Sex Differences in Comorbidity and Frailty in Europe

Abstract

Objectives

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

Methods

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.

Results

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).

Conclusions

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

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Fig. 1

References

  1. Ahrenfeldt LJ, Lindahl-Jacobsen R, Rizzi S, Thinggaard M, Christensen K, Vaupel JW (2018a) Comparison of cognitive and physical functioning of Europeans in 2004–05 and 2013. Int J Epidemiol. https://doi.org/10.1093/ije/dyy094

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ahrenfeldt LJ, Scheel-Hincke LL, Kjaergaard S, Moller S, Christensen K, Lindahl-Jacobsen R (2018b) Gender differences in cognitive function and grip strength: a cross-national comparison of four European regions. Eur J Public Health. https://doi.org/10.1093/eurpub/cky266

    Article  Google Scholar 

  3. Andersen-Ranberg K, Petersen I, Frederiksen H, Mackenbach JP, Christensen K (2009) Cross-national differences in grip strength among 50+ year-old Europeans: results from the SHARE study. Eur J Ageing 6:227–236. https://doi.org/10.1007/s10433-009-0128-6

    Article  PubMed  PubMed Central  Google Scholar 

  4. Austad SN, Fischer KE (2016) Sex differences in lifespan. Cell Metab 23:1022–1033. https://doi.org/10.1016/j.cmet.2016.05.019

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Barford A, Dorling D, Davey SG, Shaw M (2006) Life expectancy: women now on top everywhere. BMJ 332:808

    Article  PubMed  PubMed Central  Google Scholar 

  6. Beckett M, Weinstein M, Goldman N, Yu-Hsuan L (2000) Do health interview surveys yield reliable data on chronic illness among older respondents? Am J Epidemiol 151:315–323

    Article  CAS  PubMed  Google Scholar 

  7. Bergmann M, Kneip T, Luca D, Giuseppe, Scherpenzeel, Annette (2017) Survey participation in the Survey of Health, Ageing and Retirement (SHARE), wave 1–6. Based on Release 6.0.0 (March 2017)

  8. Börsch-Supan A, Jürges H (2005) The survey of health, aging, and retirement in Europe—methodology. MEA, Mannheim

    Google Scholar 

  9. Börsch-Supan A, Brandt M, Hunkler C et al (2013) Data resource profile: the Survey of Health, Ageing and Retirement in Europe (SHARE). Int J Epidemiol 42:992–1001. https://doi.org/10.1093/ije/dyt088

    Article  PubMed  PubMed Central  Google Scholar 

  10. Bouillon K, Kivimaki M, Hamer M et al (2013) Measures of frailty in population-based studies: an overview. BMC Geriatr 13:64. https://doi.org/10.1186/1471-2318-13-64

    Article  PubMed  PubMed Central  Google Scholar 

  11. Case A, Paxson C (2005) Sex differences in morbidity and mortality. Demography 42:189–214

    Article  PubMed  Google Scholar 

  12. Chen X, Mao G, Leng SX (2014) Frailty syndrome: an overview. Clin Interv Aging 9:433–441. https://doi.org/10.2147/cia.s45300

    Article  PubMed  PubMed Central  Google Scholar 

  13. Christensen K, Thinggaard M, Oksuzyan A et al (2013) Physical and cognitive functioning of people older than 90 years: a comparison of two Danish cohorts born 10 years apart. Lancet 382:1507–1513. https://doi.org/10.1016/s0140-6736(13)60777-1

    Article  PubMed  Google Scholar 

  14. Cimas M, Ayala A, Sanz B, Agullo-Tomas MS, Escobar A, Forjaz MJ (2018) Chronic musculoskeletal pain in European older adults: cross-national and gender differences. Eur J Pain 22:333–345. https://doi.org/10.1002/ejp.1123

    Article  CAS  PubMed  Google Scholar 

  15. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K (2013) Frailty in elderly people. Lancet 381:752–762. https://doi.org/10.1016/s0140-6736(12)62167-9

    Article  PubMed  Google Scholar 

  16. Collard RM, Boter H, Schoevers RA, Oude Voshaar RC (2012) Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc 60:1487–1492. https://doi.org/10.1111/j.1532-5415.2012.04054.x

    Article  PubMed  Google Scholar 

  17. Cook MB, Dawsey SM, Freedman ND et al (2009) Sex disparities in cancer incidence by period and age. Cancer Epidemiol Biomark Prev 18:1174–1182. https://doi.org/10.1158/1055-9965.epi-08-1118

    Article  Google Scholar 

  18. Crimmins EM, Kim JK, Sole-Auro A (2011) Gender differences in health: results from SHARE, ELSA and HRS. Eur J Public Health 21:81–91. https://doi.org/10.1093/eurpub/ckq022

    Article  PubMed  Google Scholar 

  19. Dahlin J, Harkonen J (2013) Cross-national differences in the gender gap in subjective health in Europe: does country-level gender equality matter? Soc Sci Med 98:24–28. https://doi.org/10.1016/j.socscimed.2013.08.028

    Article  PubMed  Google Scholar 

  20. Dix D (2014) The female health-survival advantage: paradox unwarranted. Int J Public Health 59:213. https://doi.org/10.1007/s00038-013-0505-y

    Article  PubMed  Google Scholar 

  21. Eurostat (2019) Life expectancy by age and sex. Eurostat. https://appsso.eurostat.ec.europa.eu/nui/show.do?dataset=demo_mlexpec&lang=en. Accessed 27 Feb 2019

  22. Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156

    Article  CAS  PubMed  Google Scholar 

  23. Gold CH, Malmberg B, McClearn GE, Pedersen NL, Berg S (2002) Gender and health: a study of older unlike-sex twins. J Gerontol B Psychol Sci Soc Sci 57:S168–S176

    Article  PubMed  Google Scholar 

  24. Gordon EH, Peel NM, Samanta M, Theou O, Howlett SE, Hubbard RE (2017) Sex differences in frailty: a systematic review and meta-analysis. Exp Gerontol 89:30–40. https://doi.org/10.1016/j.exger.2016.12.021

    Article  CAS  PubMed  Google Scholar 

  25. Hazra NC, Dregan A, Jackson S, Gulliford MC (2015) Differences in health at age 100 according to sex: population-based cohort study of centenarians using electronic health records. J Am Geriatr Soc 63:1331–1337. https://doi.org/10.1111/jgs.13484

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hubbard RE, Rockwood K (2011) Frailty in older women. Maturitas 69:203–207. https://doi.org/10.1016/j.maturitas.2011.04.006

    Article  PubMed  Google Scholar 

  27. Jones DM, Song X, Rockwood K (2004) Operationalizing a frailty index from a standardized comprehensive geriatric assessment. J Am Geriatr Soc 52:1929–1933. https://doi.org/10.1111/j.1532-5415.2004.52521.x

    Article  PubMed  Google Scholar 

  28. Kingston A, Davies K, Collerton J et al (2014) The contribution of diseases to the male-female disability-survival paradox in the very old: results from the Newcastle 85+ study. PLoS ONE 9:e88016. https://doi.org/10.1371/journal.pone.0088016

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Nybo H, Gaist D, Jeune B, McGue M, Vaupel JW, Christensen K (2001) Functional status and self-rated health in 2,262 nonagenarians: the Danish 1905 Cohort Survey. J Am Geriatr Soc 49:601–609

    Article  CAS  PubMed  Google Scholar 

  30. Oksuzyan A, Juel K, Vaupel JW, Christensen K (2008) Men: good health and high mortality. Sex differences in health and aging. Aging Clin Exp Res 20:91–102

    Article  PubMed  PubMed Central  Google Scholar 

  31. Oksuzyan A, Petersen I, Stovring H, Bingley P, Vaupel JW, Christensen K (2009) The male-female health-survival paradox: a survey and register study of the impact of sex-specific selection and information bias. Ann Epidemiol 19:504–511. https://doi.org/10.1016/j.annepidem.2009.03.014

    Article  PubMed  PubMed Central  Google Scholar 

  32. Oksuzyan A, Crimmins E, Saito Y, O’Rand A, Vaupel JW, Christensen K (2010) Cross-national comparison of sex differences in health and mortality in Denmark, Japan and the US. Eur J Epidemiol 25:471–480. https://doi.org/10.1007/s10654-010-9460-6

    Article  PubMed  PubMed Central  Google Scholar 

  33. Oksuzyan A, Shkolnikova M, Vaupel JW, Christensen K, Shkolnikov VM (2014) Sex differences in health and mortality in Moscow and Denmark. Eur J Epidemiol 29:243–252. https://doi.org/10.1007/s10654-014-9893-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Okura Y, Urban LH, Mahoney DW, Jacobsen SJ, Rodeheffer RJ (2004) Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure. J Clin Epidemiol 57:1096–1103. https://doi.org/10.1016/j.jclinepi.2004.04.005

    Article  PubMed  Google Scholar 

  35. Radkiewicz C, Johansson ALV, Dickman PW, Lambe M, Edgren G (2017) Sex differences in cancer risk and survival: a Swedish cohort study. Eur J Cancer 84:130–140. https://doi.org/10.1016/j.ejca.2017.07.013

    Article  PubMed  Google Scholar 

  36. Rich-Edwards JW, Manson JE, Hennekens CH, Buring JE (1995) The primary prevention of coronary heart disease in women. N Engl J Med 332:1758–1766. https://doi.org/10.1056/nejm199506293322607

    Article  CAS  PubMed  Google Scholar 

  37. Romero-Ortuno R, Walsh CD, Lawlor BA, Kenny RA (2010) A frailty instrument for primary care: findings from the Survey of Health, Ageing and Retirement in Europe (SHARE). BMC Geriatr 10:57. https://doi.org/10.1186/1471-2318-10-57

    Article  PubMed  PubMed Central  Google Scholar 

  38. Santos-Eggimann B, Cuenoud P, Spagnoli J, Junod J (2009) Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries. J Gerontol A Biol Sci Med Sci 64:675–681. https://doi.org/10.1093/gerona/glp012

    Article  PubMed  Google Scholar 

  39. Saum KU, Dieffenbach AK, Muller H, Holleczek B, Hauer K, Brenner H (2014) Frailty prevalence and 10-year survival in community-dwelling older adults: results from the ESTHER cohort study. Eur J Epidemiol 29:171–179. https://doi.org/10.1007/s10654-014-9891-6

    Article  PubMed  Google Scholar 

  40. Theou O, Rockwood MR, Mitnitski A, Rockwood K (2012) Disability and co-morbidity in relation to frailty: how much do they overlap? Arch Gerontol Geriatr 55:e1–e8. https://doi.org/10.1016/j.archger.2012.03.001

    Article  PubMed  Google Scholar 

  41. United Nations Educational, Scientific and Cultural Organisation (UNESCO) (1997) International standard classification of education (ISCED). UNESCO, Paris

    Google Scholar 

  42. Van de Velde S, Bracke P, Levecque K (2010) Gender differences in depression in 23 European countries. Cross-national variation in the gender gap in depression. Soc Sci Med 71:305–313. https://doi.org/10.1016/j.socscimed.2010.03.035

    Article  PubMed  Google Scholar 

  43. Van Oyen H, Nusselder W, Jagger C, Kolip P, Cambois E, Robine JM (2013) Gender differences in healthy life years within the EU: an exploration of the “health-survival” paradox. Int J Public Health 58:143–155. https://doi.org/10.1007/s00038-012-0361-1

    Article  PubMed  Google Scholar 

  44. Vasilopoulos T, Kotwal A, Huisingh-Scheetz MJ, Waite LJ, McClintock MK, Dale W (2014) Comorbidity and chronic conditions in the National Social Life, Health and Aging Project (NSHAP), Wave 2. J Gerontol B Psychol Sci Soc Sci 69(Suppl 2):S154–S165. https://doi.org/10.1093/geronb/gbu025

    Article  PubMed  PubMed Central  Google Scholar 

  45. Weber D, Skirbekk V, Freund I, Herlitz A (2014) The changing face of cognitive gender differences in Europe. Proc Natl Acad Sci USA 111:11673–11678. https://doi.org/10.1073/pnas.1319538111

    Article  CAS  PubMed  Google Scholar 

  46. Whitacre CC (2001) Sex differences in autoimmune disease. Nat Immunol 2:777–780. https://doi.org/10.1038/ni0901-777

    Article  CAS  PubMed  Google Scholar 

  47. World Health Organization (2013) Review of social determinants and the health divide in the WHO European Region: final report. Denmark, Copenhagen

    Google Scholar 

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Acknowledgements

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 www.share-project.org).

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Correspondence to Linda Juel Ahrenfeldt.

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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 (www.share-project.org).

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Major Revision: 22 February 2019.

Minor Revision: 29 May 2019.

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Ahrenfeldt, L.J., Möller, S., Thinggaard, M. et al. Sex Differences in Comorbidity and Frailty in Europe. Int J Public Health 64, 1025–1036 (2019). https://doi.org/10.1007/s00038-019-01270-9

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Keywords

  • Sex differences
  • Comorbidity
  • Frailty
  • Europe
  • SHARE