Aging Clinical and Experimental Research

This review examines sex differences in health and survival, with a focus on the Nordic countries. There is a remarkable discrepancy between the health and survival of the sexes: men are physically stronger and have fewer disabilities, but have substantially higher mortality at all ages compared with women: the so-called male-female health-survival paradox. A number of proposed explanations for this paradox are rooted in biological, social, and psychological interpretations. It is likely to be due to multiple causes that include fundamental biological differences between the sexes such as genetic factors, immune system responses, hormones, and disease patterns. Behavioral differences such as risk-taking and reluctance to seek and comply with medical treatment may also play a role. Another consideration is that part of the difference may be due to methodological challenges, such as selective non-participation and under-reporting of health problems, and delayed seeking of treatment by men. The Nordic countries provide a unique opportunity for such studies, as they have good-quality data in their national health registers, which cover the whole population, and a long tradition of high participation rates in surveys. (Aging Clin Exp Res 2008; 20: 91-102) ©2008, Editrice Kurtis ever, there is a remarkable discrepancy between the health and survival of men versus women. According to a recent report on health differences in 21 European countries, men rated their health higher than women in all but one country, Finland, with significant differences in 13 countries among them three other Nordic countries, Sweden, Norway and Denmark (2). Research literature generally suggests that men are physically stronger, report fewer diseases and have fewer limitations in the activities of daily living at older ages. Nonetheless, female death rates are substantially lower than those for males at all ages. That is, in terms of mortality, women are healthier than men. Interpreting this apparent contradiction that women live longer than men but experience worse health is complicated by several factors, and a number of explanations have been proposed that are rooted in biological, social and psychological interpretations. The most commonly proposed explanations are biological risks, risks acquired through social roles, lifestyle and illness behaviors, and differential healthcare access, treatment and use (3-8). This review provides data documenting sex differences in health and survival, with a focus on the Nordic countries. It is followed by a section on methodological challenges and a final section on possible explanations for the paradox and suggestions for future research. OBSERVED SEX DIFFERENCES IN HEALTH AND MORTALITY Sex differences in mortality As far back as the mid-18th century there was a female advantage in survival (9) and, with economic development and improved living conditions for women, the REVIEW ARTICLE