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
This is a preview of subscription content, log in to check access.
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.
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.
Oksuzyan A, Crimmins E, Saito Y, O’Rand A, Vaupel JW, Christensen K. Cross-national comparison of sex differences in health and mortality in Denmark, Japan and the US. Eur J Epidemiol. 2010;25:471–80.PubMedCentralPubMedCrossRefGoogle Scholar
Andersen-Ranberg K, Petersen I, Frederiksen H, Mackenbach J, Christensen K. Cross-national differences in grip strength among 50+ year-old Europeans: results from the SHARE study. Eur J Ageing. 2009;6:227–36.CrossRefGoogle Scholar
Crimmins EM, Beltran-Sanchez H. Mortality and morbidity trends: is there compression of morbidity? J Gerontol B Psychol. 2011;66B:75–86.CrossRefGoogle Scholar
Truelsen T, Piechowski-Jóźwiak B, Bonita R, Mathers C, Bogousslavsky J, Boysen G. Stroke incidence and prevalence in Europe: a review of available data. Eur J Neurol. 2006;13:581–98.PubMedCrossRefGoogle Scholar
Jarner SF, Kryger EM, Dengsoe C. The evolution of death rates and life expectancy in Denmark. Scand Actuar J. 2008;2:147–73.CrossRefGoogle Scholar
HMD. Human Mortality Database. University of California, Berkeley and Max Planck Institute for Demographic Research. (www.mortality.org. Accessed 06 December 2012.
Mesle F. Mortality in Central and Eastern Europe: long-term trends and recent upturns. Demogr Res 2004; Special Collection 2:45–70.Google Scholar
Shkolnikov V, Meslé F. The Russian epidemiological crisis as mirrored by mortality trends. In: Da Vanzo J, editor. Russia’s demographic “crisis”. Santa Monica: RAND Center for Russian and Eurasian Studies; 1996. p. 113–61.Google Scholar
Field M. Gender gaps in mortality. Dissimilarities in mortality rates: analysis of standard data. In: Shkolnikov V, Andreev E, Maleva T, editors. Inequality and mortality in Russia. Moscow: Moscow Carnegie Center; 2000. p. 20–3.Google Scholar
Andreev EM, McKee M, Shkolnikov VM. Health expectancy in the Russian Federation: a new perspective on the health divide in Europe. Bull World Health Organ. 2003;81:778–87.PubMedCentralPubMedGoogle Scholar
Bobak M, Richards M, Malyutina S, et al. Association between year of birth and cognitive functions in Russia and the Czech Republic: cross-sectional results of the HAPIEE study. Neuroepidemiol. 2009;33:231–9.CrossRefGoogle Scholar
Christensen K, Holm NV, McGue M, Corder L, Vaupel JW. A Danish population-based twin study on general health in the elderly. J Aging Health. 1999;11:49–64.PubMedCrossRefGoogle Scholar
Gaist D, Bathum L, Skytthe A, et al. Strength and anthropometric measures in identical and fraternal twins: no evidence of masculinization of females with male co-twins. Epidemiology. 2000;11:340–3.PubMedCrossRefGoogle Scholar
Skytthe A, Christiansen L, Kyvik KO, et al. The Danish Twin Registry: linking surveys, national registers, and biological information. Twin Res. 2012;16:1–8.Google Scholar
Skytthe A, Kyvik K, Holm NV, Vaupel JW, Christensen K. The Danish Twin Registry: 127 birth cohorts of twins. Twin Res. 2002;5:352–7.PubMedCrossRefGoogle Scholar
Christensen K, Petersen I, Skytthe A, Herskind AM, McGue M, Bingley P. Comparison of academic performance of twins and singletons in adolescence: follow-up study. BMJ. 2006;333:1095–1097.PubMedCentralPubMedCrossRefGoogle Scholar
Christensen K, Wienke A, Skytthe A, Holm NV, Vaupel JW, Yashin AI. Cardiovascular mortality in twins and the fetal origins hypothesis. Twin Res. 2001;4:344–9.PubMedCrossRefGoogle Scholar
Vågerö D, Leon D. Ischaemic heart disease and low birth weight: a test of the fetal-origins hypothesis from the Swedish Twin Registry. Lancet. 1994;343:260–3.PubMedCrossRefGoogle Scholar
Oeberg S, Cnattingius S, Sandin S, Lichtenstein P, Morley R, Iliadou AN. Twinship influence on morbidity and mortality across the lifespan. Int J Epidemiol. 2012;41:1002–9.CrossRefGoogle Scholar
Shkolnikova M, Shalnova S, Shkolnikov V, et al. Biological mechanisms of disease and death in Moscow: rationale and design of the survey on Stress Aging and Health in Russia (SAHR). BMC Public Health. 2009;9:293.PubMedCentralPubMedCrossRefGoogle Scholar
Andreev EM. About the accuracy of the Russia censuses and validity of different information sources [in Russian]. Voprosi statistiki [Quest Stat] 2012;11:21–35.
Jdanov DA, Scholz RD, Shkolnikov VM. Official population statistics and the Human Mortality Database estimates of populations aged 80+ in Germany and nine other European countries. Demogr Res. 2005;13:335–62.CrossRefGoogle Scholar
Christensen K, McGue M, Yashin A, Iachine I, Holm NV, Vaupel JW. Genetic and environmental Influences on functional abilities in Danish twins aged 75 years and older. J Gerontol A Biol Sci Med Sci. 2000;55:M446–52.PubMedCrossRefGoogle Scholar
Avlund K, Davidsen M, Schultz-Larsen K. Changes in functional ability from ages 70 to 75: a Danish longitudinal study. J Aging Health. 1995;7:254–82.PubMedCrossRefGoogle Scholar
Schultz-Larsen K, Avlund K, Kreiner S. Functional ability of community dwelling elderly. Criterion-related validity of a new measure of functional ability. J Clin Epidemiol. 1992;45:1315–26.PubMedCrossRefGoogle Scholar
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA. 1963;185:914–9.PubMedCrossRefGoogle Scholar
Christensen K, Frederiksen H, Vaupel JW, McGue M. Age trajectories of genetic variance in physical functioning: a longitudinal study of Danish twins aged 70 years and older. Behav Genet. 2003;33:125–36.PubMedCrossRefGoogle Scholar
Ware J, Kosinski M, Keller S. SF-36 physical and mental. Health summary scales: a user’s manual. Boston, MA: New England Medical Center, The Health Institute; 1994.Google Scholar
Ware J, Snow K, Kosinski M, Gandek B. SF-36 health survey manual and interpretation. Guide Boston, MA: New England Medical Center, The Health Institute; 1993.Google Scholar
Folstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading cognitive state of patients for the clinicians. J Psychiatr Res. 1975;12:189–98.PubMedCrossRefGoogle Scholar
Roth M, Tym E, Mountjoy CQ, et al. CAMDEX. A standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. Br J Psychiatry. 1986;149:698–709.PubMedCrossRefGoogle Scholar
McGue M, Christensen K. Genetic and environmental contributions to depression symptomatology: evidence from Danish twins 75 years of age and older. J Abnorm Psychol. 1997;106:439–48.PubMedCrossRefGoogle Scholar
Ahmad OB, Boschi-Pinto C, Lopez AD, Murray CJ, Lozano R, Inoue M. Age standardization of rates: a new WHO standard. Geneva: World Health Organization; 2001. p. 1–12.Google Scholar
StataCorp. Stata statistical software: release 11.2. In: College Station, TX 77845, USA: StataCorp LP; 2012.Google Scholar
Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2013;127:e6–245.PubMedCrossRefGoogle Scholar
Petrea RE, Beiser AS, Seshadri S, Kelly-Hayes M, Kase CS, Wolf PA. Gender differences in stroke incidence and poststroke disability in the Framingham heart study. Stroke. 2009;40:1032–7.PubMedCentralPubMedCrossRefGoogle Scholar
Wolf-Maier K, Cooper RS, Banegas JR, et al. HYpertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA. 2003;289:2363–9.PubMedCrossRefGoogle Scholar
Metelskaya VA, Shkolnikova MA, Shalnova SA, et al. Prevalence, components, and correlates of metabolic syndrome (MetS) among elderly Muscovites. Arch Gerontol Geriatr. 2012;55:231–7.PubMedCentralPubMedCrossRefGoogle Scholar
Carlson P. Risk behaviours and self rated health in Russia 1998. J Epidemiol Commun Health. 2001;55:806–17.CrossRefGoogle Scholar
Davidov MI, Axel EM. Zabolevaemost zlokachestvennimi novoobrazovaniyami naseleniya Rossii i stran SNG v 2007 [Prevalence of malignant tumor in the population of Russia and NIS] (in Russian). J NN Blokhin Russ Cancer Res Cent (RAMS). 2009;20:52–74.Google Scholar
Kjoller M, Juel K, Kamper-Jorgensen F. Public health report, Denmark 2007. Summary. Copenhagen: National Institute of Public Health; 2007.Google Scholar
Andreev E, Shkolnikov V. Dissimilarities in mortality rates: analysis of individual data. In: Shkolnikov V, Andreev E, Maleva T, editors. Inequality and mortality in Russia. Moscow: Moscow Carnegie Center; 2000. p. 70–3.Google Scholar
Shkolnikov VM, Field M, Andreev EM. Russia: socioeconomic dimensions of the gender gap in mortality. In: Evans T, Whitehead M, Diderichsen F, Bhuiya A, editors. Challenging inequities in health: from ethics to action. New York: Oxford University Press; 2001. p. 139–56.Google Scholar
Leon DA, Chenet L, Shkolnikov VM, et al. Huge variation in Russian mortality rates 1984–94: artefact, alcohol, or what? Lancet. 1997;350:383–8.PubMedCrossRefGoogle Scholar
Oksuzyan A, Petersen I, Stovring H, Bingley P, Vaupel JW, Christensen K. The male-female health-survival paradox: a survey and register study of the impact of sex-specific selection and information bias. Ann Epidemiol. 2009;19:504–11.PubMedCentralPubMedCrossRefGoogle Scholar