Encyclopedia of Gerontology and Population Aging

Living Edition
| Editors: Danan Gu, Matthew E. Dupre

The Male-Female Health-Mortality Paradox

  • Vanessa di Lego
  • Patrick Lazarevič
  • Marc LuyEmail author
Living reference work entry

Latest version View entry history

DOI: https://doi.org/10.1007/978-3-319-69892-2_798-2


The male-female health-mortality paradox results from the fact that females live longer than males but spend a higher proportion of their total life expectancy in poorer health states. The phenomenon is depicted in schematic Fig. 1, where the gray-shaded area represents the proportion of total life expectancy spent in poor health, for females and males, respectively, on panels a and b. It is clear that the gray-shaded areas, representative of poor life expectancy, are larger for women than for men. The sum of the white area and the gray-shaded area is equal to the total life expectancy. Since health is an important predictor of death, the fact that women live longer in spite of a higher proportion of their lives spent in unhealthy state puzzles researchers. Some other terms used to describe the phenomenon are “gender and health paradox,” “morbidity paradox,” “morbidity-mortality paradox,” or “male-female health-survival paradox.”
This is a preview of subscription content, log in to check access.



This work was supported by the European Research Council, within the European Community’s Seventh Framework Programme (FP7/2007–2013), ERC Grant Agreement No. 262663 (HEMOX) and within the EU Framework Programme for Research and Innovation Horizon 2020, ERC Grant Agreement No. 725187 (LETHE). PI: Marc Luy.


  1. Beckett LA, Brock DB, Lemke JH et al (1996) Analysis of change in self-reported physical function among older persons in four population studies. Am J Epidemiol 143:766–778CrossRefGoogle Scholar
  2. Case A, Paxson C (2005) Sex differences in morbidity and mortality. Demography 42:189–214.  https://doi.org/10.2307/4147343CrossRefGoogle Scholar
  3. Christensen K, Kristiansen M, Hagen-Larsen H et al (2000) X-linked genetic factors regulate hematopoietic stem-cell kinetics in females. Blood 95:2449–2451CrossRefGoogle Scholar
  4. Clutton-Brock T, Isvaran K (2007) Sex differences in ageing in natural populations of vertebrates. Proc R Soc B Biol Sci 274:3097–3104.  https://doi.org/10.1098/rspb.2007.1138CrossRefGoogle Scholar
  5. Crimmins EM, Kim JK, Hagedorn A (2002) Life with and without disease: women experience more of both. J Women Aging 14:47–59.  https://doi.org/10.1300/J074v14n01_04CrossRefGoogle Scholar
  6. Deeg DJH, Kriegsman DMW (2003) Concepts of self-rated health: specifying the gender difference in mortality risk. Gerontologist 43:376–386.  https://doi.org/10.1093/geront/43.3.376CrossRefGoogle Scholar
  7. Galdas PM, Cheater F, Marshall P (2005) Men and health help-seeking behaviour: literature review. J Adv Nurs 49:616–623.  https://doi.org/10.1111/j.1365-2648.2004.03331.xCrossRefGoogle Scholar
  8. Global Health Observatory, World Health Organization (2018) Life expectancy and healthy life expectancy data by WHO region. Retrieved from http://apps.who.int/gho/data/view.main.SDG2016LEXREGv?lang=en
  9. Green CA, Pope CR (1999) Gender, psychosocial factors and the use of medical services: a longitudinal analysis. Soc Sci Med 48:1363–1372.  https://doi.org/10.1016/S0277-9536(98)00440-7CrossRefGoogle Scholar
  10. Grundy E (2006) Gender and healthy aging. In: Longer life and healthy aging. Springer, Dordrecht, pp 173–199CrossRefGoogle Scholar
  11. Horiuchi S (1997) Postmenopausal acceleration of age-related mortality increase. J Gerontol A Biol Sci Med Sci 52:B78–B92CrossRefGoogle Scholar
  12. Idler EL (2003) Discussion: gender differences in self-rated health, in mortality, and in the relationship between the two. Gerontologist 43:372–375.  https://doi.org/10.1093/geront/43.3.372CrossRefGoogle Scholar
  13. Jenkins CD (1976) Recent evidence supporting psychologic and social risk factors for coronary disease. N Engl J Med 294:1033–1038.  https://doi.org/10.1056/NEJM197605062941904CrossRefGoogle Scholar
  14. Kalben BB (2002) Why men die younger: causes of mortality differences by sex. Society of Actuaries, SchaumburgGoogle Scholar
  15. Kalmbach E, Furness RW, Griffiths R (2005) Sex-biased environmental sensitivity: natural and experimental evidence from a bird species with larger females. Behav Ecol 16:442–449.  https://doi.org/10.1093/beheco/ari018CrossRefGoogle Scholar
  16. Keevil VL, Hayat S, Dalzell N et al (2013) The physical capability of community-based men and women from a British cohort: the European Prospective Investigation into Cancer (EPIC)-Norfolk study. BMC Geriatr 13:93.  https://doi.org/10.1186/1471-2318-13-93CrossRefGoogle Scholar
  17. Lemaire J (2002) Why do females live longer than males? N Am Actuar J 6:21–37.  https://doi.org/10.1080/10920277.2002.10596061CrossRefGoogle Scholar
  18. Leong DP, Teo KK, Rangarajan S et al (2015) Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet 386:266–273.  https://doi.org/10.1016/S0140-6736(14)62000-6CrossRefGoogle Scholar
  19. Leveille SG, Penninx BWJH, Melzer D et al (2000) Sex differences in the prevalence of mobility disability in old age: the dynamics of incidence, recovery, and mortality. J Gerontol B Psychol Sci Soc Sci 55:S41.  https://doi.org/10.1093/geronb/55.1.S41CrossRefGoogle Scholar
  20. Lorber J, Moore LJ (2002) Gender and the social construction of illness. AltaMira Press, PlymouthGoogle Scholar
  21. Luy M (2003) Causes of male excess mortality: insights from cloistered populations. Popul Dev Rev 29:647–676.  https://doi.org/10.1111/j.1728-4457.2003.00647.xCrossRefGoogle Scholar
  22. Luy M, Di Giulio P (2006) The impact of health behaviors and life quality on gender differences in mortality. In: Geppert J, Kühl J (eds) Gender und Lebenserwartung. Kleine, Bielefeld, pp 113–147Google Scholar
  23. Luy M, Gast K (2014) Do women live longer or do men die earlier? Reflections on the causes of sex differences in life expectancy. Gerontology 60:143–153CrossRefGoogle Scholar
  24. Luy M, Wegner-Siegmundt C (2015) The impact of smoking on gender differences in life expectancy: more heterogeneous than often stated. Eur J Public Health 25:706–710.  https://doi.org/10.1093/eurpub/cku211CrossRefGoogle Scholar
  25. Marmot MG, Shipley MJ, Rose G (1984) Inequalities in death – specific explanations of a general pattern? Lancet 1:1003–1006CrossRefGoogle Scholar
  26. Moore SL, Wilson K (2002) Parasites as a viability cost of sexual selection in natural populations of mammals. Science (80-) 297:2015–2018.  https://doi.org/10.1126/science.1074196CrossRefGoogle Scholar
  27. Nathanson CA, Lopez AD (1987) The future of sex mortality differentials in industrialized countries: a structural hypothesis. Popul Res Policy Rev 6:123–136.  https://doi.org/10.1007/BF00149204CrossRefGoogle Scholar
  28. 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 20:91–102CrossRefGoogle Scholar
  29. Oksuzyan A, Brønnum-Hansen H, Jeune B (2010) Gender gap in health expectancy. Eur J Ageing 7:213–218.  https://doi.org/10.1007/s10433-010-0170-4CrossRefGoogle Scholar
  30. Oksuzyan A, Gumà J, Doblhammer G (2018) Sex differences in health and survival. In: A demographic perspective on gender, family and health in Europe. Springer International Publishing, Cham, pp 65–100CrossRefGoogle Scholar
  31. Pampel F (2005) Forecasting sex differences in mortality in high income nations. Demogr Res 13:455–484.  https://doi.org/10.4054/DemRes.2005.13.18CrossRefGoogle Scholar
  32. Pressat R (1973) Surmortalité biologique et surmortalité sociale. Rev Fr Sociol 14:103–110CrossRefGoogle Scholar
  33. Preston SH, Wang H (2006) Sex mortality differences in the United States: the role of cohort smoking patterns. Demography 43:631–646CrossRefGoogle Scholar
  34. Redondo-Sendino Á, Guallar-Castillón P, Banegas J, Rodríguez-Artalejo F (2006) Gender differences in the utilization of health-care services among the older adult population of Spain. BMC Public Health 6:155.  https://doi.org/10.1186/1471-2458-6-155CrossRefGoogle Scholar
  35. Rieker PP, Bird CE (2000) Sociological explanations of gender differences in mental and physical health. In: Bird CE, Conrad P, Fremont AM (eds) Handbook of medical sociology. Prentice Hall, Upper Saddle River, pp 98–113Google Scholar
  36. Robine J-M, Jagger C, Romieu I (2001) Disability-free life expectancies in the European Union countries: calculation and comparisons. Genus 57:89–101.  https://doi.org/10.2307/29788693CrossRefGoogle Scholar
  37. Roe CM, McNamara AM, Motheral BR (2002) Gender- and age-related prescription drug use patterns. Ann Pharmacother 36:30–39.  https://doi.org/10.1345/aph.1A113CrossRefGoogle Scholar
  38. Simons-Morton BG, Farhat T, ter Bogt TFM et al (2009) Gender specific trends in alcohol use: cross-cultural comparisons from 1998 to 2006 in 24 countries and regions. Int J Public Health 54:199–208.  https://doi.org/10.1007/s00038-009-5411-yCrossRefGoogle Scholar
  39. Springer KW, Mouzon DM (2011) “Macho men” and preventive health care. J Health Soc Behav 52:212–227.  https://doi.org/10.1177/0022146510393972CrossRefGoogle Scholar
  40. Staetsky L, Hinde A (2009) Unusually small sex differentials in mortality of Israeli Jews: what does the structure of causes of death tell us? Demogr Res 20:209–252.  https://doi.org/10.4054/DemRes.2009.20.11CrossRefGoogle Scholar
  41. Théré C, Rohrbasser J-M (2006) Facing death in the early days of life: inequality between the sexes in enlightenment demographic thought. Hist Fam 11:199–210.  https://doi.org/10.1016/j.hisfam.2006.12.002CrossRefGoogle Scholar
  42. Vaccarino V, Krumholz HM, Mendes de Leon CF et al (1996) Sex differences in survival after myocardial infarction in older adults: a community-based approach. J Am Geriatr Soc 44:1174–1182CrossRefGoogle Scholar
  43. Verbrugge LM (1982) Sex differentials in health. Public Health Rep 97:417–437Google Scholar
  44. Verbrugge LM (1985) Gender and health: an update on hypotheses and evidence. J Health Soc Behav 26:156.  https://doi.org/10.2307/2136750CrossRefGoogle Scholar
  45. Verbrugge LM, Wingard DL (1987) Sex differentials in health and mortality. Women Health 12:103–145.  https://doi.org/10.1300/J013v12n02_07CrossRefGoogle Scholar
  46. Waldron I (1983) Sex differences in human mortality: the role of genetic factors. Soc Sci Med 17:321–333CrossRefGoogle Scholar
  47. Waldron I (1985) What do we know about causes of sex differences in mortality? A review of the literature. Popul Bull UN 18:59–76Google Scholar
  48. Waldron I (1995) Contributions of biological and behavioral factors to changing sex differences in ischaemic heart disease mortality. In: Lopez AD, Valkonen T, Caselli G (eds) Adult mortality in developed countries. Oxford University Press, Oxford, pp 161–178Google Scholar
  49. Wingard DL (1982) The sex differential in morbidity, mortality, and lifestyle. Am J Epidemiol 115:205–216.  https://doi.org/10.1146/annurev.pu.05.050184.002245CrossRefGoogle Scholar
  50. Wingard DL, Suarez L, Barrett-Connor E (1983) The sex differential in mortality from all causes and ischemic heart disease. Am J Epidemiol 117:165–172CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Vienna Institute of Demography/Austrian Academy of SciencesWittgenstein Centre (IIASA, VID/ÖAW, WU)ViennaAustria

Section editors and affiliations

  • Kirill Andreev
    • 1
  1. 1.Population Division, Department of Economic and Social AffairsUnited NationsNew YorkUSA