Women have more illnesses but lower risk of death - study of 480,000 cases from Spain

As we age, chronic diseases and multi-morbidity accumulate in the body, placing a significant burden on the healthcare system. At the same time, different people exhibit different aging trajectories: some remain healthy and active longer, while others experience diseases earlier. Understanding the relationship between life expectancy and the timing of disease onset is necessary to develop individualized strategies for the prevention and treatment of age-related disorders.

A team of Spanish scientists led by Sara Cruces-Salguero and Ander Mateu (GeroScience) analyzed 482,058 medical records of people over 50 who died in Catalonia and found fundamental gender differences in how illnesses accompany our path to old age. The study was published in the journal GeroScience.

Research methods

The authors conducted a retrospective cohort study analyzing electronic medical records of 41,063 deceased individuals (20,722 men with a mean age at death of 79 years and 20,341 women with a mean age at death of 84 years) from the province of Gipuzkoa (Basque Country, Spain). Participants died between 2014 and 2019. The study included an assessment of:

• age of onset of diseases in eight categories of organ systems;
• health span;
• the presence of “escapers” (people who have avoided specific pathologies until very old age);
• Multivariate analysis of the relationships between age, gender, multicomorbidity and survival.

Key Results

1. Extended lifespan delays the onset of diseases. People with a life expectancy above average (82 years) on average encountered diseases of all systems studied later.
2. The extreme groups show the best health profiles. Both the “shortest” and “longest” had the fewest body systems involved.
3. Gender differences. Women, despite higher levels of multicomorbidity, had a lower relative risk of death; men reached record ages with fewer comorbidities.

Interpretation

The study highlights two key aspects:

• "Compression of morbidity." In long-lived people, the period of life with diseases is significantly reduced, which indicates the possibility of improving the quality of aging.
• Need for a gender-oriented approach. Since women accumulate pathologies more slowly but more often have several simultaneous diseases, and men suffer from multimorbidity less often but move away from middle age more quickly when the first disease appears, it is important for clinicians to consider gender when planning preventive measures and therapy for adult patients.

Key findings

1. More illnesses but fewer deaths among women

   • At each age stage, women have a greater number of diagnoses (multimorbidity), but at the same time a lower risk of death compared to men.

2. "Compressed" trajectories in men

   • Men live to a very prestigious age with fewer concomitant diseases, but die faster when they are sick - their "multi-morbidity" occurs in a narrower age window.

3. Three patterns of aging

   • "Survivors": maintain a longer life expectancy despite illness.

   • "Delayers" - receive their first diagnoses later than average.

   • "Disease escapists" reach old age with a minimum of chronic diseases.

Why is this important?

• Healthcare planning: Understanding sex differences in aging helps to better predict hospital burden and create personalized prevention and treatment strategies.
• Search for health biomarkers: 'Preppers', especially among the female population, may hold the keys to longevity without compromising quality of life.
• Intervention development: in men, the focus should be on smoothing out the “compressed” peaks of disease in midlife; in women, on managing multimorbidity to reduce risks.

“Our study shows that men and women ‘age’ differently – women spread illnesses over a longer period but cope with them better, while in men illnesses are concentrated closer to the end of life, leading to rapid deterioration,” comments Sara Cruces-Salguero.

Authors' comments

• Sara Cruces-Salguero: "Our data show that life expectancy itself acts as a shield against the development of chronic diseases, with people at the extremes of life expectancy enjoying the best health."
• Ander Matheu: "These findings provide a deeper understanding of gender differences in ageing and call for the development of differentiated support programs for older men and women."
• Reinald Pamplona: “The use of cumulative health and multimorbidity “curves” is a new step in gerontology, opening the way for personalized medicine in geriatric practice.”