Abstract
There is consistent evidence that women live longer than men at all ages, but spend a higher proportion of their total life expectancy in poorer health, a phenomenon described as the “male-female health-survival paradox” or the “gender paradox in health and mortality”. However, it is difficult to explain the process because morbidity by sex differs considerably across domains of health, age groups, social contexts and severity level. In addition, women and men report differently their health in surveys, making it cumbersome to understand whether what drives the paradox is a higher female morbidity or male mortality, a different reporting behaviour, or all of those aspects together. The aim of this chapter is to demonstrate the magnitude of those differences in Europe using different health domain indicators (activity limitation, chronic morbidity and self-perceived health) from the EHEMU Information System and the reporting behaviour by sex from the SHARE survey vignettes.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
For a full description of the survey please refer to https://ec.europa.eu/eurostat/web/microdata/european-union-statistics-on-income-and-living-conditions
- 2.
Nonetheless, one must account for the fact that issues with harmonization still persist and that the survey excludes the institutionalized population.
- 3.
Member states of EU15 are Belgium, Denmark, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain and United Kingdom, Austria, Finland and Sweden. By July 2013 the number of states increased to 28, with the inclusion of several eastern European countries (Cyprus, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Malta, Poland, Slovakia, Slovenia, Bulgaria, Romania, and Croatia) to form the EU28.
- 4.
See Börsch-Supan and Jürges (2005) for methodological documentation about the survey.
- 5.
See full list of SHARE vignettes in http://www.share-project.org/data-documentation/questionnaires/questionnaire-wave-1.html
- 6.
The subsample of the SHARE respondents was further subdivided into two groups which received different questionnaire versions A and B. The questions of these survey variants differ only in the gender of the vignette characters, whereas the described health conditions are identical. For instance, the vignette story “Paul has a headache once a month that is relieved after taking a pill. During the headache he can carry on with his day-to-day affairs” from survey version A appears in version B for the vignette character Karen. We refrained from analyzing the vignettes assessments by gender of the vignette characters and separated the answers of female and male survey respondents only by domain and severity of the health condition.
- 7.
The distribution of the vignettes in less severe, intermediate and more severe health conditions presents some exceptions. For the health domain “sleeping difficulties” and for the limitations in the amount and kind of work “because of pain” two vignettes present conditions that are classified in-between intermediate and more severe.
References
Aden, A. S., Omar, M. M., Omar, H. M., et al. (1997). Excess female mortality in rural Somalia – Is inequality in the household a risk factor? Social Science & Medicine, 44, 709–715. https://doi.org/10.1016/S0277-9536(96)00229-8.
Arber, S., & Cooper, H. (1999). Gender differences in health in later life: The new paradox? Social Science & Medicine, 48, 61–76. https://doi.org/10.1016/S0277-9536(98)00289-5.
Auspurg, K., & Hinz, T. (2015). Factorial survey experiments. Los Angeles: Sage.
Barford, A. (2006). Life expectancy: Women now on top everywhere. BMJ, 332, 808–808. https://doi.org/10.1136/bmj.332.7545.808.
Beckett, L. A., Brock, D. B., Lemke, J. H., et al. (1996). Analysis of change in self-reported physical function among older persons in four population studies. American Journal of Epidemiology, 143, 766–778.
Berger, N., Robine, J.-M., Ojima, T., et al. (2016). Harmonising summary measures of population health using global survey instruments. Journal of Epidemiology and Community Health, 70, 1039–1044. https://doi.org/10.1136/jech-2015-206870.
Börsch-Supan, A. (2018). Survey of Health, Ageing and Retirement in Europe (SHARE) Wave 1. Release version: 611 SHARE-ERIC Data set: https://doi.org/10.6103/SHARE.w1.611
Börsch-Supan, A., & Jürges, H. (2005). The survey of health, ageing and retirement in Europe – Methodology. Mannheim: Mannheim Research Institute for the Economics of Aging.
Börsch-Supan, A., Brandt, M., Hunkler, C., et al. (2013). Data resource profile: The Survey of Health, Ageing and Retirement in Europe (SHARE). International Journal of Epidemiology, 42, 992–1001. https://doi.org/10.1093/ije/dyt088.
Case, A., & Paxson, C. (2005). Sex differences in morbidity and mortality. Demography, 42, 189–214. https://doi.org/10.2307/4147343.
Crimmins, E. M., Kim, J. K., & Hagedorn, A. (2002). Life with and without disease: Women experience more of both. Journal of Women & Aging, 14, 47–59. https://doi.org/10.1300/J074v14n01_04.
Deeg, D. J. H., & Bath, P. A. (2003). Self-rated health, gender, and mortality in older persons: Introduction to a special section. Gerontologist, 43, 369–371. https://doi.org/10.1093/geront/43.3.369.
Deparcieux, A. (1746). Essai sur les probabilités de la durée de la vie humaine. D’où l’on déduit la maniere de déterminer les rentes viagères, tant simples qu’en Tontines. Précédé d’une courte explication sur les rentes à terme, ou annuités. Frčres Guerin, Paris.
Dowd, J. B., & Todd, M. (2011). Does self-reported health Bias the measurement of health inequalities in U.S. adults? Evidence using anchoring vignettes from the health and retirement study. The Journals of Gerontology Series B, 66B, 478–489. https://doi.org/10.1093/geronb/gbr050.
Frederiksen, H., Hjelmborg, J., Mortensen, J., et al. (2006). Age trajectories of grip strength: Cross-sectional and longitudinal data among 8,342 Danes aged 46 to 102. Annals of Epidemiology, 16, 554–562. https://doi.org/10.1016/j.annepidem.2005.10.006.
Galdas, P. M., Cheater, F., & Marshall, P. (2005). Men and health help-seeking behaviour: Literature review. Journal of Advanced Nursing, 49, 616–623. https://doi.org/10.1111/j.1365-2648.2004.03331.x.
Gorman, B. K., & Read, J. G. (2006). Gender disparities in adult health: An examination of three measures of morbidity. Journal of Health and Social Behavior, 47, 95–110. https://doi.org/10.1177/002214650604700201.
Green, C. A., & Pope, C. R. (1999). Gender, psychosocial factors and the use of medical services: A longitudinal analysis. Social Science & Medicine, 48, 1363–1372. https://doi.org/10.1016/S0277-9536(98)00440-7.
Grol-Prokopczyk, H., Verdes-Tennant, E., McEniry, M., et al. (2015). Promises and pitfalls of anchoring vignettes in health survey research. Demography, 52, 1703–1728. https://doi.org/10.1007/s13524-015-0422-1.
Grundy, E. (2006). Gender and healthy aging. In: Longer life and healthy aging (pp. 173–199).
Jagger, C., Van Oyen, H., & Robine, J. (2014). Health expectancy calculation by the Sullivan method: A practical guide (pp. 1–40). Newcastle upon Tyne: Newcastle University Isntitute Ageing.
Kersseboom, W. (1737). Vertoog van 6 May 1737, bewijzende dat de faculteit om de renten in t’Hollands negotiatie, bij wege van loterije van obligation en renten, te mogen nemen op lijven bij verkiezingen zonder eenige distinctie geen nadeel aan den lande heeft kunnen toebrengen.
Kersseboom, W. (1740). Observatien, waar in voornamentlyk getoont word wat is gelyktydigheid, dewelke vereischt word in alle calculatien, die tot voorwerp hebben de probable leevenskracht van persoonen van eenigen voorgestelden ouderdom. Hier is bygevoegt een proeve van de cons.
King, G., Murray, C. J. L., Salomon, J. A., et al. (2004). Enhancing the validity and cross-cultural comparability of measurement in survey research. The American Political Science Review, 98, 191–207.
Kulminski, A. M., Culminskaya, I. V., Ukraintseva, S. V., et al. (2008). Sex-specific health deterioration and mortality: The morbidity-mortality paradox over age and time. Experimental Gerontology, 43, 1052–1057. https://doi.org/10.1016/j.exger.2008.09.007.
Lorber, J., & Moore, L. J. (2002). Gender and the social construction of illness. Lanham: Rowman & Littlefield.
Luy, M. (2003). Causes of male excess mortality: Insights from cloistered populations. Population and Development Review, 29, 647–676. https://doi.org/10.1111/j.1728-4457.2003.00647.x.
Luy, M. (2016). The impact of biological factors on sex differences in life expectancy: Insights gained from a natural experiment. In M. Dinges & A. Weigl (Eds.), Gender-specific life expectancy in Europe 1850–2010 (pp. 17–46). Stuttgart: Steiner.
Luy, M., & Minagawa, Y. (2014). Gender gaps–life expectancy and proportion of life in poor health. Health Reports, 25, 12–19.
Macintyre, S. (1993). Gender differences in the perceptions of common cold symptoms. Social Science & Medicine, 36, 15–20.
Mathers, C. D. (2002). Health expectancies: An overview and critical appraisal. Summary measures of population health concepts, ethics, measurement and applications (pp. 177–204). Geneva: World Health Organization.
Molina, T. (2016). Reporting heterogeneity and health disparities across gender and education levels: Evidence from four countries. Demography, 53, 295–323. https://doi.org/10.1007/s13524-016-0456-z.
Nusselder, W. J., & Looman, C. W. (2004). Decomposition of differences in health expectancy by cause. Demography, 41, 315–334.
Nusselder, W. J., Looman, C. W. N., Van Oyen, H., et al. (2010). Gender differences in health of EU10 and EU15 populations: The double burden of EU10 men. European Journal of Ageing, 7, 219–227. https://doi.org/10.1007/s10433-010-0169-x.
Oksuzyan, A., Petersen, I., Stovring, H., et al. (2009). The male–female health–survival paradox: A survey and register study of the impact of sex-specific selection and information Bias. Annals of Epidemiology, 19, 504–511. https://doi.org/10.1016/j.annepidem.2009.03.014.
Oksuzyan, A., Gumà, J., & Doblhammer, G. (2018). Sex differences in health and survival. In A demographic perspective on gender, family and health in Europe (pp. 65–100). Cham: Springer.
Redondo-Sendino, Á., Guallar-Castillón, P., Banegas, J., et al. (2006). Gender differences in the utilization of health-care services among the older adult population of Spain. BMC Public Health, 6, 155. https://doi.org/10.1186/1471-2458-6-155.
Rieker, P. P., & Bird, C. E. (2005). Rethinking gender differences in health: Why we need to integrate social and biological perspectives. The Journals of Gerontology Series B, Psychological Science and Social Science, 60B, 40–47. https://doi.org/10.1093/geronb/60.Special_Issue_2.S40.
Robine, J.-M. (2006). Summarizing health status. In D. Pencheon, C. Guest, D. Melzer, & J. A. Muir Gray (Eds.), Oxford handbook of public health practice (pp. 160–168). New York: OUP.
Robine, J.-M., Jagger, C., & Romieu, I. (2001). Disability-free life expectancies in the European Union countries: Calculation and comparisons. Genus, 57, 89–101. https://doi.org/10.2307/29788693.
Roe, C. M., McNamara, A. M., & Motheral, B. R. (2002). Gender- and age-related prescription drug use patterns. The Annals of Pharmacotherapy, 36, 30–39. https://doi.org/10.1345/aph.1A113.
Spiers, N., Jagger, C., Clarke, M., & Arthur, A. (2003). Are gender differences in the relationship between self-rated health and mortality enduring? Results from three birth cohorts in Melton Mowbray, United Kingdom. Gerontologist, 43, 406–411. https://doi.org/10.1093/geront/43.3.406.
Struyck, N. (1740). Inleiding tot de Algemeene Geographie, benevens eenige sterrekundige en andere Verhandelingen.
Sullivan, D. (1971). A single index of mortality and morbidity. HSMHA Health Reports, 86, 347–354.
Tabutin, D. (1978). La surmortalité féminine en Europe avant 1940. Population (French Ed), 33, 121. https://doi.org/10.2307/1531720.
Van Oyen, H., Nusselder, W., Jagger, C., et al. (2013). Gender differences in healthy life years within the EU: An exploration of the “health–survival” paradox. International Journal of Public Health, 58, 143–155. https://doi.org/10.1007/s00038-012-0361-1.
Verbrugge, L. M. (1982). Sex differentials in health. Public Health Reports, 97, 417–437.
Verbrugge, L. M. (1985). Gender and health: An update on hypotheses and evidence. Journal of Health and Social Behavior, 26, 156. https://doi.org/10.2307/2136750.
Verbrugge, L. M., & Wingard, D. L. (1987). Sex differentials in health and mortality. Women & Health, 12, 103–145. https://doi.org/10.1300/J013v12n02_07.
Waldron, I. (1983a). The role of genetic and biological factors in gender differences in mortality. In A. D. Lopez & L. T. Ruzicka (Eds.), Gender differentials in mortality: Trends, determinants and consequences (pp. 141–164). Canberra: Australian National University Press.
Waldron, I. (1983b). Sex differences in human mortality: The role of genetic factors. Social Science & Medicine, 17, 321–333. https://doi.org/10.1016/0277-9536(83)90234-4.
Wingard, D. L. (1982). The sex differential in morbidity, mortality, and lifestyle. American Journal of Epidemiology, 115, 205–216. https://doi.org/10.1146/annurev.pu.05.050184.002245.
Wingard, D. L. (1984). The sex differential in morbidity, mortality, and lifestyle. Annual Review of Public Health, 5, 433–458. https://doi.org/10.1146/annurev.pu.05.050184.002245.
Yokota, R. T. C., Nusselder, W. J., Robine, J.-M., et al. (2019). Contribution of chronic conditions to gender disparities in health expectancies in Belgium, 2001, 2004 and 2008. European Journal of Public Health, 29, 82–87. https://doi.org/10.1093/eurpub/cky105.
Acknowledgements
This work was supported by the European Research Council, within the European Community’s Seventh Framework Programme (FP7/2007–2013), ERC Grant Agreement No. 262663 (HEMOX) and within the EU Framework Programme for Research and Innovation Horizon 2020, ERC Grant Agreement No. 725187 (LETHE).
The SHARE data collection has been primarily funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812) and FP7 (SHARE-PREP: N°211909, SHARE-LEAP: N°227822, SHARE M4: N°261982). Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the U.S. National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C) and from various national funding sources is gratefully acknowledged (see www.share-project.org).
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Di Lego, V., Di Giulio, P., Luy, M. (2020). Gender Differences in Healthy and Unhealthy Life Expectancy. In: Jagger, C., Crimmins, E.M., Saito, Y., De Carvalho Yokota, R.T., Van Oyen, H., Robine, JM. (eds) International Handbook of Health Expectancies. International Handbooks of Population, vol 9. Springer, Cham. https://doi.org/10.1007/978-3-030-37668-0_11
Download citation
DOI: https://doi.org/10.1007/978-3-030-37668-0_11
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-37666-6
Online ISBN: 978-3-030-37668-0
eBook Packages: Social SciencesSocial Sciences (R0)