---
title: "Health survival paradox"
chunk: 1/3
source: "https://en.wikipedia.org/wiki/Health_survival_paradox"
category: "reference"
tags: "science, encyclopedia"
date_saved: "2026-05-05T03:57:59.615345+00:00"
instance: "kb-cron"
---

The male-female health survival paradox, also known as the morbidity-mortality paradox or gender paradox, is the phenomenon in which female humans experience more medical conditions and disability during their lives, but live longer than males.  The observation that females experience greater morbidity (diseases) but lower mortality (death) in comparison to males is paradoxical since it is expected that experiencing disease increases the likelihood of death. However, in this case, the part of the population that experiences more disease and disability is the one that lives longer.

== Background and history ==

The male-female health survival paradox has been most reliably reported in literature and documented as far back as the 18th century in European historical records. Some of the last records of European men outliving women are from the Netherlands in 1860 and Italy in 1889. The earliest records of European women outliving men were from Sweden in 1751, Denmark in 1835, and both England and Wales in 1841. While women were documented to outlive men in Europe, data from 1887 through 1930 showed that females between ages 5 and 25 in Massachusetts disproportionately faced mortality due to infectious diseases. With improvements in infectious disease prevention, treatment, and eradication of Smallpox around the 1970s, mortality rates declined in both sexes. At this time, female life expectancy also peaked in the United States; females were expected to live eight years longer than males. Since the 1970s, the life expectancy gap between females and males has been on the decline in the United States and Western Europe.
Although more research needs to be completed, it is postulated that there is a "biopsychosocial" component which causes this paradox. In other words, women and men differ in biological, behavioral, and social factors which causes the male-female health survival paradox.
Biopsychosocial factors that have been hypothesized to cause this paradox include genetics, hormone differences, immunological differences, reproduction, chronic diseases, disability, physiological reserve, risk-related activities, illness perception, health reporting behavior, health care utilization, gender roles, and social assets and deficits.
Scholars relate the male-female health survival paradox to the concept of frailty, which is the vulnerability that the aging population has to adverse health outcomes. Such geriatric propensity to frailty is an emerging topic of research given new therapeutic interventions aimed at improving the health of the aging population, such as healthy nutrition, physical exercise, cognitive training, and multimodal interventions that encompass all of these components.

== Influential factors ==

=== Risk Factors and Behaviors ===
Different rates of alcohol and tobacco usage by men and women contribute to the paradox in developed countries. More women abstain from alcohol for lifetime, drink less, and have less drinking problems in comparison to men. However, more women tend to have alcohol-related disorders and withdrawal symptoms due to differences in pharmacokinetics and sex hormones.
Similarly, a review on substance-use disorder (SUDs) observed sex/gender differences on the biology, epidemiology, and treatment of substance-use disorder. Women were generally afflicted with more severe adverse events, but prognosis after treatment between men and women did not differ. However, due to conflict of emerging SUDs findings, future studies are needed to confirm whether biological and environmental constituents impact gender/sex differences on substance-use disorder.
It has also been stated that while men experience smoking-related conditions more than women, women have more trouble maintaining cessation than men. However, a recent review showed mixed findings on smoking behavior, and that bio-psycho-social factors may be more impactful than gender differences. In addition, a higher proportion of men use alternative tobacco options to replace cigarettes, and gender-based comparisons may be skewed from failing to stratify randomization in treatment groups.

=== Diseases ===
Men are more likely to suffer from heart disease, cancer, and stroke than women. These diseases are the main cause of the gender gap in life expectancy.
Despite men having more fatal conditions such as ischemic heart disease, lung cancer, liver cirrhosis, traffic accidents, and suicide, women have more non-fatal acute and chronic conditions. The majority of the female survival advantage is accounted for by differences in mortality rates between men and women ages 50–70 due to differing rates of cardiovascular diseases. While women report more symptoms and experience higher incidence of musculoskeletal and autoimmune disease, men have earlier and higher rates of cardiovascular diseases, after adjusting the data for the gap in life expectancy. Other studies report women having higher rates of cardiovascular disease, while not accounting for women having longer life expectancy. A recent review found that women afflicted with coronary heart disease are generally older and have more cardiovascular risks than men with coronary heart disease. While men have nearly twice the incidence of coronary heart disease and related mortality, women experience more incidence at increasing age.
Women also have higher rates of autoimmune disorders than men; one hypothesis for this is that testosterone facilitates immunosuppression in men, decreasing the likelihood men create autoantibodies that can target their own bodies, leading to autoimmune disease.
Most countries report higher rates of chronic kidney disease (CKD) in women compared to men. However, the difference in CKD rates may be due to the longer life expectancy of women, as kidney function declines with age. Although more women are diagnosed with CKD, among individuals diagnosed with CKD who are not on dialysis treatment, the men exhibit greater mortality rates compared to women. Studies investigating sex differences in kidney disease have suggested that men lose kidney function faster than women. It is hypothesized that this may be due to the protective effects of estrogens and the harmful effects of testosterone on the kidneys, or due to lifestyle differences between men and women.

=== Biological factors ===
Proposed explanations for the paradox range from genetic, hormonal, and physiological processes unique to females and males.