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Stephan, Anna-Janina; Schwettmann, Lars; Meisinger, Christa; Ladwig, Karl-Heinz; Linkohr, Birgit; Thorand, Barbara; Schulz, Holger; Peters, Annette and Grill, Eva (2021): Living longer but less healthy: The female disadvantage in health expectancy. Results from the KORA(1)-Age study. In: Experimental Gerontology, Vol. 145, 111196

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Objectives: We explored the male-female health-survival paradox in the context of health expectancy (HE) at age 65 and thereafter, using three different morbidity measures and different severity cut-offs with and without adjustments for the share of nursing home residents. Methods: HE at ages 65, 70, 75, 80, and 85 was estimated with the Sullivan method, linking morbidity prevalence from the KORA (Cooperative Health Research in the Region of Augsburg)-Age study to 2016 Bavarian mortality data. Morbidity measures comprised deficit accumulation (Frailty Index, FI, cut-offs 0.08 and 0.25), disability (Health Assessment Questionnaire-Disability Index, HAQ-DI, cut-off >0) and participation (Global Activity Limitation Indicator, GALI, limited vs not limited). Results: Morbidity data were available for 4083 participants (52.7% female). HE was lower in women than in men at all ages. Differences in morbidity prevalence, absolute HE, and health proportions of life expectancy (relative HE) increased with age for FI >= 0.25 and GALI, but not for HAQ-DI > 0 and FI > 0.08. Accounting for the share of nursing home residents resulted in a slight reduction of HE estimates but had no impact on estimated sex differences. Conclusions: In HE at age 65 and thereafter, women's health disadvantage was larger than their life expectancy advantage over men.

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