The Male-Female Health-Survival Paradox: A Survey and Register Study of the Impact of Sex-Specific Selection and Information Bias

Anna Oksuzyan, Max Planck Institute for Demographic Research
Inge Petersen, University of Southern Denmark
Henrik Stovring, University of Southern Denmark
Matt McGue, University of Minnesota
Paul Bingley, University of Aarhus
Kaare Christensen, University of Southern Denmark

The present study examined whether a remarkable discrepancy between the health and survival of men versus women could partially be due to selection and information bias in surveys. The study is based on the linkage of three population-based surveys of 45 to 102 years old Danes with health registers covering the total Danish population regarding hospitalizations and prescription medicine. Men had higher participation rates than women at all ages. Non-hospitalized men had higher participation rates than hospitalized men, whereas no consistent pattern was observed among women. Women taking medications had higher participation rates than female non-users, while no such pattern was seen in men. Men used fewer medications than women, but they under-reported medication use to a similar degree as did women. The present study suggests that selection bias in surveys may contribute to the explanation of the health–survival paradox, though its contribution is likely to be small.