The male-female health-survival paradox and sex differences in cohort life expectancy in Utah, Denmark, and Sweden 1850-1910

The association between physical activity intensity and frailty risk among older adults across different age groups and genders: Evidence from four waves of the China Health and Retirement Longitudinal Survey

"Exercise is the best medicine" is well known, but the optimal dose of physical activity (PA) for males and females across different age groups is still unknown. This study, using data from the four waves of CHARLS, aimed to determine the optimal PA dose that reduces frailty risks among older adults across various age groups and both sexes. We created a frailty index score using 63 health-related variables and used 0.21 as the frailty cut point. Binary logistic regression was used to compare the effect of vigorous, moderate, and light intensity PA under IPAQ criteria on frailty risk. The study found that regardless of whether males or females, the optimal effect of vigorous-intensity PA in reducing the risk of frailty is consistently observed throughout the entire old age career. Moreover, the age groups at which moderate-intensity PA reduces the risk of frailty were from age 70 for males and from age 80 for females. And light-intensity PA had no effect on reducing the risk of frailty. Moderate and vigorous intensity of PA in older adults should be promoted, but guidelines and recommendations must account for optimal associations with PA dose across genders and age groups.

Sex-based tuberculosis mortality in Newfoundland, 1900-1949: Implications for populations in transition

OBJECTIVE

During the second epidemiological transition, tuberculosis (TB) is one disease that declined substantially enough to reduce all-cause mortality. Sex-based differences in TB mortality may reveal an important dimension of population health transitions between the urbanizing and rural regions of Newfoundland.

MATERIALS AND METHODS

For the island of Newfoundland, yearly age-standardized sex-based TB mortality rates were calculated using individual death records from 1900 to 1949 (n = 30 393). Multiple linear regression models predict the relative rates (RR) of sex-based mortality and the absolute difference between males and females while controlling for time and region (the urbanizing Avalon Peninsula or rural Newfoundland). Multiple linear regression models also predict the median age at death from TB while controlling for time, region, and sex to assess if TB was shifting to an older adult disease compared to those typically afflicted in ages 20-44.

RESULTS

Female TB mortality was relatively and absolutely higher than males; additionally, RR and absolute differences between male and female mortality were significantly lower in rural Newfoundland than the Avalon Peninsula. Median age at death for males was significantly higher than females, and differences in median age at death increased over time.

DISCUSSION

The historically high prevalence of TB throughout Newfoundland, including domestic, social, and public health responsibilities of women, likely contributed to increased exposure and transmission, leading to higher observed mortality. Sex-based TB outcomes should be considered in the discussion of the progression of the epidemiological transition as dynamic inequalities that do not necessarily fit contemporary generalizations of sex-based TB epidemiology.

Gender differences in all-cause and cardiovascular mortality among US adults: from NHANES 2005-2018

Background

Gender disparities in mortality have drawn great interest, with previous studies identifying various biological, social, and behavioral factors contributing to the observed gender differences. This study aims to identify the sources of gender disparities in mortality rates and quantify the extent to which these factors mediate the gender differences in all-cause mortality.

Methods

Data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2018 were analyzed. A total of 38,924 participants were included in the study. Gender information, socioeconomic status, lifestyle factors, and baseline disease status were obtained through questionnaires. Blood samples were collected to assess serological indicators. All-cause and cardiovascular mortality were considered as primary and secondary outcomes, respectively.

Results

The study with an average age of 50.1 ± 17.9 years. Among the participants, 50.7% were women, and 41.8% were non-Hispanic White. The median follow-up length was 87 months [Inter-Quartile Range (IQR): 47-128]. Men showed higher rates of all-cause and cardiovascular mortality compared to women in both the general population and the population with cardiovascular disease. After adjustment for potential confounders (age, race, marital status, socioeconomic status, lifestyle level, smoking status, cardiovascular disease, hypertension, diabetes and cancer), the men: women hazard ratios (HRs) for all-cause and cardiovascular mortality were 1.58 [95% Confidence Interval (CI): 1.48-1.68] and 1.60 (95%CI:1.43-1.80) in the general population. Among individuals with cardiovascular disease, the fully adjusted HR for all-cause mortality was 1.34 (95% CI: 1.20 to 1.51), and for cardiovascular mortality, the fully adjusted HRs was 1.52 (95% CI: 1.26 to 1.83). Mediation analysis revealed that uric acid levels significantly mediated the association between gender and all-cause mortality, accounting for 17.53% (95% CI: 11.0% to 23.7%) in the general population and 27.47% (95% CI: 9.0% to 13.6%) in the population with cardiovascular disease.

Conclusions

The study highlights the complex interplay of biological and social factors contributing to gender disparities in mortality. Uric acid was identified as key mediators of the gender-mortality association. These findings can inform targeted interventions aimed at reducing gender disparities in mortality and promoting better public health outcomes.

Regional differences regarding the occurrence of falls and associated factors in two populations of Brazilian longevous people

Background

Few studies have explored regional asymmetries and their implications for health policies regarding episodes of falls among the population of ≥80 years old in continental and developing countries like Brazil with deep inequalities and sociocultural differences.

Objective

To evaluate the occurrence of falls and their association with functional capacity and nutritional status in the longest oldest-old living in two municipalities in the Northeast and Southeast of Brazil.

Methods

This is a cross-sectional study, with primary data collection in which were included in the research seniors aged 80 years or more, of both sexes, belonging to two Brazilian municipalities of discrepant socioeconomic aspects. The dependent variable was the occurrence of falls in the last year. The independent variables were grouped into demographic aspects, functional capacity and nutritional status. To identify variables that contribute to the occurrence of falls, the multiple logistic regression model, adopts a significance level of 5%.

Results

The sample was composed of 415 oldest-old adults. From the total, 32.3% reported having fallen in the last year, 24.7% in Brejo dos Santos and 37.8% in São Paulo. Among the former population, the mean value of walking speed for those who had falls was 0.27 m/s and for those who had no occurrence of falls was 0.33 m/s; and, among the seniors from São Paulo, the mean values were 0.51 m/s and 0.58 m/s, respectively. Significant correlations between walking speed and falls were verified for both populations, showing that the lower the walking speed, the higher the predisposition to falls. In the final regression model, the occurrence of falls was associated with moderate balance (OR = 5.28; CI: 1.11–25.18) among the longevous people Brejo dos Santos and with very poor functional performance (OR = 16.09; CI:1.46–177.06) among those from São Paulo.

Conclusion

The results pointed out a lower prevalence of falls in longevous people from Brejo dos Santos than in those from São Paulo and differences regarding the associated factors, showing heterogeneity between the two populations; indicating the need for public policies and effective programmes aimed at preventing falls based on the maintenance or increase of functional capacity.

Probability of males to outlive females: an international comparison from 1751 to 2020

OBJECTIVE

To measure sex differences in lifespan based on the probability of males to outlive females.

DESIGN

International comparison of national and regional sex-specific life tables from the Human Mortality Database and the World Population Prospects.

SETTING

199 populations spanning all continents, between 1751 and 2020.

PRIMARY OUTCOME MEASURE

We used the outsurvival statistic ( φ ) to measure inequality in lifespan between sexes, which is interpreted here as the probability of males to outlive females.

RESULTS

In random pairs of one male and one female at age 0, the probability of the male outliving the female varies between 25% and 50% for life tables in almost all years since 1751 and across almost all populations. We show that φ is negatively correlated with sex differences in life expectancy and positively correlated with the level of lifespan variation. The important reduction of lifespan inequality observed in recent years has made it less likely for a male to outlive a female.

CONCLUSIONS

Although male life expectancy is generally lower than female life expectancy, and male death rates are usually higher at all ages, males have a substantial chance of outliving females. These findings challenge the general impression that 'men do not live as long as women' and reveal a more nuanced inequality in lifespans between females and males.

Abandonment of the Middle Cumberland Region of Tennessee during the Mississippian period: Temporal and sex differences in survivorship

OBJECTIVES

The current research explores survivorship differences in the Middle Cumberland Region of Tennessee during the Mississippian period (ca. 1000-1500 AD). Using updated paleodemographic methods, this study investigates whether individuals from the Late Mississippian period had lower survivorship compared to individuals from the Early Mississippian period, foreshadowing groups on the brink of abandonment. Additionally, this study examines whether there were sex disparities in survivorship.

MATERIALS AND METHODS

Adult age-at-death estimates from human skeletal remains (n = 545) were calculated using Transition Analysis, a Bayesian maximum likelihood method. Survivorship was reconstructed using Gompertz and Gompertz-Makeham hazards models, with Akaike Information Criterion compared to determine the best fitting model.

RESULTS

For individuals surviving into adulthood, mean age-at-death decreased by 7 years from the Early Mississippian to Late Mississippian period. Marked differences between the sexes indicate lower survivorship of females compared to males. Male survivorship decreased sharply from the Early Mississippian to Late Mississippian period, from a mean age-at-death of 57.99 years to 44.45 years. Female survivorship remained constant throughout the Mississippian period (41 years).

DISCUSSION

Temporal differences in male survivorship may be the result of interactions between climate change, decreased maize harvests, and sociopolitical strife. Sustained maternal mortality may have destabilized small-scale communities that characterized the Mississippian MCR, thereby precipitating population decline.

Health care utilization in very advanced ages: A study on predisposing, enabling and need factors

This study aims to examine the effects of predisposing, enabling, and need factors on healthcare utilization in advanced age. Data from a sample of 270 Portuguese community-dwelling persons aged ≥80 years was used. Face-to-face interviews were conducted and included the application of a research protocol addressing a set of sociodemographic and health-related variables that expressed the Andersen Behavioral model (i.e., predisposing, enabling, and need factors). Predictors of visits to general practitioners (GP) and specialist physicians, as well as emergency department (ED) use and hospitalizations were investigated. Multivariate linear and logistic regression analyzes were used to model the effects of predictor factors specified in the Andersen Behavioral model. Our findings underscore that younger age and having multimorbidity were significantly associated with having GP visits. Specialist physician visits were associated with younger age and a higher number of daily medications. ED use was associated with being male, having formal social support and a higher number of daily medications. Hospitalizations were associated with being younger, being male and having multimorbidity. Our findings revealed that need and predisposing factors determined the most healthcare use.

Considering religion and spirituality in precision medicine

The emerging era of precision medicine (PM) holds great promise for patient care by considering individual, environmental, and lifestyle factors to optimize treatment. Context is centrally important to PM, yet, to date, little attention has been given to the unique context of religion and spirituality (R/S) and their applicability to PM. R/S can support and reinforce health beliefs and behaviors that affect health outcomes. The purpose of this article is to discuss how R/S can be considered in PM at multiple levels of context and recommend strategies for integrating R/S in PM. We conducted a descriptive, integrative literature review of R/S at the individual, institutional, and societal levels, with the aim of focusing on R/S factors with a high level of salience to PM. We discuss the utility of considering R/S in the suitability and uptake of PM prevention and treatment strategies by providing specific examples of how R/S influences health beliefs and practices at each level. We also propose future directions in research and practice to foster greater understanding and integration of R/S to enhance the acceptability and patient responsiveness of PM research approaches and clinical practices. Elucidating the context of R/S and its value to PM can advance efforts toward a more whole-person and patient-centered approach to improve individual and population health.

Age and sex differences in outcomes after in-hospital cardiac arrest

INTRODUCTION

While specific factors have been associated with outcomes after in-hospital cardiac arrest, the association between sex and outcomes remains debated. Moreover, age-specific sex differences in outcomes have not been fully characterized in this population.

METHODS

Adult patients (≥18 years) with an index in-hospital cardiac arrest were included from the Danish In-Hospital Cardiac Arrest Registry (DANARREST) from January 1st, 2017 to December 31st, 2018. Population-based registries were used to obtain data on patient characteristics, cardiac arrest characteristics, and outcomes. Unadjusted and adjusted estimates for return of spontaneous circulation (ROSC), survival to 30 days, survival to one year, duration of resuscitation, and post-cardiac arrest time-to-death were computed.

RESULTS

A total of 3266 patients were included, of which 2041 (62%) patients were male with a median age of 73 years (quartiles: 64, 80). Among 1225 (38%) female patients, the median age was 76 years (quartiles: 67, 83). Younger age was associated with higher odds of ROSC and survival. Sex was not associated with ROSC and survival in the unadjusted analyses. In the adjusted analyses, women had 1.32 (95%CI: 1.12, 1.54) times the odds of survival to 30 days and 1.26 (95%CI: 1.02, 1.57) times the odds of survival to one year compared to men. The overall association between sex and survival did not vary substantially across age categories, although female sex was associated with a higher survival within certain age categories. Among patients who did not achieve ROSC, female sex was associated with a shorter duration of resuscitation, which was more pronounced in younger age categories.

CONCLUSIONS

In this study of patients with in-hospital cardiac arrest, female sex was associated with a shorter duration of resuscitation among patients without ROSC but a higher survival to 30 days and one year. While the overall association between sex and outcomes did not vary substantially across age categories, female sex was associated with a higher survival within certain age categories.

Effects of Sex and Physical Activity Level on Serum Biomarker-Based Physiological Dysregulation: The Impact to Predict Frailty and Mortality in the Quebec NuAge Cohort

BACKGROUND

Age-related changes in biological processes such as physiological dysregulation (the progressive loss of homeostatic capacity) vary considerably among older adults and may influence health profiles in late life. These differences could be related, at least in part, to the impact of intrinsic and extrinsic factors such as sex and physical activity level (PAL).

OBJECTIVES

The objectives of this study were (1) to assess the magnitude and rate of changes in physiologi-cal dysregulation in men and women according to PAL and (2) to determine whether/how sex and PAL mediate the apparent influence of physiological dysregulation on health outcomes (frailty and mortality).

METHODS

We used data on 1,754 community-dwelling older adults (age = 74.4 ± 4.2 years; women = 52.4%) of the Quebec NuAge cohort study. Physiological dysregulation was calculated based on Mahalanobis distance of 31 biomarkers regrouped into 5 systems: oxygen transport, liver/kidney function, leukopoiesis, micronutrients, and lipids.

RESULTS

As expected, mean physiological dysregulation significantly increased with age while PAL decreased. For the same age and PAL, men showed higher levels of physiological dysregulation globally in 3 systems: oxygen transport, liver/kidney function, and leukopoiesis. Men also showed faster global physiological dysregulation in the liver/kidney and leukopoiesis systems. Overall, high PAL was associated with lower level and slower rate of change of physiological dysregulation. Finally, while mortality and frailty risk significantly increased with physiological dysregulation, there was no evidence for differences in these effects between sexes and PAL.

CONCLUSION

Our results showed that both sex and PAL have a significant effect on physiological dysregulation levels and rates of change. Also, although a higher PAL was associated with lower level and slower rate of change of physiological dysregulation, there was no evidence that PAL attenuates the effect of physiological dysregulation on subsequent declines in health at the end of life. Substantial work remains to understand how modifiable behaviors impact the relationship between physiological dysregulation, frailty, and mortality in men and women.

Multi-system physiological dysregulation and ageing in a subsistence population

Humans have the longest post-reproductive lifespans and lowest rates of actuarial ageing among primates. Understanding the links between slow actuarial ageing and physiological change is critical for improving the human 'healthspan'. Physiological dysregulation may be a key feature of ageing in industrialized populations with high burdens of chronic 'diseases of civilization', but little is known about age trajectories of physiological condition in subsistence populations with limited access to public health infrastructure. To better characterize human physiological dysregulation, we examined age trajectories of 40 biomarkers spanning the immune (n = 13 biomarkers), cardiometabolic (n = 14), musculoskeletal (n = 6) and other (n = 7) systems among Tsimane forager-horticulturalists of the Bolivian Amazon using mixed cross-sectional and longitudinal data (n = 22 115 observations). We characterized age-related changes using a multi-system statistical index of physiological dysregulation (Mahalanobis distance; Dm) that increases with age in both humans and other primates. Although individual biomarkers showed varied age profiles, we found a robust increase in age-related dysregulation for Tsimane (β = 0.17-0.18) that was marginally faster than that reported for an industrialized Western sample (β = 0.14-0.16), but slower than that of other non-human primates. We found minimal sex differences in the pace or average level of dysregulation for Tsimane. Our findings highlight some conserved patterns of physiological dysregulation in humans, consistent with the notion that somatic ageing exhibits species-typical patterns, despite cross-cultural variation in environmental exposures, lifestyles and mortality. This article is part of the theme issue 'Evolution of the primate ageing process'.

Healthy cardiovascular biomarkers across the lifespan in wild-born chimpanzees (Pan troglodytes)

Chimpanzees (Pan troglodytes) are a crucial model for understanding the evolution of human health and longevity. Cardiovascular disease is a major source of mortality during ageing in humans and therefore a key issue for comparative research. Current data indicate that compared to humans, chimpanzees have proatherogenic blood lipid profiles, an important risk factor for cardiovascular disease in humans. However, most work to date on chimpanzee lipids come from laboratory-living populations where lifestyles diverge from a wild context. Here, we examined cardiovascular profiles in chimpanzees living in African sanctuaries, who range semi-free in large forested enclosures, consume a naturalistic diet, and generally experience conditions more similar to a wild chimpanzee lifestyle. We measured blood lipids, body weight and body fat in 75 sanctuary chimpanzees and compared them to publicly available data from laboratory-living chimpanzees from the Primate Aging Database. We found that semi-free-ranging chimpanzees exhibited lower body weight and lower levels of lipids that are risk factors for human cardiovascular disease, and that some of these disparities increased with age. Our findings support the hypothesis that lifestyle can shape health indices in chimpanzees, similar to effects observed across human populations, and contribute to an emerging understanding of human cardiovascular health in an evolutionary context. This article is part of the theme issue 'Evolution of the primate ageing process'.

Male survival advantage on the Baja California peninsula

A consistent finding from contemporary Western societies is that women outlive men. However, what is unclear is whether sex differences in survival are constant across varying socio-ecological conditions. We test the universality of the female survival advantage with mortality data from a nineteenth century population in the Baja California peninsula of Mexico. When examined simply, we find evidence for a male-biased survival advantage. However, results from Cox regression clearly show the importance of age intervals for variable survival patterns by sex. Our key findings are that males: (i) experience significantly lower mortality risk than females during the ages 15-30 (RR = 0.69), (ii) are at a significantly increased risk of dying in the 61+ category (RR = 1.30) and (iii) do not experience significantly different mortality risk at any other age interval (0-14, 31-45, 46-60). We interpret our results to stem from differing intrinsic and extrinsic risk factors for sex-biased mortality across age intervals, highlighting the relevance of a lifecourse approach to the study of survival advantage. Ultimately, our results make clear the need to more broadly consider variability in mortality risk factors across time and place to allow for a clearer understanding of human survival differences.

Age and cohort trajectories of gender inequality in health among elderly people in China

Using a multistate model, this article examines gender gap and its trend in health transition, life expectancy (LE), and active life expectancy (ALE) in different age groups and birth cohorts. The transition rate from life independence/disability to death for elderly women is lower than for elderly men. However, their disability rate is higher. The gender gap in LE, ALE, and DLE (disabled life expectancy) declines as age increases. In successive birth cohorts, men's LE increases more, and gender gaps in LE and ALE decrease over time. In the future, gender issues should be considered for health-care policy to provide nursing care for elderly women in China.

The Long Harm of Childhood: Childhood Exposure to Mortality and Subsequent Risk of Adult Mortality in Utah and The Netherlands

How do early-life conditions affect adult mortality? Research has yielded mixed evidence about the influence of infant and child mortality in birth cohorts on adult health and mortality. Studies rarely consider the specific role of mortality within the family. We estimated how individuals' exposure to mortality as a child is related to their adult mortality risk between ages 18 and 85 in two historical populations, Utah (USA) 1874-2015 and Zeeland (The Netherlands) 1812-1957. We examined these associations for early community-level exposure to infant and early (before sixth birthday) and late (before eighteenth birthday) childhood mortality as well as exposure during these ages to sibling deaths. We find that that exposure in childhood to community mortality and sibling deaths increases adult mortality rates. Effects of sibling mortality on adult all-cause mortality risk were stronger in Utah, where sibling deaths were less common in relation to Zeeland. Exposure to sibling death due to infection was related to the surviving siblings' risk of adult mortality due to cardiovascular disease (relative risk: 1.06) and metabolic disease (relative risk: 1.42), primarily diabetes mellitus, a result consistent with an inflammatory immune response mechanism. We conclude that early-life conditions and exposure to mortality in early life, especially within families of origin, contribute to adult mortality.

The Mechanism Underlying Change in the Sex Gap in Life Expectancy at Birth: An Extended Decomposition

The relationship between differential mortality rates and differences in life expectancy is well understood, but how changing differential rates translate into changing differences in life expectancy has not been fully explained. To elucidate the mechanism involved, this study extends existing decomposition methods. The extended method decomposes change in the sex gap in life expectancy at birth into three components capturing the effects of the sex difference in mortality improvement (ρ-effect), life table deaths density by age (f-effect), and remaining life expectancy by age (e-effect). These three effects oppose and augment each other, depending on relative change in sex-differential mortality rates. The new method is applied to period data for 35 countries and cohort data for 25 countries. The results demonstrate how the mechanism, involving the three effects, operates to determine change in the sex difference in life expectancy. We observe the pivotal importance of the f-effect, which is predominantly negative because of lower female mortality, in favoring narrowing rather than widening of the sex gap, in shifting the overall effect to younger ages, and in exaggerating fluctuations due to crisis mortality. The new decomposition provides a more detailed basis for substantive analyses examining change in differences in life expectancy.

Macronutrient intake and frailty: the Rotterdam Study

Purpose

To investigate the longitudinal association between the macronutrient composition of the diet and frailty.

Methods

Data were obtained from 5205 Dutch middle-aged and older adults participating in the Rotterdam Study. Frailty was measured using a frailty index based on the accumulation of 38 health-related deficits, score between 0 and 100, and a higher score indicating more frailty. Frailty was assessed at baseline and 11 years later (range of 23 years). Macronutrient intake was assessed using food-frequency questionnaires. The association between macronutrients and frailty over time was evaluated using multivariable linear regression, adjusted for the frailty index at baseline, energy intake, and other relevant confounders. All analyses were performed in strata of BMI.

Results

Median frailty index score was 13.8 points (IQR 9.6; 19.1) at baseline and increased by a median of 2.3 points (IQR − 2.0; 7.6) after 11 years. Overall, we found no significant associations between intake of carbohydrates or fat and frailty over time. We did observe a significant positive association between an iso-energetic intake of 10 g protein and frailty over time (β 0.31 (95% CI 0.06; 0.55)) which was mainly driven by animal protein (β 0.31 (95% CI 0.07; 0.56)). It did not depend on whether it was substituted fat or carbohydrates.

Conclusions

Our findings suggest that a reduction in the intake of animal protein may improve the overall health status over time in a relatively healthy population. More research is needed on the optimal macronutrient composition of the diet and frailty in more vulnerable populations.

Electronic supplementary material

The online version of this article (10.1007/s00394-019-02131-0) contains supplementary material, which is available to authorized users.

Men Sustain Higher Dysregulation Levels Than Women Without Becoming Frail

The aging process differs in important ways between the sexes, with women living longer but at higher risk for frailty (the male-female health-survival paradox). The underlying biological mechanisms remain poorly understood, but may relate to sex differences in physiological dysregulation patterns. Here, using biomarkers from two longitudinal cohort studies (InCHIANTI and BLSA) and one cross-sectional survey (NHANES), we assess sex differences in trajectories of dysregulation globally and for five physiological systems: oxygen transport, electrolytes, hematopoiesis, lipids, and liver/kidney function. We found higher dysregulation levels in men, both globally and in the oxygen transport and hematopoietic systems (p < .001 for all), though differences for other systems were mixed (electrolytes) or absent (lipids and liver/kidney). There was no clear evidence for sex differences in rates of change in dysregulation with age. Although risk of frailty and mortality increase with dysregulation, there was no evidence for differences in these effects between sexes. These findings imply that the greater susceptibility of women to frailty is not simply due to a tolerance for higher dysregulation; rather, it may actually be men that have a greater tolerance for dysregulation, creating a male-female dysregulation-frailty paradox. However, the precise physiological mechanisms underlying the sex differences appear to be diffuse and hard to pin down.

Contribution of chronic conditions to disability in men and women in France

Background

Women report more disability than men perhaps due to gender differences in the prevalence of diseases and/or in their disabling impact. We compare the contribution of chronic diseases to disability in men and women in France, using a disability survey conducted in both private households and institutions, and we also examine the effect of excluding the institutionalized population.

Methods

Data comprised 17 549 individuals age 50+, who participated in the 2008-09 French Disability Health Survey including people living in institutions. Disability was defined by limitations in activities people usually do due to health problems (global activity limitation indicator). Additive regression models were fitted separately by gender to estimate the contribution of conditions to disability taking into account multi-morbidity.

Results

Musculoskeletal diseases caused most disability for both men (10.1%, CI: 8.1-12.0) and women (16.0%, CI 13.6-18.2). The second contributor for men was heart diseases (5.7%, CI: 4.5-6.9%), and for women anxiety-depression (4.0, CI 3.1-5.0%) closely followed by heart diseases (3.8%, CI 2.9-4.7%). Women's higher contribution of musculoskeletal diseases reflected their higher prevalence and disabling impact; women's higher contribution of anxiety-depression and lower contributions of heart diseases reflected gender differences in prevalence. Excluding the institutionalized population did not change the overall conclusions.

Conclusions

The largest contributors to the higher disability of women than men are moderately disabling conditions with a high prevalence. Whereas traditional disabling conditions such as musculoskeletal diseases are more prevalent and disabling in women, fatal diseases such as cardiovascular disease are also important contributors in women and men.

Longevity defined as top 10% survivors and beyond is transmitted as a quantitative genetic trait

Survival to extreme ages clusters within families. However, identifying genetic loci conferring longevity and low morbidity in such longevous families is challenging. There is debate concerning the survival percentile that best isolates the genetic component in longevity. Here, we use three-generational mortality data from two large datasets, UPDB (US) and LINKS (Netherlands). We study 20,360 unselected families containing index persons, their parents, siblings, spouses, and children, comprising 314,819 individuals. Our analyses provide strong evidence that longevity is transmitted as a quantitative genetic trait among survivors up to the top 10% of their birth cohort. We subsequently show a survival advantage, mounting to 31%, for individuals with top 10% surviving first and second-degree relatives in both databases and across generations, even in the presence of non-longevous parents. To guide future genetic studies, we suggest to base case selection on top 10% survivors of their birth cohort with equally long-lived family members.

Sex differences in healthy life expectancy among nonagenarians: A multistate survival model using data from the Vitality 90+ study

OBJECTIVES

Little is known about sex differences in healthy life expectancy among the oldest old, the fastest growing segment of the older population. This study examines sex differences in total, healthy and unhealthy life expectancy among nonagenarians.

METHODS

Longitudinal data of 884 older adults aged 90 and over participating in the Vitality 90+ study (Tampere, Finland) were used, including 2501 observations (health or death states) from 5 measurement waves between 2001 and 2014. Using the MSM and ELECT packages in R, multistate survival models were performed to estimate the transition probabilities of older adults through the different health states and to calculate life expectancies. The analyses were done separately for two health indicators (disability and multimorbidity) to see whether patterns were consistent.

RESULTS

Women had higher total life expectancies than men (about 8 months), but also higher unhealthy life expectancies. Men had a higher disability-free life expectancy between the age of 90 and 95 compared to women. For multimorbidity, no sex differences in healthy life expectancy were found.

CONCLUSIONS

This study showed that the male-female health-survival paradox remains at very old age. Women aged 90+ live longer than men, and spend more time in poor health.

Tykes, Toddlers, Teens, and Twins of Robust Mothers: Do the Offspring of Twinning Mothers Share in Their Mother's Robust Phenotype?

Women who bear twins may possess a robust phenotype compared to non-twinning mothers. We examine mortality patterns for the singleton offspring of mothers of twins compared to the offspring of non-twinning mothers to determine whether they share the hypothesized robust phenotype of their mothers. Using data from the Utah Population Database, we show that both male and female singleton offspring of twinning mothers experience a survival disadvantage prior to age 5, no survival benefit or penalty between ages 5 and 49, and - for males only - a statistically significant survival advantage after age 50. We further examine the survival effects on singletons born before and after a twinset. We observe a survival disadvantage in early life for singleton offspring of twinning mothers born after the twinset for both sexes. In addition, we find a significant survival advantage at older ages in certain categories of male singleton offspring - a likely reflection of mortality selection. The findings suggest that while bearing twins may reflect a robust maternal phenotype, the toll of bearing twins may disadvantage subsequent offspring, especially during infancy.

Modeling and forecasting sex differences in mortality: a sex-ratio approach

Female and male life expectancies have converged in most industrialized societies in recent decades. To achieve coherent forecasts between females and males, this convergence needs to be considered when forecasting sex-specific mortality. We introduce a model forecasting a matrix of the age-specific death rates of sex ratio, decomposed into two age profiles and time indices-before and after age 45-using principal component analysis. Our model allows visualization of both age structure and general level over time of sex differences in mortality for these two age groups. Based on a prior forecast for females, we successfully forecast male mortality convergence with female mortality. The usefulness of the developed model is illustrated by its comparison with other coherent and independent models in an out-of-sample forecast evaluation for 18 countries. The results show that the new proposal outperformed the other models for most countries.

Intralocus sexual conflict can resolve the male-female health-survival paradox

At any given age, men are more likely to die than women, but women have poorer health at older ages. This is referred to as the “male-female, health-survival paradox”, which is not fully understood. Here, we provide a general solution to the paradox that relies on intralocus sexual conflict, where alleles segregating in the population have late-acting positive effects on male fitness, but negative effects on female health. Using an evolutionary modelling framework, we show that male-benefit, female-detriment alleles can spread if they are expressed after female reproduction stops. We provide support for our conflict based solution using experimental Drosophila data. Our results show that selecting for increased late-life male reproductive effort can increase male fitness but have a detrimental effect on female fitness. Furthermore, we show that late-life male fertility is negatively genetically correlated with female health. Our study suggests that intralocus sexual conflict could resolve the health-survival paradox.

Although men have lower survival across ages, women have poorer health than men as they age. Here, Archer et al. suggest that this pattern is explained by intralocus sexual conflict and provide supporting evidence from a mathematical model and experiments with Drosophila.

Opportunities for life course research through the integration of data across Clinical and Translational Research Institutes

Introduction

Early life exposures affect health and disease across the life course and potentially across multiple generations. The Clinical and Translational Research Institutes (CTSIs) offer an opportunity to utilize and link existing databases to conduct lifespan research.

Methods

A survey with Lifespan Domain Taskforce expert input was created and distributed to lead lifespan researchers at each of the 64 CTSIs. The survey requested information regarding institutional databases related to early life exposure, child-maternal health, or lifespan research.

Results

Of 64 CTSI, 88% provided information on a total of 130 databases. Approximately 59% (n=76/130) had an associated biorepository. Longitudinal data were available for 72% (n=93/130) of reported databases. Many of the biorepositories (n=44/76; 68%) have standard operating procedures that can be shared with other researchers.

Conclusions

The majority of CTSI databases and biorepositories focusing on child-maternal health and lifespan research could be leveraged for lifespan research, increased generalizability and enhanced multi-institutional research in the United States.

Effects of FOXO3 Polymorphisms on Survival to Extreme Longevity in Four Centenarian Studies

Previous studies note specific FOXO3 single-nucleotide polymorphisms (SNPs) associated with human longevity. However, it is not clear if these SNPs influence mortality risk beyond the oldest 1 percentile of survival. Using data from four longevity studies (total n = 8,266, age range 96-119 years for cases), we tested gene-wide association between 107 SNPs and survival to at least the oldest 1 percentile of survival for the 1900 birth cohort (≥96, white males; ≥100 white females). This analysis replicated 17 previously published variants, several of which are significant expression quantitative trait loci of FOXO3; rs6911407 and rs2253310 have the most significant effect on FOXO3 expressions in brain tissue. We then performed a survival analysis to determine if any of these 107 SNPs impact upon mortality risk beyond the oldest 1 percentile. While none of the 17 published variants was significantly associated with mortality risk beyond this extreme age, an uncommon homozygote genotype of rs9384680 exhibited the strongest association with mortality risk (p = 2.68E-04) in only 11 females, a heretofore unreported association. These analyses replicate the previous association of common variants of FOXO3 with older age but these common variants do not modify risk for mortality at ages beyond the oldest 1 percentile age of survival.

How Well Does the Family Longevity Selection Score Work: A Validation Test Using the Utah Population Database

The Family Longevity Selection Score (FLoSS) was used to select families for the Long Life Family Study (LLFS) but has never been validated in other populations. The goal of this paper is to validate how well the FLoSS-based selection procedure works in an independent dataset. In this paper, we computed FLoSS using the lifespan data of 234,155 individuals from a large comprehensive genealogically-based resource, the Utah Population Database (UPDB), born between 1779 and 1910 with mortality follow-up through 2012-2013. Computations of FLoSS in a specific year (1980) confirmed the survival advantage of the "exceptional" sibships (defined by LLFS FLoSS threshold, FLoSS ≥ 7). We found that the subsample of the UPDB participants born after 1900 who were from the "exceptional" sibships had survival curves similar to that of the US participants from the LLFS probands' generation. Comparisons between the offspring of parents with "exceptional" and "ordinary" survival showed the survival advantage of the "exceptional" offspring. Investigators seeking to explain the extent genetics and environment contribute to exceptional survival will benefit from the use of exceptionally long-lived individuals and their relatives. Appropriate ranking of families by survival exceptionality and their availability for the purposes of providing genetic and phenotypic data is critical for selecting participants into such studies. This study validated the FLoSS as selection criteria in family longevity studies using UPDB.

Sleep Duration Interacts With Lifestyle Risk Factors and Health Status to Alter Risk of All-Cause Mortality: The Rural Chinese Cohort Study

STUDY OBJECTIVES

Many studies suggest an association of both short and long sleep duration with all-cause mortality, but the effect of co-occurrence of sleep duration and other lifestyle risk factors or health status remains unclear.

METHODS

A total of 17,184 participants aged 18 years or older from rural areas of China were examined at baseline from 2007 to 2008 and followed up from 2013 to 2014. Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI).

RESULTS

During 6-year follow-up, we identified 1,101 deaths. The multivariable-adjusted mortality risk was significantly higher with short-duration sleepers (< 6.5 hours) (HR = 1.37, 95% CI 1.01-1.86) and long-duration sleepers (≥ 9.5 hours) (HR = 1.35, 95% CI 1.05-1.74) versus 6.5-7.5 hours. The multiplicative interaction of long sleep duration with some lifestyle risk factors and health statuses increased the mortality risk in men (low level of physical activity: HR = 1.03, 95% CI 1.02-1.04; hypertension: HR = 1.06, 95% CI 1.04-1.09; type 2 diabetes mellitus [T2DM]: HR = 1.07, 95% CI 1.04-1.11). Similar results were found in women (low level of physical activity: HR = 1.03, 95% CI 1.02-1.05; T2DM: HR = 1.07, 95% CI 1.05-1.10).

CONCLUSIONS

Sleep duration could be a predictor of all-cause mortality and its interaction with physical activity, hypertension, and T2DM may increase the risk of mortality.

Women live longer than men even during severe famines and epidemics

Women live longer than men in nearly all populations today. Some research focuses on the biological origins of the female advantage; other research stresses the significance of social factors. We studied male–female survival differences in populations of slaves and populations exposed to severe famines and epidemics. We find that even when mortality was very high, women lived longer on average than men. Most of the female advantage was due to differences in mortality among infants: baby girls were able to survive harsh conditions better than baby boys. These results support the view that the female survival advantage is modulated by a complex interaction of biological environmental and social factors.

Women in almost all modern populations live longer than men. Research to date provides evidence for both biological and social factors influencing this gender gap. Conditions when both men and women experience extremely high levels of mortality risk are unexplored sources of information. We investigate the survival of both sexes in seven populations under extreme conditions from famines, epidemics, and slavery. Women survived better than men: In all populations, they had lower mortality across almost all ages, and, with the exception of one slave population, they lived longer on average than men. Gender differences in infant mortality contributed the most to the gender gap in life expectancy, indicating that newborn girls were able to survive extreme mortality hazards better than newborn boys. Our results confirm the ubiquity of a female survival advantage even when mortality is extraordinarily high. The hypothesis that the survival advantage of women has fundamental biological underpinnings is supported by the fact that under very harsh conditions females survive better than males even at infant ages when behavioral and social differences may be minimal or favor males. Our findings also indicate that the female advantage differs across environments and is modulated by social factors.

Health Impacts of Religious Practices and Beliefs Associated with The Church of Jesus Christ of Latter-Day Saints

The aim of the study is to discuss the relationship between lifestyle marked by The Church of Jesus Christ of Latter-day Saints and health. PubMed, CINAHL, PsycINFO, WOS y Scopus were the databases used for this literature review, with these descriptors: "Mormons", "mormons religion", "health". Inclusion criteria were articles with full text available, published between 2005 and 2016, in English or Spanish language. Results show that following the restrictive Mormon doctrine generates beneficial effects for the health. Habits related to toxics and food, as well as social support, from family and Mormon community are an important basis for good health. On the other hand, not following the prescriptions or leaving the group, opposed sexual identities or not fulfilling the roles associated with women are associated with worse mental and physical health.

Offspring Socioeconomic Status and Parent Mortality Within a Historical Population

Considering a network approach to health determinants, we test the hypothesis that benefits of high socioeconomic status (SES) may be transmitted up the generational ladder from offspring to parents. Studies that examine own SES and own health outcomes, or SES of parents and outcomes of young or adolescent children, are common. Those that investigate SES of offspring and their association with parental health are rare. Employing data from a historical population of individuals extracted from a comprehensive population database that links demographic and vital records across generations, this study tests the hypothesis that higher offspring SES associates with lower parental mortality after controlling for parental SES. The sample includes 29,972 individuals born between 1864 and 1883 whose offspring were born between 1886 and 1920. SES is operationalized using Nam-Powers occupational status scores divided into quartiles and a category for farmers. Models assess mortality risk after age 40. Included is a test for whether effects are proportional across parents who died younger and older. Estimated life expectancies across categories of offspring SES conditioned on parental SES are calculated to illustrate specifically how differences in SES relate to differences in years lived. Results indicate a longevity penalty for those whose offspring have low SES and a longevity dividend for those with high-SES offspring. The influence of offspring attributes on well-being of parents points to fluid and myriad linkages between generations.

Reduced costs of reproduction in females mediate a shift from a male-biased to a female-biased lifespan in humans

The causes underlying sex differences in lifespan are strongly debated. While females commonly outlive males in humans, this is generally less pronounced in societies before the demographic transition to low mortality and fertility rates. Life-history theory suggests that reduced reproduction should benefit female lifespan when females pay higher costs of reproduction than males. Using unique longitudinal demographic records on 140,600 reproducing individuals from the Utah Population Database, we demonstrate a shift from male-biased to female-biased adult lifespans in individuals born before versus during the demographic transition. Only women paid a cost of reproduction in terms of shortened post-reproductive lifespan at high parities. Therefore, as fertility decreased over time, female lifespan increased, while male lifespan remained largely stable, supporting the theory that differential costs of reproduction in the two sexes result in the shifting patterns of sex differences in lifespan across human populations. Further, our results have important implications for demographic forecasts in human populations and advance our understanding of lifespan evolution.

"Healthy Men" and High Mortality: Contributions from a Population-Based Study for the Gender Paradox Discussion

BACKGROUND

Inequalities between men and women in morbidity and mortality show a contrast, which has been called gender paradox. Most studies evaluating this paradox were conducted in high-income countries and, until now, few investigations have been performed in Brazil. This study aims to estimate the magnitude of inequalities between adult men and women in several dimensions: demographic and socioeconomic, health behaviors, morbidity, use of health services and mortality.

METHODS

The data were obtained from population-based household survey carried out in Campinas (Campinas Health Survey 2008/09) corresponding to 957 people, and data from the Mortality Information System (MIS) between 2009 and 2011. Prevalences and prevalence ratios were analyzed in order to verify the differences between men and women regarding socioeconomic and demographic variables, health behaviors, morbidities and consultations in the last two weeks. Mortality rates and the ratio between coefficients considering the underlying causes of death were calculated.

RESULTS

Women had a greater disadvantage in socioeconomic indicators, chronic diseases diagnosed by a health professional and referred health problems as well as make more use of health services, while men presented higher frequency of most unhealthy behaviors and excessive mortality for all causes investigated.

CONCLUSIONS

The findings contribute to the discussion of gender paradox and demonstrate the need to employ health actions that consider the differences between men and women in the various health dimensions analyzed. The premature male mortality from preventable causes was outstanding, making clear the need for more effective prevention and health promotion directed to this segment of the population.

The impact of smoking on gender differences in life expectancy: more heterogeneous than often stated

Background: Throughout industrialized countries, tobacco consumption is seen as the predominant driver of both the trend and the extent of gender differences in life expectancy. However, several factors raise doubts to this generalization. We hypothesize that the impact of smoking on the gender gap is context-specific and differs between populations. Methods: We decompose the gender differences in life expectancy into fractions caused by smoking and other non-biological factors for 53 industrialized countries and the period 1955–2009 to assess the significance of smoking among the causes that can be influenced by direct or indirect interference. Results: The trend of the gender gap can indeed be attributed to smoking in most populations of the western world. However, with regard to the overall extent of male excess mortality, smoking is the main driver only in the minority of the studied populations. While the impact of smoking to gender differences in life expectancy declines in all populations, the contribution of other non-biological factors is in most cases higher at the end than at the beginning of the observation period. Conclusions: Over-generalized statements suggesting that smoking is the main driver of the gender gap in all populations can be misleading. The results of this study demonstrate that—regardless of the prevailing effect of smoking—many populations have still remarkable potentials to further narrow their gender gaps in life expectancy. Although measures to further reduce the prevalence of tobacco consumption must be continued, more attention should be directed to the growing importance of other non-biological factors.

How to classify the oldest old according to their health status: a study on 1160 subjects belonging to 552 90+ Italian sib-ships characterized by familial longevity recruited within the GEHA EU Project

The health status of the oldest old, the fastest increasing population segment worldwide, progressively becomes more heterogeneous, and this peculiarity represents a major obstacle to their classification. We compared the effectiveness of four previously proposed criteria (Franceschi et al., 2000; Evert et al., 2003; Gondo et al., 2006; Andersen-Ranberg et al., 2001) in 1160 phenotypically fully characterized Italian siblings of 90 years of age and older (90+, mean age: 93 years; age range: 90-106 years) belonging to 552 sib-ships, recruited in Northern, Central and Southern Italy within the EU-funded project GEHA, followed for a six-year-survival. Main findings were: (i) "healthy" subjects varied within a large range, i.e. 5.2% (Gondo), 8.7% (Evert), 17.7% (Franceschi), and 28.5% (Andersen-Ranberg); (ii) Central Italy subjects showed better health than those from Northern and Southern Italy; (iii) mortality risk was correlated with health status independently of geographical areas; and (iv) 90+ males, although fewer in number, were healthier than females, but with no survival advantage. In conclusion, we identified a modified version of Andersen-Ranberg criteria, based on the concomitant assessment of two basic domains (cognitive, SMMSE; physical, ADL), called "Simple Model of Functional Status" (SMFS), as the most effective proxy to distinguish healthy from not-healthy subjects. This model showed that health status was correlated within sib-ships, suggesting a familial/genetic component.