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Women’s excess unhealthy life years: disentangling the unhealthy life years gap

Lookup NU author(s): Emerita Professor Carol Jagger



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© The Author(s) 2019. Published by Oxford University Press on behalf of the European Public Health Association.BACKGROUND: Compared to men, women live longer but have more years with disability. We assessed the contribution of gender differences in mortality and disability, total and by cause, to women's excess unhealthy life years (ULYs). METHODS: We used mortality data for France 2008 from Eurostat, causes of death from the CépiDc-INSERM-database; and disability and chronic conditions data from the French Disability Health Survey 2008-09. ULYs were calculated by the Sullivan method. The contributions of mortality and disability differences to gender differences in ULY were based on decomposition analyses. RESULTS: Life expectancy of French women aged 50 was 36.3 years of which 19.0 were ULYs; life expectancy of men was 30.4 years of which 14.2 were ULYs. Of the 4.8 excess ULYs in women, 4.0 years were due to lower mortality. Of these 4.0 ULYs, 1.8 ULY originated from women's lower mortality from cancer, 0.8 ULY from heart disease and 0.3 ULY from accidents. The remaining 0.8 excess ULY in women were from higher disability prevalence, including higher disability from musculoskeletal diseases (+1.8 ULY) and anxiety-depression (+0.6 ULY) partly offset by lower disability from heart diseases (-0.8 ULY) and accidents (-0.3 ULY). CONCLUSION: Lower mortality and higher disability prevalence contributed to women's longer life expectancy with disability. Women's higher disability prevalence due to non-fatal disabling conditions was partly offset by lower disability from heart disease and accidents. Conditions differentially impact gender differences in ULY, depending on whether they are mainly life-threatening or disabling. The conclusions confirm the health-survival paradox.

Publication metadata

Author(s): Nusselder WJ, Cambois EM, Wapperom D, Mesle F, Looman CWN, Yokota RTC, Van Oyen H, Jagger C, Robine JM

Publication type: Article

Publication status: Published

Journal: European Journal of Public Health

Year: 2019

Volume: 29

Issue: 5

Pages: 914-919

Online publication date: 05/07/2019

Acceptance date: 02/04/2016

Date deposited: 08/10/2019

ISSN (print): 1101-1262

ISSN (electronic): 1464-360X

Publisher: Oxford University Press


DOI: 10.1093/eurpub/ckz114

PubMed id: 31280299


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