This project uses longitudinal data from all waves and all cohorts of the Health and Retirement Study(MRS) to examine the gender health-survival paradox which proposes that men have better health but worse mortality than women. Gender differences in health and survival have not been studied comprehensively in the U.S. population across multiple components of health using a life course framework and longitudinal data covering a substantial period over the life course. Following this rationale, this project has three major objectives. (1) We will decompose the gender health-survival paradox across multiple components of health including biological risk factors, diseases and conditions, self-rated health, disabilities, loss of functioning, and mortality. We will examine gender differences in prevalence, onset, and recovery rates. Life-table methods will be applied to link health and mortality transitions to reveal the complex temporal linkages among dimensions of health and to determine the lengths of healthy and unhealthy lives among women and men. (2) We will estimate gender differences in the relative influences of individual attributes, diverse life circumstances, and behaviors across the life course on the onset and progression of multiple components of health. Survival, latent growth curve, and latent class modeling techniques will be used to assess gender differences in the influences of multiple fixed and time-varying life course factors (such as childhood health, lifetime SES, health behaviors, health care, psychosocial factors and family and work roles) on adult health trajectories and mortality patterns. The richness of the data on health and life course factors in the MRS provides an unparalleled opportunity to systematically and comprehensively study this question. We will supplement analyses of the MRS with information and parallel studies from the Cardiovascular Health Study (CHS), Artherosclerosis Risk in Communities (ARIC), and Coronary Artery Risk Development in Young Adults (CARDIA). (3) We will compare gender differences that we identify in the U.S. with those found in other national samples in Project 2 (Denmark) and Project 4 (Japan, Singapore, Philippines), respectively, using comparable variables measuring health and survival outcomes and life course factors.

Public Health Relevance

Findings from this project will provide a deeper understanding of the basis for sex differences in health and survival. We will better understand the importance of differences in family and work involvement, health behaviors (e.g., weight and exercise), and use of medical care and how these affect health differences between men and women. We will clarify 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)
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Special Emphasis Panel (ZAG1-ZIJ-7)
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Duke University
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