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

Avdic, D; Hägglund, P; Lindahl, B; Johansson, P

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

Avdic, D Hägglund, P Lindahl, B Johansson, P

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Publisher:: BMJ PUBLISHING GROUP
Publication Type:: Journal Article
Citation:: BMJ Open, 2019, 9, (8), pp. e024098
Issue Date:: 2019-09-03

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Field	Value	Language
dc.contributor.author	Avdic, D
dc.contributor.author	Hägglund, P
dc.contributor.author	Lindahl, B
dc.contributor.author	Johansson, P
dc.date.accessioned	2025-08-27T03:12:43Z
dc.date.available	2019-07-04
dc.date.available	2025-08-27T03:12:43Z
dc.date.issued	2019-09-03
dc.identifier.citation	BMJ Open, 2019, 9, (8), pp. e024098
dc.identifier.issn	2044-6055
dc.identifier.issn	2044-6055
dc.identifier.uri	http://hdl.handle.net/10453/189520
dc.description.abstract	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.
dc.format	Electronic
dc.language	eng
dc.publisher	BMJ PUBLISHING GROUP
dc.relation.ispartof	BMJ Open
dc.relation.isbasedon	10.1136/bmjopen-2018-024098
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1103 Clinical Sciences, 1117 Public Health and Health Services, 1199 Other Medical and Health Sciences
dc.subject.classification	32 Biomedical and clinical sciences
dc.subject.classification	42 Health sciences
dc.subject.classification	52 Psychology
dc.subject.mesh	Adolescent
dc.subject.mesh	Adult
dc.subject.mesh	Aged
dc.subject.mesh	Female
dc.subject.mesh	Health Behavior
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Middle Aged
dc.subject.mesh	Morbidity
dc.subject.mesh	Registries
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Sex Distribution
dc.subject.mesh	Sex Factors
dc.subject.mesh	Sick Leave
dc.subject.mesh	Survival Rate
dc.subject.mesh	Sweden
dc.subject.mesh	Young Adult
dc.subject.mesh	Humans
dc.subject.mesh	Registries
dc.subject.mesh	Morbidity
dc.subject.mesh	Survival Rate
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Health Behavior
dc.subject.mesh	Sex Factors
dc.subject.mesh	Sex Distribution
dc.subject.mesh	Adolescent
dc.subject.mesh	Adult
dc.subject.mesh	Aged
dc.subject.mesh	Middle Aged
dc.subject.mesh	Sick Leave
dc.subject.mesh	Sweden
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Young Adult
dc.subject.mesh	Adolescent
dc.subject.mesh	Adult
dc.subject.mesh	Aged
dc.subject.mesh	Female
dc.subject.mesh	Health Behavior
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Middle Aged
dc.subject.mesh	Morbidity
dc.subject.mesh	Registries
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Sex Distribution
dc.subject.mesh	Sex Factors
dc.subject.mesh	Sick Leave
dc.subject.mesh	Survival Rate
dc.subject.mesh	Sweden
dc.subject.mesh	Young Adult
dc.title	Sex differences in sickness absence and the morbidity-mortality paradox: a longitudinal study using Swedish administrative registers.
dc.type	Journal Article
utslib.citation.volume	9
utslib.location.activity	England
utslib.for	1103 Clinical Sciences
utslib.for	1117 Public Health and Health Services
utslib.for	1199 Other Medical and Health Sciences
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
pubs.organisational-group	University of Technology Sydney/UTS Groups
pubs.organisational-group	University of Technology Sydney/UTS Groups/Centre for Health Economics Research and Evaluation (CHERE)
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0/
dc.date.updated	2025-08-27T03:12:41Z
pubs.issue	8
pubs.publication-status	Published online
pubs.volume	9
utslib.citation.issue	8

Abstract:

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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http://hdl.handle.net/10453/189520