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This Article Full Text Full Text (PDF) All Versions of this Article: AJPH.2006.107912v1 AJPH.2006.107912v2 98/12/2251    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Singh-Manoux, A. Articles by Marmot, M. Search for Related Content PubMed PubMed Citation Articles by Singh-Manoux, A. Articles by Marmot, M. Related Collections Aging Gender Mortality

Archana Singh-Manoux, PhD, Alice Guéguen, PhD, Jane Ferrie, PhD, Martin Shipley, MSc, Pekka Martikainen, PhD, Sébastien Bonenfant, MSc, Marcel Goldberg, MD, PhD and Michael Marmot, FRCP

Archana Singh-Manoux is with unit U687-IFR69, l'Institut National de la Santé et de la Recherche Médicale (INSERM), Villejuif, France; the Department of Epidemiology and Public Health, University College London, London, England; and the Centre de Gérontologie, Hôpital Ste Périne, Assistance Publique–Hôpitaux de Paris, Paris, France. Alice Guéguen, Sébastien Bonenfant, and Marcel Goldberg are with unit U687-IFR69, INSERM, Villejuif. Jane Ferrie, Martin Shipley, and Michael Marmot are with the Department of Epidemiology and Public Health, University College London, London. Pekka Martikainen is with the University of Helsinki, Helsinki, Finland.

Correspondence: Requests for reprints should be sent to Archana Singh-Manoux, INSERM U687; Hôpital Paul Brousse, 16 avenue Paul Vaillant Couturier, Bâtiment 15/16 94807 Villejuif Cedex, France (e-mail: archana.singh-manoux{at}st-maurice.inserm.fr).

Objectives. 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.