issue=4 |pages=617–624 |year=1996 |last1=MacIntyre |first1=Sally |last2=Hunt |first2=Kate |last3=Sweeting |first3=Helen |pmid=8643986 }}</ref><ref>{{cite journal |doi=10.1016/j.exger.2008.09.007 |pmid=18835429 |pmc=2703431 |title=Sex-specific health deterioration and mortality: The morbidity–mortality paradox over age and time |journal=Experimental Gerontology |volume=43 |issue=12 |pages=1052–1057 |year=2008 |last1=Kulminski |first1=Alexander M. |last2=Culminskaya |first2=Irina V. |last3=Ukraintseva |first3=Svetlana V. |last4=Arbeev |first4=Konstantin G. |last5=Land |first5=Kenneth C. |last6=Yashin |first6=Anatoli I. }}</ref> The majority of the female survival advantage is accounted for by differences in mortality rates between men and women ages 50–70 due to differing rates of [[cardiovascular disease]]s.<ref>{{cite journal|last1=Beltrán-Sánchez|first1=Hiram|last2=Finch|first2=Caleb E.|last3=Crimmins|first3=Eileen M.|year=2015|title=Twentieth century surge of excess adult male mortality|journal=Proceedings of the National Academy of Sciences|volume=112|issue=29|pages=8993–8998|bibcode=2015PNAS..112.8993B|doi=10.1073/pnas.1421942112|pmc=4517277|pmid=26150507}}</ref><ref>{{Cite journal|last=Eskes|first=Tom|last2=Haanen|first2=Clemens|date=2007|title=Why do women live longer than men?|url=https://linkinghub.elsevier.com/retrieve/pii/S0301211507000395|journal=European Journal of Obstetrics & Gynecology and Reproductive Biology|language=en|volume=133|issue=2|pages=126–133|doi=10.1016/j.ejogrb.2007.01.006}}</ref> While women report more symptoms and experience higher incidence of musculoskeletal and autoimmune disease, men have earlier and higher rates of cardiovascular diseases, after adjusting the data for the gap in [[life expectancy]].<ref name=":3" /> Other studies report women having higher rates of cardiovascular disease, while not accounting for women having longer life expectancy.<ref>{{Cite journal|date=March 2007|title=Gender differences in cardiovascular disease and comorbid depression|url=https://pubmed.ncbi.nlm.nih.gov/17506227/|journal=Dialogues in Clinical Neuroscience|language=en|volume=9|issue=1|pages=71–83|doi=10.31887/DCNS.2007.9.1/ammoeller|pmc=3181845|pmid=17506227}}</ref> A recent review found that women afflicted with coronary heart disease are generally older and have more cardiovascular risks than men with coronary heart disease. While men have nearly twice the incidence of coronary heart disease and related mortality, women experience more incidence at increasing age.<ref name="sciencedirect.com">{{Cite journal|date=2019-12-01|title=Gender differences in cardiovascular disease|url=https://www.sciencedirect.com/science/article/pii/S2590093519300256|journal=Medicine in Novel Technology and Devices|language=en|volume=4|pages=100025|doi=10.1016/j.medntd.2019.100025|issn=2590-0935}}</ref>


Women also have higher rates of [[autoimmune disorder]]s than men; one hypothesis for this is that testosterone facilitates immunosuppression in men, decreasing the likelihood men create autoantibodies that can target their own bodies, leading to autoimmune disease.<ref name=":3" />
Women also have higher rates of [[autoimmune disorder]]s than men; one hypothesis for this is that testosterone facilitates immunosuppression in men, decreasing the likelihood men create autoantibodies that can target their own bodies, leading to autoimmune disease.<ref name=":3" />
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== Female survival advantage ==
== Female survival advantage ==
Records of the female survival advantage can be traced back to the 18th century, but gained popularity and caught the eyes of researchers in the 19th century. Women outlive men for all age groups and every year for which reliable records exist.<ref>{{cite journal|last1=Austad|first1=Steven N.|last2=Bartke|first2=Andrzej|year=2015|title=Sex Differences in Longevity and in Responses to Anti-Aging Interventions: A Mini-Review|journal=Gerontology|volume=62|issue=1|pages=40–46|doi=10.1159/000381472|pmid=25968226|doi-access=free}}</ref> Specifically in "contemporary industrialized countries", female survival is 1.5-2.0 times higher than that of males.<ref name="Christensen 2001 175–183">{{Cite journal|last=Christensen|first=K.|last2=Orstavik|first2=K. H.|last3=Vaupel|first3=J. W.|date=2001|title=The X chromosome and the female survival advantage: an example of the intersection between genetics, epidemiology and demography|url=https://pubmed.ncbi.nlm.nih.gov/11797856|journal=Annals of the New York Academy of Sciences|volume=954|pages=175–183|issn=0077-8923|pmid=11797856}}</ref>
Records of the female survival advantage can be traced back to the 18th century, but gained popularity and caught the eyes of researchers in the 19th century. Women outlive men for all age groups and every year for which reliable records exist.<ref>{{cite journal|last1=Austad|first1=Steven N.|last2=Bartke|first2=Andrzej|year=2015|title=Sex Differences in Longevity and in Responses to Anti-Aging Interventions: A Mini-Review|journal=Gerontology|volume=62|issue=1|pages=40–46|doi=10.1159/000381472|pmid=25968226|doi-access=free}}</ref><ref>{{Cite journal|last=Thorslund|first=Mats|last2=Wastesson|first2=Jonas W.|last3=Agahi|first3=Neda|last4=Lagergren|first4=Mårten|last5=Parker|first5=Marti G.|date=2013|title=The rise and fall of women’s advantage: a comparison of national trends in life expectancy at age 65 years|url=http://link.springer.com/10.1007/s10433-013-0274-8|journal=European Journal of Ageing|language=en|volume=10|issue=4|pages=271–277|doi=10.1007/s10433-013-0274-8|issn=1613-9372|pmc=PMC3851807|pmid=24319404}}</ref> Specifically in "contemporary industrialized countries", female survival is 1.5-2.0 times higher than that of males.<ref name="Christensen 2001 175–183">{{Cite journal|last=Christensen|first=K.|last2=Orstavik|first2=K. H.|last3=Vaupel|first3=J. W.|date=2001|title=The X chromosome and the female survival advantage: an example of the intersection between genetics, epidemiology and demography|url=https://pubmed.ncbi.nlm.nih.gov/11797856|journal=Annals of the New York Academy of Sciences|volume=954|pages=175–183|issn=0077-8923|pmid=11797856}}</ref>


A female survival advantage is found in some, but not all species. Various explanations for this have been proposed but none are strongly supported.<ref>{{cite journal|last1=Austad|first1=Steven N.|year=2006|title=Why women live longer than men: Sex differences in longevity|journal=Gender Medicine|volume=3|issue=2|pages=79–92|doi=10.1016/S1550-8579(06)80198-1|pmid=16860268}}</ref> Most species studied for differences in morbidity and mortality between sexes show conditional sex differences in life span, with both male and females experiencing advantage depending on the species. In humans, females appear to have a consistent survival advantage. Women outlive men in 176 of 178 countries for which records are available, both at age 5 and at age 50.<ref name="Sex Differences in Lifespan">{{cite journal|last1=Austad|first1=Steven N.|last2=Fischer|first2=Kathleen E.|year=2016|title=Sex Differences in Lifespan|journal=Cell Metabolism|volume=23|issue=6|pages=1022–1033|doi=10.1016/j.cmet.2016.05.019|pmc=4932837|pmid=27304504}}</ref> In a study in the UK, men scoring higher "femininity scores", when compared to their more stereotypical "masculine" male counterparts, had lower death rates from hear disease, suggesting that masculine behavior increases the risk of premature mortality<ref name=":3" />
A female survival advantage is found in some, but not all species. Various explanations for this have been proposed but none are strongly supported.<ref>{{cite journal|last1=Austad|first1=Steven N.|year=2006|title=Why women live longer than men: Sex differences in longevity|journal=Gender Medicine|volume=3|issue=2|pages=79–92|doi=10.1016/S1550-8579(06)80198-1|pmid=16860268}}</ref> Most species studied for differences in morbidity and mortality between sexes show conditional sex differences in life span, with both male and females experiencing advantage depending on the species. In humans, females appear to have a consistent survival advantage. Women outlive men in 176 of 178 countries for which records are available, both at age 5 and at age 50.<ref name="Sex Differences in Lifespan">{{cite journal|last1=Austad|first1=Steven N.|last2=Fischer|first2=Kathleen E.|year=2016|title=Sex Differences in Lifespan|journal=Cell Metabolism|volume=23|issue=6|pages=1022–1033|doi=10.1016/j.cmet.2016.05.019|pmc=4932837|pmid=27304504}}</ref> In a study in the UK, men scoring higher "femininity scores", when compared to their more stereotypical "masculine" male counterparts, had lower death rates from hear disease, suggesting that masculine behavior increases the risk of premature mortality<ref name=":3" />

Revision as of 22:02, 30 July 2021

The male-female health-survival paradox, also known as the morbidity-mortality paradox or gender paradox, is the phenomenon in which women experience more medical conditions and disability during their lives, but they unexpectedly live longer than men.[1][2] This paradox, where women experience greater morbidity (diseases) but lower mortality (death) in comparison to men, is unusual since it is usually expected that experiencing a disease would likely increase the likelihood of death.[3] However, in this case, the population that experiences more disease and disability is the one that lives longer.

Background and History

Figure illustrating the biopsychosocial model for the male-female health-survival paradox.
Figure illustrating the three types of factors that may contribute to the male-female health-survival paradox: biology, psychology, and social factors.

The male-female health-survival paradox has been most reliably reported in literature and documented as far back as the 18th century in European historical records.[1][4] Some of the last records of European men outliving women are from the Netherlands in 1860 and Italy in 1889. The earliest records of European women outliving men were from Sweden in 1751, Denmark in 1835, and both England and Wales in 1841.[4] While women were documented to outlive men in Europe[1][4], data from 1887 through 1930 showed that females between ages 5 and 25 in Massachusetts disproportionately faced mortality due to infectious diseases.[5] With improvements in infectious disease prevention, treatment, and eradication of Smallpox around the 1970's, mortality rates declined in both sexes[4][5]. At this time, female life expectancy also peaked in the United States; females were expected to live eight years longer than males[5]. Since the 1970's, the life expectancy gap between females and males has been on the decline in the United States[5] and Western Europe[4].

Although more research needs to be completed, it is postulated that there is a "biopsychosocial" component which causes this paradox.[1] In other words, women and men differ in biological, behavioral, and social factors which causes the male-female health-survival paradox.[1]

Biopsychosocial factors that have been hypothesized to cause this paradox include genetics, hormone differences, immunological differences, reproduction, chronic diseases, disability, physiological reserve, risk-related activities, illness perception, health reporting behavior, health care utilization, gender roles, and social assets and deficits.[1][2][6]

Scholars relate the male-female health-survival paradox to the concept of frailty, which is the vulnerability that the aging population has to adverse health outcomes.[1] Such geriatric propensity to frailty is an emerging topic of research given new therapeutic interventions aimed at improving the health of the aging population, such as healthy nutrition, physical exercise, cognitive training, and multimodal interventions that encompass all of these components .[1]

Influential factors

Risk Factors and Behaviors

Different rates of alcohol and tobacco usage by men and women contribute to the paradox in developed countries.[1][2][4] More women abstain from alcohol for lifetime, drink less, and have less drinking problems in comparison to men. However, more women tend to have alcohol-related disorders and withdrawal symptoms due to differences in pharmacokinetics and sex hormones.[7]

It has also been stated that while men experience smoking-related conditions more than women, women have more trouble maintaining cessation than men.[8][2][9] However, a recent review showed mixed findings on smoking behavior, and that bio-psycho-social factors may be more impactful than gender differences. In addition, a higher proportion of men use alternative tobacco options to replace cigarettes, and gender-based comparisons may be skewed from failing to stratify randomization in treatment groups.[10][11][12]

Diseases

Men are more likely to suffer from heart disease, cancer, and stroke more than women do.[2] These diseases are the main cause of the gender gap in life expectancy.[13]

Despite men having more fatal conditions such as ischemic heart disease, lung cancer, liver cirrhosis, traffic accidents, and suicide, women have more non-fatal acute and chronic conditions.[2][14][15][16] The majority of the female survival advantage is accounted for by differences in mortality rates between men and women ages 50–70 due to differing rates of cardiovascular diseases.[17][18] While women report more symptoms and experience higher incidence of musculoskeletal and autoimmune disease, men have earlier and higher rates of cardiovascular diseases, after adjusting the data for the gap in life expectancy.[2] Other studies report women having higher rates of cardiovascular disease, while not accounting for women having longer life expectancy.[19] A recent review found that women afflicted with coronary heart disease are generally older and have more cardiovascular risks than men with coronary heart disease. While men have nearly twice the incidence of coronary heart disease and related mortality, women experience more incidence at increasing age.[20]

Women also have higher rates of autoimmune disorders than men; one hypothesis for this is that testosterone facilitates immunosuppression in men, decreasing the likelihood men create autoantibodies that can target their own bodies, leading to autoimmune disease.[2]

Most countries report higher rates of chronic kidney disease (CKD) in women compared to men[21]. However, the difference in CKD rates may be due to the longer life expectancy of women, as kidney function declines with age[21]. Although more women are diagnosed with CKD, among individuals diagnosed with CKD who are not on dialysis treatment, the men exhibit greater mortality rates compared to women. Studies investigating sex differences in kidney disease have suggested that men lose kidney function faster than women.[21] It is hypothesized that this may be due to the protective effects of oestrogens and the harmful effects of testosterone on the kidneys, or due to lifestyle differences between men and women.[22]

Overall, men and women are affected by mental disorders at similar rates, but men and women are diagnosed with different kinds of disorders at different rates. For example, men are more prone to experience substance abuse, whereas women are more prone to be diagnosed with depression and anxiety disorders.[23] An additional factor in male mortality is the gender differences in suicide - men are more likely to die from suicide despite suicide attempt rates being equal between genders.[24][25]

Social and biological factors

It has been concluded that sociological and biological factors both contribute to the paradox.[26]

Proposed explanations for the paradox range from genetic, e.g. two X chromosomes protecting against recessive genes; hormonal, e.g. estrogen protecting against cardiovascular diseases; and behavioral, e.g. the expectations around the female sex role making women more willing to seek medical help sooner.[2] Although studies have shown the protective effects of estrogen on cardiovascular health (i.e. by lowering LDL and increasing HDL) and brain cell health, there are doubts about the role of hormones due to mixed results in hormone replacement therapy studies on elderly women.[2] For instance, although lower levels of LDL may prevent atherosclerotic buildup which can lead to chronic heart disease, estrogen may overall elevate chronic heart disease in older women with advanced plaque buildup by causing thrombosis.[2]

It is also a possibility that the female hormone, estrogen, contributes to the female survival advantage.[27][28][2] In cutaneous melanoma, estrogen was evaluated to determine its effect on a steroid hormone-sensitive cancer. While no difference in survival was concluded between two genders due to limited data, women tend to have better prognosis due to the presence of estrogen receptor beta. However, this is a continued study that may be due to biological factors--such as immune response, inflammation, pharmacokinetics, or hormones--or from social factors--such as women tending to have more ultraviolet protection and frequent medical visits.[29]

There is also mixed evidence on the role of help-seeking and reporting behavior, with some studies reporting that women are more likely to seek and report medical treatment for all symptoms, while others report that women only tend to seek more treatment on malaise-type symptoms.[2]

Genetic and physiological factors

Women can store excess high-density lipoproteins, which most likely slows the progression of plaque growth.[30] Interestingly, calcium metabolism may contribute to the female mortality advantage. After age 35, where the human skeleton grows to its maximum size, calcium buildup increases significantly due to constant release from a deteriorating skeleton, less exercise for calcium release via sweating, and continued dietary intake. Consequently, excess calcium deposits in soft tissues, causing stiffening of arteries and higher blood pressure, thus cardiovascular disease.[31] For women, however, calcium influx can halt or be reversed during pregnancy and lactation. Women can also release calcium via menstrual cycle until menopause.[30]

Women additionally have lower mortality rates in high-mortality conditions like famine and epidemics. In such conditions, most of the advantage comes from differences in infant mortality rates.[32]

A research study conducted on flies indicated that the alleles that contribute to male inclusive fitness also harm female health, and thus contribute to the paradox.[33]

Psychological factors

A study conducted in the United States (US) consisting of 9,000 participants determined that women have a 1.5 times greater risk of experiencing a mood disorder compared to men.[34] Additionally, a 2006 study examining mental health in New Zealand found that lifetime rates for major depression are higher in women (20.3%) compared to men (11.4%).[34] Not only do women experiences a greater preponderance of depression compared to men, they also experience greater severity of symptoms.[35][36] The symptoms that women experienced with greater severity included weight gain and increased appetite, greater interpersonal sensitivity, and reduced energy[37]. Women also experience onset of depression at an earlier age, and experience more years of depression when compared to men.[38]

Female survival advantage

Records of the female survival advantage can be traced back to the 18th century, but gained popularity and caught the eyes of researchers in the 19th century. Women outlive men for all age groups and every year for which reliable records exist.[39][40] Specifically in "contemporary industrialized countries", female survival is 1.5-2.0 times higher than that of males.[41]

A female survival advantage is found in some, but not all species. Various explanations for this have been proposed but none are strongly supported.[42] Most species studied for differences in morbidity and mortality between sexes show conditional sex differences in life span, with both male and females experiencing advantage depending on the species. In humans, females appear to have a consistent survival advantage. Women outlive men in 176 of 178 countries for which records are available, both at age 5 and at age 50.[43] In a study in the UK, men scoring higher "femininity scores", when compared to their more stereotypical "masculine" male counterparts, had lower death rates from hear disease, suggesting that masculine behavior increases the risk of premature mortality[2]

The female survival advantage holds true among humans, but the same can not be said for baboons[44][43] and birds.[45] In a study conducted on Amboseli baboons, it was found that although females outlive their male counterparts similar to humans, both sexes had either similar rates of age-related declines in health, or greater health declines in males compared to females.[44] In another study focused on Eurasian Blackbirds found lower survival in females due to more passive phenotypes that increased predation susceptibility.[45]

A significant biological factor that may contribute to the female survival advantage is the difference in sex chromosome composition in males and females. The male sex is biologically defined by having one Y sex chromosome, and are heterogametic. While, females only have X chromosomes. Typically females have two X chromosomes, one active and one inactive, that can compensate one another for X chromosome gene mutations. In a longitudinal study following identical female twins and changes in X chromosome inactivation, skewed X chromosome inactivation patterns present at later stages of life suggested homologous sex chromosomes to benefit survival. Without multiple X chromosomes, males are more susceptible to X-linked diseases, or the effects of X chromosome mutations. These X-linked diseases include color blindness, hemophilia, and Duchenne's muscular dystrophy.[41]

Male morbidity advantage

Although males experience greater mortality, they appear to have the advantage of lower morbidity. Women tend to report poorer health and more hospital visits than men.[46] Women also have a greater tendency to develop psychological disorders compared to men.[2] Women spend more years in good health than men, however, women spend more years in poor health than men as a proportion of their life expectancy. This implies that the male morbidity advantage is linked to the female survival advantage.[13]

Potential bias

Data collected from a research study in Denmark indicated that the paradox is likely due, in part, to selection bias.[47] Women have higher preferences for absenteeism. On average, they are absent from work for health reasons more often than men, including when they do not have objectively worse health.[48]

It may also be a possibility that under-reporting and selective non-participation of health problems, and delaying medical attention and treatment may make it appear that men have less medical problems than women.[2] Misperceptions, such as women being more protected from cardiovascular diseases, may contribute to the morbidity-mortality paradox; women tend to have less aggressive treatment regiments, shown by having lower diagnostic angiograms and interventional procedures when compared to men.[20]

Researchers also suggest that because men have been shown to have an increased likelihood of suddenly dying, women may appear to have higher incidence of morbidity when surveyed in research studies; in other words, women tend to outlive men, and the women carry diseases that are counted as morbidity in studies while men die earlier from these morbidities and leave healthier male counterparts in the study, which makes it appear that they have lower morbidity than women.[4] However, in a systematic review encompassing over 37,000 adults from developed and developing countries, this confounder appearred to be discredited since women experienced higher frailty index scores (used as a surrogate to measure morbidity) than males for any age group.[6]

References

  1. ^ a b c d e f g h i Gordon, Emily H; Hubbard, Ruth E (2020). "Differences in frailty in older men and women". Medical Journal of Australia. 212 (4): 183–188. doi:10.5694/mja2.50466. ISSN 0025-729X.
  2. ^ a b c d e f g h i j k l m n o p Oksuzyan, Anna; Juel, Knud; Vaupel, James W.; Christensen, Kaare (2008). "Men: good health and high mortality. Sex differences in health and aging". Aging Clinical and Experimental Research. 20 (2): 91–102. doi:10.1007/BF03324754. ISSN 1594-0667.
  3. ^ Gordon, Emily H.; Hubbard, Ruth E. (2020). "Differences in frailty in older men and women". Medical Journal of Australia. 212 (4): 183–188. doi:10.5694/mja2.50466. ISSN 1326-5377.
  4. ^ a b c d e f g Mary, Barford, Anna Dorling, Danny Smith, George Davey Shaw,. Life expectancy: women now on top everywhere: During 2006, even in the poorest countries, women can expect to outlive men. BMJ Publishing Group Ltd. OCLC 679204411.{{cite book}}: CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link) Cite error: The named reference ":8" was defined multiple times with different content (see the help page).
  5. ^ a b c d "XX > XY?: The changing female advantage in life expectancy". Journal of Health Economics. 67: 102224. 2019. doi:10.1016/j.jhealeco.2019.102224. ISSN 0167-6296.
  6. ^ a b Gordon, E.H.; Peel, N.M.; Samanta, M.; Theou, O.; Howlett, S.E.; Hubbard, R.E. (2017). "Sex differences in frailty: A systematic review and meta-analysis". Experimental Gerontology. 89: 30–40. doi:10.1016/j.exger.2016.12.021.
  7. ^ Erol, Almila; Karpyak, Victor M. (November 2015). "Sex and gender-related differences in alcohol use and its consequences: Contemporary knowledge and future research considerations". Drug and Alcohol Dependence. 156: 1–13. doi:10.1016/j.drugalcdep.2015.08.023.
  8. ^ Case, Anne; Paxson, Christina H. (2005). "Sex Differences in Morbidity and Mortality" (PDF). Demography. 42 (2): 189–214. doi:10.1353/dem.2005.0011. JSTOR 4147343. PMID 15986983. S2CID 1112587.
  9. ^ "Sex/gender differences in smoking cessation: A review". Preventive Medicine. 92: 135–140. 2016-11-01. doi:10.1016/j.ypmed.2016.07.013. ISSN 0091-7435.
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