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Review
, 65 (1), 135-145

Differences Between Men and Women in Mortality and the Health Dimensions of the Morbidity Process

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Review

Differences Between Men and Women in Mortality and the Health Dimensions of the Morbidity Process

Eileen M Crimmins et al. Clin Chem.

Abstract

Background: Do men have worse health than women? This question is addressed by examining sex differences in mortality and the health dimensions of the morbidity process that characterize health change with age. We also discuss health differences across historical time and between countries.

Content: Results from national-level surveys and data systems are used to identify male/female differences in mortality rates, prevalence of diseases, physical functioning, and indicators of physiological status. Male/female differences in health outcomes depend on epidemiological and social circumstances and behaviors, and many are not consistent across historical time and between countries. In all countries, male life expectancy is now lower than female life expectancy, but this was not true in the past. In most countries, women have more problems performing instrumental activities of daily living, and men do better in measured performance of functioning. Men tend to have more cardiovascular diseases; women, more inflammatory-related diseases. Sex differences in major cardiovascular risk factors vary between countries-men tend to have more hypertension; women, more raised lipids. Indicators of physiological dysregulation indicate greater inflammatory activity for women and generally higher cardiovascular risk for men, although women have higher or similar cardiovascular risk in some markers depending on the historical time and country.

Summary: In some aspects of health, men do worse; in others, women do worse. The lack of consistency across historical times and between countries in sex differences in health points to the complexity and the substantial challenges in extrapolating future trends in sex differences.

Conflict of interest statement

Authors’ Disclosures or Potential Conflicts of Interest: Upon manuscript submission, all authors completed the author disclosure form. Disclosures and/or potential conflicts of interest:

Employment or Leadership: None declared.

Consultant or Advisory Role: None declared.

Stock Ownership: None declared.

Honoraria: None declared.

Expert Testimony: None declared.

Patents: None declared.

Figures

Fig. 1.
Fig. 1.. Dimensions of the morbidity process.
Dimensions indicate time patterns of aspects of change in health with age at the population level. Reproduced with permission from Crimmins et al. (3).
Fig. 2.
Fig. 2.. Male and female life expectancy in 1960 and 2016 (198 countries).
Each dot represents male and female life expectancy in an individual country; the line indicates equal life expectancy. Source of data: The World Bank Life Expectancy at Birth, Male and Female (available from https://data.worldbank.org/indicator/SP.DYN.LE00.IN).
Fig. 3.
Fig. 3.. Odds ratios and regression coefficients of effect of being a woman on functioning difficulties and performance.
(A and B), odds ratios (ORs) indicating effect of being a woman on self-reports of functioning difficulties: ADL and IADL (population age, ≥50 years). (C and D), regression coefficients indicating effect of being a woman on measured functioning performance (population age, ≥50 years): grip strength and gait speed. ADL is the ability to bathe, dress, eat, toilet, get in and out of a bed, and to walk across a room; IADL is the ability to make telephone calls, take medications, manage money, prepare a hot meal, shop for groceries, and use a map to figure out how to get around in a strange place. IADLs also include doing work around the house or garden in SHARE and community activities and concentration for 10 minutes instead of medication and managing money in SAGE. Grip strength, average of 2 or 3 trials in kilograms; gait speed, timed walk in seconds over 2 trials. Vertical line represents equality of men and women. Source of data (A and B): Odds ratios from logistic regressions of age on ADL and IADL; China, CHARLS (2011); Korea, KLoSA (2010); India and Russia, WHO SAGE (2007–2010); SHARE (2004), HRS (2004), and ELSA (2004) from Crimmins et al. (25); (C and D): Coefficients from Wheaton and Crimmins (26).
Fig. 3.
Fig. 3.. Odds ratios and regression coefficients of effect of being a woman on functioning difficulties and performance.
(A and B), odds ratios (ORs) indicating effect of being a woman on self-reports of functioning difficulties: ADL and IADL (population age, ≥50 years). (C and D), regression coefficients indicating effect of being a woman on measured functioning performance (population age, ≥50 years): grip strength and gait speed. ADL is the ability to bathe, dress, eat, toilet, get in and out of a bed, and to walk across a room; IADL is the ability to make telephone calls, take medications, manage money, prepare a hot meal, shop for groceries, and use a map to figure out how to get around in a strange place. IADLs also include doing work around the house or garden in SHARE and community activities and concentration for 10 minutes instead of medication and managing money in SAGE. Grip strength, average of 2 or 3 trials in kilograms; gait speed, timed walk in seconds over 2 trials. Vertical line represents equality of men and women. Source of data (A and B): Odds ratios from logistic regressions of age on ADL and IADL; China, CHARLS (2011); Korea, KLoSA (2010); India and Russia, WHO SAGE (2007–2010); SHARE (2004), HRS (2004), and ELSA (2004) from Crimmins et al. (25); (C and D): Coefficients from Wheaton and Crimmins (26).
Fig. 4.
Fig. 4.. Odds ratios indicating effect of being a woman on presence of disease or condition (population age, ≥50 years).
Odds ratios from logistic regressions of sex and age on the presence of condition; vertical line indicates equality for men and women. Source of data: China, CHARLS (2011); Korea, KLoSA (2010); India and Russia, WHO SAGE (2007–2010); SHARE (2004), HRS (2004), and ELSA (2004) from Crimmins et al. (25).
Fig. 5.
Fig. 5.. Percentage of men and women with high-risk levels of fasting glucose and high blood pressure and mean total cholesterol in individual countries.
Note: Each dot represents the percentage or mean level for men and women in an individual country. The number of countries is 191 for blood glucose and blood pressure (age, ≥18 years) and 189 countries for cholesterol (age, ≥25 years). All numbers are age-standardized. Source of data: WHO Global Health Observatory Data Repository (available from http://apps.who.int/gho/data/node.main.A867?lang-en). To convert cholesterol concentrations in mmol/L to mg/dL, multiply by 38.67.

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