European Journal of Epidemiology

, Volume 29, Issue 4, pp 243–252 | Cite as

Sex differences in health and mortality in Moscow and Denmark

  • A. OksuzyanEmail author
  • M. Shkolnikova
  • J. W. Vaupel
  • K. Christensen
  • V. M. Shkolnikov


In high income countries females outlive men, although they generally report worse health, the so-called male–female health-survival paradox. Russia has one of the world’s largest sex difference in life expectancy with a male disadvantage of more than 10 years. We compare components of the paradox between Denmark and Moscow by examining sex differences in mortality and several health measures. The Human Mortality Database and the Russian Fertility and Mortality Database were used to examine sex differences in all-cause death rates in Denmark, Russia, and Moscow in 2007–2008. Self-reported health data were obtained from the Study of Middle-Aged Danish Twins (n = 4,314), the Longitudinal Study of Aging Danish Twins (n = 4,731), and the study of Stress, Aging, and Health in Russia (n = 1,800). In both Moscow and Denmark there was a consistent female advantage at ages 55–89 years in survival and a male advantage in self-rated health, physical functioning, and depression symptomatology. Only on cognitive tests males performed similarly to or worse than women. Nevertheless, Muscovite males had more than twice higher mortality at ages 55–69 years compared to Muscovite women, almost double the ratio in Denmark. The present study showed that despite similar directions of sex differences in health and mortality in Moscow and Denmark, the male–female health-survival paradox is very pronounced in Moscow suggesting a stronger sex-specific disconnect between health indicators and mortality among middle-aged and young-old Muscovites.


Sex differences Cross-national comparison Health Mortality Russia Denmark 



The study was supported by the US National Institute of Health, P01AG031719, and the VELUX foundation. SAHR was funded by the National Institute on Aging (Grant Number R01AG026786). None had any role in the design, execution, analysis, and interpretation of data, or writing of the study. Vladimir Shkolnikov was partly funded by the Dynasty Foundation (Russia). We are grateful to Evgeny Andreev at the New Economic School in Moscow, and Alexander Deev at the National Research Center for Preventive Medicine (NRCPM) in Moscow for massive data cleaning and processing, to Svetlana Shalnova at the NRCPM for major contributions to the collection, handling and processing various biological markers and for her help in ensuring the quality of these data, and to Viktoria Metelskaya at the NRCPM for providing consultation on the biochemical measurements.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

The study involves secondary data analysis existing survey data. The LSADT and MADT have been through review and are approved by the ethical committee assigned through the Danish National Committee on Biomedical Research and the Danish Data Protection Agency. The SAHR was approved by the Ethical Committee of the State Research Centre for Preventive Medicine, Moscow, Russia and the Institutional Review Board at Duke University, Durham, USA.

Supplementary material

10654_2014_9893_MOESM1_ESM.docx (42 kb)
Supplementary material 1 (DOCX 42 kb)


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Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • A. Oksuzyan
    • 1
    • 2
    Email author
  • M. Shkolnikova
    • 2
    • 3
  • J. W. Vaupel
    • 1
    • 2
  • K. Christensen
    • 1
    • 4
    • 5
    • 6
  • V. M. Shkolnikov
    • 1
    • 7
  1. 1.Max Planck Odense Center on the Biodemography of AgingOdenseDenmark
  2. 2.Max Planck Institute for Demographic ResearchRostockGermany
  3. 3.Federal Arrhythmia CentreMoscow Institute of Pediatry and SurgeryMoscowRussian Federation
  4. 4.Institute of Public HealthUniversity of Southern DenmarkOdenseDenmark
  5. 5.Department of Clinical GeneticsOdense University HospitalOdense CDenmark
  6. 6.Department of Clinical Biochemistry and PharmacologyOdense University HospitalOdense CDenmark
  7. 7.New Economic SchoolMoscowRussian Federation

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