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Sex differences in sickness absence and the morbidity-mortality paradox: a longitudinal study using Swedish administrative registers

OBJECTIVE: To analyse whether gender-specific health behaviour can be an explanation for why women outlive men, while having worse morbidity outcomes, known as the morbidity-mortality or gender paradox. SETTING: The working population in Sweden. PARTICIPANTS: Thirty per cent random sample of Swedish...

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Autores principales: Avdic, Daniel, Hägglund, Pathric, Lindahl, Bertil, Johansson, Per
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6731828/
https://www.ncbi.nlm.nih.gov/pubmed/31481361
http://dx.doi.org/10.1136/bmjopen-2018-024098
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author Avdic, Daniel
Hägglund, Pathric
Lindahl, Bertil
Johansson, Per
author_facet Avdic, Daniel
Hägglund, Pathric
Lindahl, Bertil
Johansson, Per
author_sort Avdic, Daniel
collection PubMed
description OBJECTIVE: To analyse whether gender-specific health behaviour can be an explanation for why women outlive men, while having worse morbidity outcomes, known as the morbidity-mortality or gender paradox. SETTING: The working population in Sweden. PARTICIPANTS: Thirty per cent random sample of Swedish women and men aged 40–59 with a hospital admission in the 1993–2004 period were included. The sample for analysis consists of 233 274 individuals (115 430 men and 117 844 women) and in total 1 867 013 observations on sickness absence. INTERVENTION: Hospital admission across 18 disease categories. MAIN OUTCOME MEASURES: The main outcome measures were sickness absence (morbidity) and mortality. Longitudinal data at the individual level allow us to study how sickness absence changed after a hospital admission in men and women using a difference-in-differences regression analysis. Cox regression models are used to study differences in mortality after the admission. RESULTS: Women increased their sickness absence after a hospital admission by around five more days per year than men (95% CI 5.25 to 6.22). At the same time, men had higher mortality in the 18 diagnosis categories analysed. The pattern of more sickness absence in women was the same across 17 different diagnosis categories. For neoplasm, with a 57% higher risk of death for men (54.18%–59.89%), the results depended on the imputation method of sickness for those deceased. By using the premortality means of sickness absence, men had an additional 14.47 (-16.30– -12.64) days of absence, but with zero imputation women had an additional 1.6 days of absence (0.05–3.20). Analyses with or without covariates revealed a coherent picture. CONCLUSIONS: The pattern of increased sickness absence (morbidity) and lower mortality in women provides evidence on the more proactive and preventive behaviour of women than of men, which could thus explain the morbidity-mortality paradox.
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spelling pubmed-67318282019-09-20 Sex differences in sickness absence and the morbidity-mortality paradox: a longitudinal study using Swedish administrative registers Avdic, Daniel Hägglund, Pathric Lindahl, Bertil Johansson, Per BMJ Open Public Health OBJECTIVE: To analyse whether gender-specific health behaviour can be an explanation for why women outlive men, while having worse morbidity outcomes, known as the morbidity-mortality or gender paradox. SETTING: The working population in Sweden. PARTICIPANTS: Thirty per cent random sample of Swedish women and men aged 40–59 with a hospital admission in the 1993–2004 period were included. The sample for analysis consists of 233 274 individuals (115 430 men and 117 844 women) and in total 1 867 013 observations on sickness absence. INTERVENTION: Hospital admission across 18 disease categories. MAIN OUTCOME MEASURES: The main outcome measures were sickness absence (morbidity) and mortality. Longitudinal data at the individual level allow us to study how sickness absence changed after a hospital admission in men and women using a difference-in-differences regression analysis. Cox regression models are used to study differences in mortality after the admission. RESULTS: Women increased their sickness absence after a hospital admission by around five more days per year than men (95% CI 5.25 to 6.22). At the same time, men had higher mortality in the 18 diagnosis categories analysed. The pattern of more sickness absence in women was the same across 17 different diagnosis categories. For neoplasm, with a 57% higher risk of death for men (54.18%–59.89%), the results depended on the imputation method of sickness for those deceased. By using the premortality means of sickness absence, men had an additional 14.47 (-16.30– -12.64) days of absence, but with zero imputation women had an additional 1.6 days of absence (0.05–3.20). Analyses with or without covariates revealed a coherent picture. CONCLUSIONS: The pattern of increased sickness absence (morbidity) and lower mortality in women provides evidence on the more proactive and preventive behaviour of women than of men, which could thus explain the morbidity-mortality paradox. BMJ Publishing Group 2019-09-03 /pmc/articles/PMC6731828/ /pubmed/31481361 http://dx.doi.org/10.1136/bmjopen-2018-024098 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Public Health
Avdic, Daniel
Hägglund, Pathric
Lindahl, Bertil
Johansson, Per
Sex differences in sickness absence and the morbidity-mortality paradox: a longitudinal study using Swedish administrative registers
title Sex differences in sickness absence and the morbidity-mortality paradox: a longitudinal study using Swedish administrative registers
title_full Sex differences in sickness absence and the morbidity-mortality paradox: a longitudinal study using Swedish administrative registers
title_fullStr Sex differences in sickness absence and the morbidity-mortality paradox: a longitudinal study using Swedish administrative registers
title_full_unstemmed Sex differences in sickness absence and the morbidity-mortality paradox: a longitudinal study using Swedish administrative registers
title_short Sex differences in sickness absence and the morbidity-mortality paradox: a longitudinal study using Swedish administrative registers
title_sort sex differences in sickness absence and the morbidity-mortality paradox: a longitudinal study using swedish administrative registers
topic Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6731828/
https://www.ncbi.nlm.nih.gov/pubmed/31481361
http://dx.doi.org/10.1136/bmjopen-2018-024098
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