title: Gender differences in the association between morbidity and mortality among middle-aged men and women.
abstract: OBJECTIVE
  We examined gender differences in mortality, morbidity, and the association between the 2.
  
  
  METHODS
  We used health data from 2 studies of middle-aged men and women: the British Whitehall II cohort of employees from 20 civil service departments in London and the 1989 French GAZEL (this acronym refers to the French gas and electric companies) of employees of France's national gas and electricity company. Participants were aged 35 to 55 years when assessed for morbidity and followed up for mortality over 17 years.
  
  
  RESULTS
  Male mortality was higher than female mortality in Whitehall II (hazard ratio [HR] = 1.56; 95% confidence interval [CI] = 1.28, 1.91) and the GAZEL cohort (HR = 1.99; CI = 1.66, 2.40). Female excess morbidity was observed for some measures in the Whitehall II data and for 1 measure in the GAZEL data. Only self-reported sickness absence in the Whitehall II data was more strongly associated with mortality among men (P = .01).
  
  
  CONCLUSIONS
  Mortality was lower among women than among men, but morbidity was not consistently higher. The lack of gender differences in the association between morbidity and mortality suggests that this is not a likely explanation for the gender paradox, which refers to higher morbidity but lower mortality among women than among men.
authors.affiliation: INSERM U687, Villejuif Cedex, France. archana.singh-manoux@st-maurice.inserm.fr
authors.forename: Archana
authors.initials: A
authors.lastname: Singh-Manoux
authors.forename: Alice
authors.initials: A
authors.lastname: Guéguen
authors.forename: Jane
authors.initials: J
authors.lastname: Ferrie
authors.forename: Martin
authors.initials: M
authors.lastname: Shipley
authors.forename: Pekka
authors.initials: P
authors.lastname: Martikainen
authors.forename: Sébastien
authors.initials: S
authors.lastname: Bonenfant
authors.forename: Marcel
authors.initials: M
authors.lastname: Goldberg
authors.forename: Michael
authors.initials: M
authors.lastname: Marmot
mesh_terms: D000041:Absenteeism; D000328:Adult; D000704:Analysis of Variance; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008017:Life Expectancy / Q000639:trends; D008131:London / Q000453:epidemiology; D008297:Male; D008571:Men; D008875:Middle Aged; D009017:Morbidity / Q000639:trends*; D009026:Mortality / Q000639:trends*; D016016:Proportional Hazards Models; D012727:Sex Characteristics; D017678:Sex Distribution; D012737:Sex Factors; D014930:Women