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Women have worse self-rated health and more hospitalization episodes than men from early adolescence to late middle age, but are less likely to die at each age. We use 14 years of data from the U.S. National Health Interview Survey to examine this paradox. Our results indicate that the difference in self-assessed health between women and men can be entirely explained by differences in the distribution of the chronic conditions they face. This is not true, however, for hospital episodes and mortality. Men with several smoking-related conditions-including cardiovascular disease and certain lung disorders-are more likely to experience hospital episodes and to die than women who suffer from the same chronic conditions, implying that men may experience more-severe forms of these conditions. While some of the difference in mortality can be explained by differences in the distribution of chronic conditions, an equally large share can be attributed to the larger adverse effects of these conditions on male mortality. The greater effects of smoking-related conditions on men's health may be due to their higher rates of smoking throughout their lives.
Research on sex differences in health in a large number of countries has brought to light an important paradox: women use more health services and report worse self-rated health than men, but women are less likely to die than same-aged men throughout life, indicating that they may, in fact, be healthier. This paradox has been the subject of earlier articles, starting with that by Nathanson (1975) and followed by numerous others (see, e.g., Idler 2003; Maclntyre, Ford, and Hunt 1999; Molarius and Janson 2002; Verbrugge 1989). In this article, we revisit this issue using more recent and larger data sets that contain information on both mortality and morbidity.
There are several possible explanations for the worse self-rated health but lower mortality of women. First, there may be sex differences in the distributions of chronic conditions, driven by biological, behavioral, or psychosocial factors (Lawlor, Ebrahim, and Davey Smith 2001; Molarius and Janson 2002; Verbrugge 1989). Women may be more likely than men to suffer from health conditions, such as arthritis or headaches, that result in poorer self-rated health but contribute relatively little to the risk of mortality, whereas men may be more likely to have conditions such...