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Sex differences in health and mortality by income and income changes
  1. Linda Juel Ahrenfeldt1,
  2. Jacob Krabbe Pedersen1,
  3. Mikael Thinggaard1,
  4. Kaare Christensen1,2,3,
  5. Rune Lindahl-Jacobsen1
  1. 1 Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
  2. 2 Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
  3. 3 Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
  1. Correspondence to Mrs Linda Juel Ahrenfeldt, Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense 5000, Denmark; lahrenfeldt{at}


Background The adverse association between income, health and survival is well documented, but little is known about how income trajectories influence health and survival for men and women. We aim to investigate sex differences in mortality and hospitalisations by income and income changes.

Methods We performed a population-based, nationwide study including 1 063 787 Danes born 1935–1955 and residing in Denmark during 1980–2015. Income was calculated during two age intervals: 45–49 and 55–59 years. The average income was divided into quartiles for men and women separately, which formed the basis for the income trajectories. Individuals were followed up from age 60 until 2014/2015 for hospital admission and mortality, respectively.

Results Men had higher mortality and were more hospitalised than women. Sex differences in mortality were most pronounced for people with stable low income (relative difference in hazard=1.93; 95% CI 1.89 to 1.98) and a downward income trajectory (1.91; 95% CI 1.85 to 1.98) with smaller sex differences for people with an upward trajectory (1.59; 95% CI 1.56 to 1.62) and stable high income (1.37; 95% CI 1.33 to 1.41). A similar pattern was found for family income. Regarding hospitalisations, similar results were found, though less pronounced. Investigation of mortality and hospitalisations by all possible trajectories demonstrated that income at ages 55–59 was an important predictor of mortality, with increasing mortality for decreasing income quartile.

Conclusion Income trajectories as a proxy for change in social position have a larger influence on men’s than women’s health and mortality. Income in the late 50s is an important predictor of mortality, particularly for men.

  • Sex differences
  • income
  • mortality
  • hospital admissions
  • Denmark

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  • Contributors LJA and RLJ conceptualised and designed the study. LJA conducted the analyses, drafted all versions of the manuscript and revised the manuscript. JKP contributed substantially to the analyses and helped interpret the data. MT contributed to the analyses and interpretation of data, and provided input on the manuscript. KC and RLJ provided valuable input on the drafts of the manuscript. All authors approved the final version.

  • Funding This study was supported by research grants from the National Institute on Aging (NIA-PO1-AG08761, NIAP01-AG031719) and from the European Union’s Seventh Framework Programme (FP7/2007–2011) under grant agreement number 259679.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study involves secondary data analyses of existing register data approved by the Danish Data Protection Agency.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.