International Journal of Public Health

, Volume 64, Issue 7, pp 1025–1036 | Cite as

Sex Differences in Comorbidity and Frailty in Europe

  • Linda Juel AhrenfeldtEmail author
  • Sören Möller
  • Mikael Thinggaard
  • Kaare Christensen
  • Rune Lindahl-Jacobsen
Original article



To examine sex differences in prevalent comorbidity and frailty across age and European regions.


This is a cross-sectional study based on 113,299 Europeans aged 50+ participating in the Survey of Health, Ageing and Retirement in Europe from 2004–2005 to 2015. Sex differences in the Comorbidity Index and the Frailty Phenotype were investigated using ordinal logistic regressions.


European women had generally higher odds of prevalent comorbidity (OR 1.11, 95% CI 1.07–1.15) and frailty (OR 1.56, 95% CI 1.51–1.62). Sex differences increased with advancing age. No overall sex difference in comorbidity was found in Western Europe, but women had more comorbidity than men in Eastern (OR 1.30, 95% CI 1.18–1.44), Southern (OR 1.23, 95% CI 1.15–1.30), and Northern (OR 1.08, 95% CI 1.01–1.16) Europe. Women were frailer than men in all regions, with the largest sex difference in Southern Europe (OR 1.84, 95% CI 1.72–1.96).


European women are frailer and have slightly more comorbidity than European men lending support for the male–female health survival paradox.


Sex differences Comorbidity Frailty Europe SHARE 



This paper uses data from SHARE Waves 1, 2, 4, 5 and 6, see Börsch-Supan et al. (2013) for methodological details (Börsch-Supan et al. 2013). 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: No. 211909, SHARE-LEAP: No. 227822, SHARE M4: No. 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

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interests.

Ethical approval

This study was part of the Survey of Health, Ageing and Retirement in Europe (SHARE), a cross-national panel database of microdata on health, socioeconomic status and social and family networks of more than 120,000 individuals aged 50 or older covering 27 European countries and Israel. The SHARE study is under continuous ethics review. Waves 1–4 were approved by the Ethics Committee of the University of Mannheim. Wave 4 and onwards were approved by the Ethics Council of the Max Planck Society for the Advancement of Science (MPG). Further information on SHARE is presented in Börsch-Supan et al. (2013) and Börsch-Supan and Jürges (2005) and on the SHARE webpage (

Informed consent

Written informed consent was obtained from all participants included in the study.

Supplementary material

38_2019_1270_MOESM1_ESM.docx (57 kb)
Supplementary material 1 (DOCX 57 kb)


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Copyright information

© Swiss School of Public Health (SSPH+) 2019

Authors and Affiliations

  • Linda Juel Ahrenfeldt
    • 1
    Email author
  • Sören Möller
    • 2
    • 3
  • Mikael Thinggaard
    • 1
    • 4
  • Kaare Christensen
    • 1
    • 4
    • 5
    • 6
  • Rune Lindahl-Jacobsen
    • 1
  1. 1.Epidemiology, Biostatistics and Biodemography, Department of Public HealthUniversity of Southern DenmarkOdense CDenmark
  2. 2.OPEN – Odense Patient Data Explorative Network, Odense University HospitalOdenseDenmark
  3. 3.Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
  4. 4.Danish Aging Research CenterUniversity of Southern DenmarkOdenseDenmark
  5. 5.Department of Clinical Biochemistry and PharmacologyOdense University HospitalOdenseDenmark
  6. 6.Department of Clinical GeneticsOdense University HospitalOdenseDenmark

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