Exploring the role of biological factors in the male-female health-survival paradox using Health Claims Data

Michael Nerius, German Center for Neurodegenerative Diseases (DZNE)
Anne Fink, German Center for Neurodegenerative Diseases (DZNE)
Gabriele Doblhammer-Reiter, Universität Rostock

Background: Even though men tend to be healthier, they have higher mortality rates at all ages than women. This male-female health-survival paradox may be explained by behavioral and biological factors. We indirectly examine the role of the female sex hormone estrogen as a potential neuroprotective factor and explore its effect on PD incidence and mortality with PD. In this context, we use the occurrence of osteoporosis in women as a surrogate for the lack of estrogens. We hypothesize that women with osteoporosis have a similar incidence rate compared to men without osteoporosis. Methods: We performed PD analyses using routine claims data from the years 2004-2013 of the largest German statutory health insurance. We drew a randomized sample in the first quarter of the year 2004, containing a size of 250,000 persons ages 50 years and older and calculated age- and sex-specific incidence and death rates which are expressed per 100,000 person-years. We used proportional hazard models to examine whether PD was associated with the occurrence of osteoporosis. Results: Men had a higher incidence rate for PD (262; CI 251-273) than women (179; CI 171-186). We further found higher incidence rates among women with osteoporosis (228; CI 202-253) whereas women without osteoporosis showed a rate of 165 (CI 157-173). The increased risk remained after adjusting for major confounder. Regarding mortality among PD cases, men were still at a higher risk of death throughout all ages compared to women with and without osteoporosis. However, there was no difference by osteoporosis within the two sexes. Conclusion: The increased incidence rates of PD for women with osteoporosis may indicate a negative effect of the lack of estrogens for developing PD.