Objectives: To examine sex differences in prevalent comorbidity and frailty across age and European regions. Methods: This is a cross-sectional study based on 113,299 Europeans aged 50+ participating in the Survey of Health, Ageing and Retirement in Europe from 2004–2005 to 2015. Sex differences in the Comorbidity Index and the Frailty Phenotype were investigated using ordinal logistic regressions. Results: European women had generally higher odds of prevalent comorbidity (OR 1.11, 95% CI 1.07–1.15) and frailty (OR 1.56, 95% CI 1.51–1.62). Sex differences increased with advancing age. No overall sex difference in comorbidity was found in Western Europe, but women had more comorbidity than men in Eastern (OR 1.30, 95% CI 1.18–1.44), Southern (OR 1.23, 95% CI 1.15–1.30), and Northern (OR 1.08, 95% CI 1.01–1.16) Europe. Women were frailer than men in all regions, with the largest sex difference in Southern Europe (OR 1.84, 95% CI 1.72–1.96). Conclusions: European women are frailer and have slightly more comorbidity than European men lending support for the male–female health survival paradox.

Original languageEnglish
JournalInternational Journal of Public Health
Issue number7
Pages (from-to)1025-1036
Publication statusPublished - Sep 2019


  • Comorbidity
  • Europe
  • Frailty
  • Sex differences


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