Objectives

We explored the male-female health-survival paradox in the context of health expectancy (HE) at age 65 and thereafter, using three different morbidity measures and different severity cut-offs with and without adjustments for the share of nursing home residents.

Methods

HE at ages 65, 70, 75, 80, and 85 was estimated with the Sullivan method, linking morbidity prevalence from the KORA (Cooperative Health Research in the Region of Augsburg)-Age study to 2016 Bavarian mortality data. Morbidity measures comprised deficit accumulation (Frailty Index, FI, cut-offs 0.08 and 0.25), disability (Health Assessment Questionnaire-Disability Index, HAQ-DI, cut-off >0) and participation (Global Activity Limitation Indicator, GALI, “limited” vs “not limited”).

Results

Morbidity data were available for 4083 participants (52.7% female). HE was lower in women than in men at all ages. Differences in morbidity prevalence, absolute HE, and health proportions of life expectancy (relative HE) increased with age for FI ≥ 0.25 and GALI, but not for HAQ-DI > 0 and FI > 0.08. Accounting for the share of nursing home residents resulted in a slight reduction of HE estimates but had no impact on estimated sex differences.

Conclusions

In HE at age 65 and thereafter, women's health disadvantage was larger than their life expectancy advantage over men.

中文翻译：

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寿命更长但健康程度较低：女性在预期健康方面的劣势。KORA ¹ -Age研究的结果

目标

我们探讨了在65岁及以后的健康预期（HE）背景下的男女健康生存悖论，使用了三种不同的发病率指标和不同的严重性临界值，并调整了疗养院居民的比例。

方法

使用Sullivan方法估算了65、70、75、80和85岁的HE，将KORA（奥格斯堡地区合作健康研究）-年龄研究的发病率与2016年巴伐利亚州的死亡率数据联系起来。发病率指标包括赤字积累（脆弱指数，FI，临界值0.08和0.25），残疾（健康评估问卷-残疾指数，HAQ-DI，临界值> 0）和参与（全球活动限制指标，GALI，“有限”和“不受限制”）。

结果

有4083名参与者（女性占52.7％）的发病率数据。所有年龄段的女性中，HE均低于男性。FI≥0.25和GALI的发病率，绝对HE和预期寿命的健康比例（相对HE）的差异随年龄增加而增加，但HAQ-DI> 0和FI> 0.08则没有。考虑到疗养院居民的份额，HE估计数略有减少，但对估计的性别差异没有影响。

结论

在65岁及之后的高等教育中，女性的健康劣势大于男性的预期寿命优势。