Gender Differences in Survival in Old Age

Background: Although increased survival among females is observed throughout much of adult life, supporting evidence among the oldest old is lacking. Objective: We examined the hypothesis that gender differences in survival diminish with advancing age. Methods: The Jerusalem Longitudinal Study follows a representative cohort born 1920-1921, comprehensively assessed at ages 70, 78, 85, and 90 (n=463, 927, 1224, and 673, respectively). Mortality data were collected during 1990-2013. Kaplan-Meier survival curves and mortality hazards ratios (HRs) were determined, adjusting for gender, marital status, education, loneliness, self-rated health, physical activity, functional status, neoplasm, diabetes mellitus, hypertension, and ischemic heart disease. Results: Survival between ages 70-78 was 77.3% (n=358/463), 78-85 was 68.9% (n=635/927), 85-90 years was 71.1% (n=870/1224), and 90-93 years was 80.5% (n=542/673). With advancing age, the survival advantage among females versus men declined-at ages 70-78 (85.6% vs. 71%, p<0.0001), 78-85 (74% vs. 63%, p=0.001), 85-90 (74% vs. 67.5%, p=0.06), and 90-93 (80% vs. 81%, p=0.92). Compared to females (HR=1.0), the adjusted HR for male mortality at ages 70-78 was 2.93 (95% confidence interval [CI] 1.75-4.91), ages 78-85 was 2.1 (95% CI 1.5-2.92), ages 85-90 was 1.6 (95% CI 1.2-2.2), and ages 90-93 was 1.1 (95% CI 0.7-1.8). Conclusions: Our findings confirm the hypothesis that the increased longevity observed among females at age 70 gradually diminishes with advancing age, and disappears beyond age 90.