Li Guannan, Tampubolon Gindo, Maharani Asri, Tu Chenglin
Global Development Institute, School of Environment, Education and Development, The University of Manchester, Manchester, United Kingdom.
Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
PLoS One. 2024 Dec 26;19(12):e0315594. doi: 10.1371/journal.pone.0315594. eCollection 2024.
The female advantage in life expectancy sits uneasily with female disadvantage in health and well-being in later life compared to their male counterparts. This health disparity has been suggested to rest on sex difference in allostatic load (AL). We aim to delineate the sex-specific age trajectories of AL among midlife and older adults in China and to interpret the contradiction between the female advantage in life expectancy and their disadvantage in health in later life from the perspective of physiological dysregulation. Using data from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011 and 2015, we included 3,836 male and 3,308 female Chinese adults aged 45 and older. Two-level mixed-effects models were fitted to examine how AL changed over time. Missing values were addressed by performing multiple imputations using chained equations. Results show AL increases with age for both sexes, with a steeper rise in females and a slight decline in males after adjusting for the sex-age interaction. Older males born before the People's Republic of China (PRC) exhibited different AL trajectories from younger cohorts. The sex-specific trajectories converge around the late 60s, with females surpassing males, aligning with the life expectancy-health paradox. The presence of a healthier older male cohort in CHARLS suggests future studies should account for cohort effects.
与男性相比，女性在预期寿命上的优势与她们在晚年健康和幸福方面的劣势并不相符。有人认为这种健康差异取决于性别在压力负荷（AL）方面的差异。我们旨在描绘中国中年及老年成年人中AL的性别特异性年龄轨迹，并从生理失调的角度解释女性在预期寿命上的优势与其在晚年健康方面的劣势之间的矛盾。利用2011年和2015年中国健康与养老追踪调查（CHARLS）的数据，我们纳入了3836名年龄在45岁及以上的中国男性和3308名中国女性成年人。采用二级混合效应模型来检验AL随时间的变化情况。通过使用链式方程进行多次插补来处理缺失值。结果显示，两性的AL均随年龄增长，在调整性别-年龄交互作用后，女性的上升幅度更大，男性略有下降。中华人民共和国成立前出生的老年男性呈现出与年轻队列不同的AL轨迹。性别特异性轨迹在60年代末左右趋同，女性超过男性，这与预期寿命-健康悖论相符。CHARLS中存在一个更健康的老年男性队列表明未来的研究应考虑队列效应。
