This project aims to advance our understanding of sex differences in health by analyzing newly available longitudinal data on older adults living in Japan, Singapore, and the Philippines. Previous research on sex differences in health has identified a paradox. Women have lower mortality than men, but they have higher morbidity, functional limitation, disability, and worse self-rated health. Yet, recent studies suggest that this health-survival paradox may be partly due to the particular dimensions of health examined, how they are measured, which subgroups of populations are examined, and the periods in which the studies are conducted. Some studies also suggest that women's higher self-reported rates of functional loss and disability may partly reflect differential assessment and reporting of these conditions by sex. When, to what extent, and why the above health-survival paradox by sex exists are not fully understood in Western developed countries, but the gap in knowledge is even greater for contexts outside the West due to limited availability of appropriate data and a lack of rigorous systematic analysis on the topic. We will utilize data that we have been and will be collecting in Japan, Singapore, and the Philippines, which provide an unusually rich source of information on multiple dimensions of health for large, nationally representative samples of older populations in Asia. Each dataset also contains a wide range of detailed data on social, economic, psychological, and behavioral characteristics that are critical to understanding the complex paths and processes leading to sex differences in health. Such rich information on older populations is rare outside Western developed countries. We will take advantage of these data and conduct rigorous and systematic analyses of sex differences in health and their underlying causes in Asia. We will first examine sex differences across multiple dimensions and measures of health, then explore various pathways and processes underlying these outcomes. Because these datasets are designed to be comparable across most measures, they also provide a valuable opportunity to test the extent to which findings vary across the three settings. We will also compare our findings with US and Danish results.

Public Health Relevance

Is it true that males are healthier than females but die younger? If so, why? This research Project addresses these questions concerning the human health-survival paradox. Findings will provide a deeper understanding of the basis for sex differences in health and survival?and of the opportunities that society and particularly health professionals have to improve health and survival for males and females.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Program Projects (P01)
Project #
Application #
Study Section
Special Emphasis Panel (ZAG1-ZIJ-7)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Duke University
United States
Zip Code
Ahrenfeldt, Linda Juel; Larsen, Lisbeth Aagaard; Lindahl-Jacobsen, Rune et al. (2017) Early-life mortality risks in opposite-sex and same-sex twins: a Danish cohort study of the twin testosterone transfer hypothesis. Ann Epidemiol 27:115-120.e2
Miller, Elizabeth A; Livermore, Joshua A; Alberts, Susan C et al. (2017) Ovarian cycling and reproductive state shape the vaginal microbiota in wild baboons. Microbiome 5:8
Jones, Owen R; Vaupel, James W (2017) Senescence is not inevitable. Biogerontology 18:965-971
Zeng, Yi; Feng, Qiushi; Hesketh, Therese et al. (2017) Survival, disabilities in activities of daily living, and physical and cognitive functioning among the oldest-old in China: a cohort study. Lancet 389:1619-1629
Brasher, Melanie Sereny; George, Linda K; Shi, Xiaoming et al. (2017) Incorporating biomarkers into the study of socio-economic status and health among older adults in China. SSM Popul Health 3:577-585
Oksuzyan, Anna; Singh, Prashant Kumar; Christensen, Kaare et al. (2017) A Cross-National Study of the Gender Gap in Health Among Older Adults in India and China: Similarities and Disparities. Gerontologist :
Colchero, Fernando; Rau, Roland; Jones, Owen R et al. (2016) The emergence of longevous populations. Proc Natl Acad Sci U S A 113:E7681-E7690
Tung, Jenny; Archie, Elizabeth A; Altmann, Jeanne et al. (2016) Cumulative early life adversity predicts longevity in wild baboons. Nat Commun 7:11181
Wall, Jeffrey D; Schlebusch, Stephen A; Alberts, Susan C et al. (2016) Genomewide ancestry and divergence patterns from low-coverage sequencing data reveal a complex history of admixture in wild baboons. Mol Ecol 25:3469-83
Ahrenfeldt, Linda J; Lindahl-Jacobsen, Rune; Möller, Sören et al. (2016) Differences in Religiousness in Opposite-Sex and Same-Sex Twins in a Secular Society. Twin Res Hum Genet 19:35-46

Showing the most recent 10 out of 47 publications