At a Glance
Gender, Hospitalization, and Mortality (Dissertation)
Andreas Höhn, Anna Oksuzyan, Roland Rau, Kaare Christensen (University of Southern Denmark, Epidemiology, Biostatistics and Biodemography Unit, Odense, Denmark)
Women tend to have poorer health than men; nevertheless, they have a survival advantage. This finding has been documented across different countries and contexts. However, the generalizability of this paradox is being contested – particularly as to individuals of post-reproductive ages, i.e., ages at which health deteriorates and aging accelerates. Routinely-collected hospital records provide a unique setting to study gender differences in mortality and health. These data cover information on medically diagnosed conditions, can often be linked with mortality data, and they exist for a variety of countries, including Denmark.
Using register data for the total Danish population, four subprojects were developed to analyze particular features of gender differences in mortality and health surrounding hospital admissions. In the first subproject, male excess mortality following first all-cause and cause-specific hospitalization after age 50 was estimated. Results indicate that part of the survival advantage women have at post-reproductive ages can be attributed to the fact that they have a lower risk of dying following health deterioration.
The second subproject examined how gender patterns in treatment-seeking behavior changed around a major health shock, measured as the first admission to hospital after age 60 for either stroke, myocardial infarction, chronic obstructive pulmonary disease, or gastrointestinal cancers. Findings indicate that the higher levels of primary healthcare use among women are attributable to a combination of both a lower threshold to seek medical advice and a health disadvantage resulting from lower mortality in bad health.
The third subproject addressed the question of whether the mean age at first hospital admission after age 60 increased among Danish men and women over time and whether this trend was accompanied by rising or declining variation in the mean age. Results show that morbidity shifted towards older ages. However, increasing variation in the age at first admission indicates that this average increase has not been experienced by everyone.
The fourth subproject described the current demographic profile of hospital care use in Denmark and projected changes up to 2050. Increasing longevity among men and women in combination with a higher risk of men to be hospitalized at post-reproductive ages mean that men aged 70+ are projected to be the fastest-growing patient group.
Findings of this PhD project indicate that women at post-reproductive ages have multiple advantages over men in terms of hospital admission: Women have a lower risk of being admitted to hospital, and they have a lower mortality following hospitalization. One potential explanation for these patterns is that women have a higher likelihood to engage with primary healthcare services before admission to hospital becomes necessary. Healthcare systems preparing for population aging should be aware of these gender patterns to ensure that hospitals meet the needs of future patients.
Aging, Mortality and Longevity, Health Care, Public Health, Medicine, and Epidemiology
Odense: University of Southern Denmark. (2020)
Journal of Epidemiology and Community Health 74:7, 573–579. (2020)
PLoS One, 1–12. (2020)
European Journal of Epidemiology 35:5, 381–388. (2020)
BMJ Open 8:7, e021813–e021813. (2018)