Sex-specific health deterioration and mortality: The morbidity–mortality paradox over age and time

The traditional sex morbidity–mortality paradox that females have worse health but better survival than males is based on studies of major health traits. We applied a cumulative deficits approach to study this paradox, selecting 34 minor health deficits consistently measured in the 9th (1964) and 14th (1974) Framingham Heart and 5th (1991–1995) Offspring Study exams focusing on the 55–78 age range. We constructed four deficit indices (DIs) using all 34 deficits as well as subsets of these deficits characterizing males’ (DIM) and females’ (DIF) health disadvantages, and no relative sex-disadvantages. The DI34-specific age patterns are sex-insensitive within the 55–74 age range. The DI34, however, tends to selectively increase the risk of death for males. The DIF-associated health dimension supports the traditional morbidity paradox, whereas the DIM-associated dimension supports the inverse paradox, wherein males have worse health but better survival than females. The traditional paradox became less pronounced, whereas the inverse paradox became more pronounced from the 1960s to the 1990s. The sex-specific excess in minor health deficits may vary according to particular set of deficits, thus providing evidence for traditional and inverse morbidity paradoxes. The time-trends suggest the presence of a strong exogenous effect modifier affecting the rate of health deterioration and mortality risk.