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Sex, health, and years of sexually active life gained due togood health: evidence from two US population based crosssectional surveys of ageing Stacy Tessler Lindau, associate professor,1,2 Natalia Gavrilova, senior research associate1 with their peers in poor or fair health. Women in very good Objectives To examine the relation between health and or excellent health gained 3-6 years compared with several dimensions of sexuality and to estimate years of MC2050, Chicago, IL 60637, USA,and Chicago Core on Biomeasures sexually active life across sex and health groups in middle Conclusion Sexual activity, good quality sexual life, and interest in sex were higher for men than for women and this gender gap widened with age. Sexual activity, quality Setting Two samples representative of the US population: of sexual life, and interest in sex were positively MIDUS (the national survey of midlife development in the associated with health in middle age and later life.
United States, 1995-6) and NSHAP (the national social life, Sexually active life expectancy was longer for men, but men lost more years of sexually active life as a result of Participants 3032 adults aged 25 to 74 (1561 women, 1471 men) from the midlife cohort (MIDUS) and 3005 adults aged 57 to 85 (1550 women, 1455 men) from the Human sexuality is increasingly recognised by doctors Main outcome measures Sexual activity, quality of sexual and policymakers as an important aspect of health and life, interest in sex, and average remaining years of quality of life throughout the life course.1-3 Sexual sexually active life, referred to as sexually active life activity has been associated with health benefits and longevity.4-6 Recent data from the US national social Results Overall, men were more likely than women to be life, health and aging project (NSHAP) indicate that sexually active, report a good quality sex life, and be more than half of people aged 57-85 and about a interested in sex. These gender differences increased with third of those aged 75-85 are sexually active and that age and were greatest among the 75 to 85 year old group: physical health is significantly correlated with sexual 38.9% of men compared with 16.8% of women were activity and many aspects of sexual function, indepen- sexually active, 70.8% versus 50.9% of those who were sexually active had a good quality sex life, and 41.2%versus 11.4% were interested in sex. Men and women Since 2000, a focus on sexuality in older adults has reporting very good or excellent health were more likely to been heavily driven by the availability of drugs to treat be sexually active compared with their peers in poor or fair male erectile dysfunction. Effective treatment of this health: age adjusted odds ratio 2.2 (P<0.01) for men and condition is likely to extend the duration of sexually 1.6 (P<0.05) for women in the midlife study and 4.6 active life for men and their partners as they age.
(P<0.001) for men and 2.8 (P<0.001) for women in the later Problems with sexual functioning are prevalent life study. Among sexually active people, good health was among older adults in the United States and other also significantly associated with frequent sex (once or countries.1 7 About half of all sexually active men and more weekly) in men (adjusted odds ratio 1.6 to 2.1), with women aged 57-85 in the United States report at least a good quality sex life among men and women in the one bothersome sexual problem; one third report at midlife cohort (adjusted odds ratio 1.7), and with interest least two. Yet doctors rarely address sexual concerns in sex. People in very good or excellent health were 1.5 to in older adults, particularly in women.1 As the older 1.8 times more likely to report an interest in sex than population grows in developed and developing those in poorer health. At age 30, sexually active life nations,8 projecting the population structure of sexual expectancy was 34.7 years for men and 30.7 years for activity is useful for anticipating need for public health women compared with 14.9 to 15.3 years for men and 10.
resources, expertise, and services related to maintain- 6 years for women at age 55. This gender disparity ing sexual function, regaining sexual function lost as a attenuated for people with a spouse or other intimate consequence of disease or treatments for common partner. At age 55, men in very good or excellent health on medical conditions that occur in later life, and prevent- average gained 5-7 years of sexually active life compared ing sexually transmitted diseases or risky sexual behaviour among older adults. Population estimates of of Computerized Data on Aging collection (www.
sexual activity in later life can help motivate and icpsr.umich.edu/NACDA/). This analysis uses ver- inform the design of policies pertaining to sexual expression and rights among cognitively impairedand institutionalised elderly people. In addition, expectations about the duration of sexually active life Self rated health is widely regarded as an appropriate may influence important health behaviours. For exam- measure of health, correlating well with other mea- ple, patients may be motivated to stop smoking or to sures of morbidity and survival.10 11 In both MIDUS adhere to drug regimens if the behaviour changes are and NSHAP, respondents were asked to rate their phy- expected to prolong or preserve a sexually active or sical health using the standard five point scale responses to the question: “Would you say your health Using two nationally representative datasets, we is excellent, very good, good, fair, or poor?” Both sur- examined the association between sexuality (sexual veys included measures of partnership, sexual activity, activity and quality of sexual life) and global self rated sexual frequency, quality of sexual life, and interest in physical health in middle aged and older men and sex. Additionally, NSHAP assessed the degree to women. We also estimated the average remaining which sex was regarded an important part of life.
years of sexually active life gained as a result of good Table 1 summarises and compares the items used in health, using sexually active life expectancy, a new health expectancy indicator for clinical and public NSHAP defined sexual activity for respondents as “any mutually voluntary activity with another personthat involves sexual contact, whether or not inter- course or orgasm occurs.” MIDUS defined sexual The study populations were drawn from two large, activity broadly as having “had sex with anyone.” In publicly available and nationally representative recent MIDUS, 97.1% of men and 97.8% of women were health surveys with sufficiently large numbers of older identified as heterosexual, or “sexually attracted only respondents and comparable data on sexuality: the to the opposite sex.” In NSHAP, 96.4% of men and national survey of midlife development in the United 95.0% of women reported only heterosexual contacts States (MIDUS, or midlife cohort) and the national social life, health and aging project (NSHAP, or later Non-response to items in both surveys was low for measures of sexual activity, quality, and, in MIDUS, The 1995-6 wave of MIDUS provides nationally sexual interest (0.3% to 5.1%). Non-response for the representative data on adults aged 25 to 74. Partici- NSHAP questions about sexual interest ranged from pants were selected by using a random digit dial sam- 7.4% to 11.3%. Non-response to questions on sexuality ple of the non-institutionalised, English speaking was higher among women compared with men and population of the 48 conterminous United States. Par- older people compared with younger people. For a ticipants completed a telephone interview and postal random subset of NSHAP respondents, these ques- questionnaire. The response rate was 60.8%, with tions were modularised to a questionnaire that was 3032 respondents (1561 women, 1471 men) for both self completed after the face to face interview and parts of the survey. Sampling weights correcting for returned by post to the investigators. In general, non- differential probabilities of selection and non-response response to items was the same or higher for questions allow estimates from this sample to be generalisable to asked on this questionnaire compared with identical the United States population in terms of age, gender, questions asked face to face. Overall, 84% of respon- race, and education. Details on the design, field proce- dures, and sampling weights of MIDUS have beendescribed previously.9 The 2005-6 wave of NSHAP provides a nationally Distributions of race, education, marital status, self representative probability sample of community rated health, and sexuality variables are summarised dwelling people aged 57-85, generated from house- separately by gender for MIDUS and NSHAP. We car- holds screened in 2004 across the United States. Afri- ried out analyses for each dataset separately to estab- can-Americans, Latinos, men, and the oldest old (75 to lish external validity of the findings.
84 years at the time of screening in 2004) were over- We used logistic regression14 to model the likelihood sampled. Interviews at home and collection of biomea- of being sexually active, having a good quality sex life, sures were carried out in English and Spanish by pro- and being interested in sex. These models included age fessional interviewers, yielding 3005 respondents and group and self rated health (excellent or very good, a response rate of 75.5% weighted (74.8% unweighted).
good, and fair or poor) as covariates, which were fit Sampling weights account for differential probabilities separately by gender. Models for quality of sex life of selection and differential non-response. Details on and frequency of sex were fit for participants who had the design, field procedures, and sampling weights a spouse or other intimate partner. We present results have been described previously.1 Both datasets are as odds ratios with 95% confidence intervals, indicat- available to researchers through the National Archive ing the multiplicative change in the odds of the Table 1 | Comparison of health and sexuality measures used in national survey of midlife development in the United States (MIDUS) and national social life,health and ageing project (NSHAP) “Would you say your health is excellent, very good, good, fair, or poor?” “Would you say your health is excellent, very good, good, fair, or poor?” Respondents who were married or cohabiting at time of survey, even if Respondents who were married or cohabiting at time of survey, even if they they were not sexually active, were defined as having a partner were not sexually active, were defined as having a partner Respondents who had had sex with at least one partner in previous six Respondents who had had sex with at least one partner in previous months were considered to be sexually active 12 months were considered to be sexually active* “Over the past six months, on average, how often have you had sex with “During the last 12 months, about how often did you have sex with someone?” Responses ranged from: “never or not at all” to “two or more [partner]?” Responses ranged from “once a month or less” to “once a day or times a week.” Respondents having sex 2-3 times a month or more were more.” Respondents having sex 2-3 times a month or more were defined as “How physically pleasurable did/do you find your relationship with[partner] to be: extremely pleasurable, very pleasurable, moderatelypleasurable, slightly pleasurable, or not at all pleasurable?” Individualswho reported their most recent relationship to be extremely or verypleasurable were defined as having a good quality of physical sexual life “How emotionally satisfying did/do you find your relationship with[partner]: extremely satisfying, very satisfying, moderately satisfying,slightly satisfying, or not at all satisfying?” Individuals who reported theirmost recent relationship to be extremely or very satisfying were defined ashaving a good quality of emotional sexual life “How would you rate the sexual aspect of your life these days?” Responses Individuals having good quality of both physical and emotionalranged from 0, “the worst possible situation,” to 10, “the best possible components of sexual life were considered to have an overall good quality situation.” Individuals with a rating of ≥6 were considered to have an “How much thought and effort do you put into the sexual aspect of your Estimated using the following question: “About how often do you think life?” Responses ranged from 0, “none,” to 10, “very much.” Respondents about sex?” with six variants ranging from “never” to “several times a day.” with rating of ≥6 were considered to be interested in sex Respondents who reported thinking about sex “one to a few times a week”or more were considered to be interested in sex *A 12 month, rather than 6 month, time frame was used in consideration of older age of NSHAP population, and for comparability to only other comprehensive, nationally representativestudy of adult sexuality in the United States.12 outcome associated with a particular age or health cate- We calculated sexually active life expectancy by Sul- gory compared with those of the baseline category.
livan’s method, using publicly available data from life For all analyses we used weights to adjust for differ- tables and prevalence data on sexual activity to divide ential probabilities of selection and differential non- the number of person years into years with and without response. Standard errors were computed using the sexual activity.22 23 We obtained US age and gender linearisation method,15 taking into account the stratifi- specific population and death counts for 1995 and cation and clustering of the sample design. P values are 2004 from the human mortality database24 and we cal- two sided. Analyses were done using Stata software, culated age specific person years using standard meth- ods for life tables.22 Prevalence data on sexual activityfrom MIDUS and NSHAP by age, gender, partnership Calculation of sexually active life expectancy status, and health status were used to calculate sexuallyactive life expectancy. Life tables for 1995 (the year of Population health is often summarised using measures enrolment of the midlife cohort) and 2004 (the year for of health expectancy. The concept of healthy life expec- which data were available closest to the 2005 enrol- tancy is typically based on self rated measures of overall ment of the later life cohort) were used in conjunction or global health and is an effective tool for quantifying with MIDUS and NSHAP data, respectively. Using differences in health between populations.16 Related guidelines provided by the International Network on concepts include active life expectancy based on activ- Health Expectancy22 we calculated standard errors and ities of daily living, disability-free life expectancy based confidence intervals for sexually active life expec- on disability measures, dementia-free life expectancy, tancy. The proportion of life spent as sexually active and others.16-21 These indicators project future health means the proportion of years of any sexual activity based on health or function at baseline. No such mea- with a partner out of all remaining years of life.
sures account for sexual function or sexual activity in Taking into account that a substantial proportion of projecting future health expectancy. We introduce a the older population lives in institutions, we adjusted for new health expectancy concept, sexually active life no sexual activity among such a population. This adjust- expectancy, defined as the average number of years ment decreased sexually active life expectancy mea- remaining spent as sexually active, and investigate its sured at age 55 years by 2% for men and women. A relation to health among middle aged and older sensitivity analysis, assuming a 20% rate of sexual activ- ity among the institutionalised elderly population, had no effect on final estimates for sexually active life expec- (77.6% to 82.1%) in the later life cohort. The preva- tancy (data not shown). Data were taken from the 2000 lence of partnership was stable across all age groups US Bureau of Census table on age and gender specific of men. In contrast, the prevalence of partnership proportions of the institutionalised population.25 We among women declined steadily across age groups: fitted the age specific proportions of the institutionalised 69.9% (95% confidence interval 67.5% to 72.4%) in population older than age 60 with a two variable model the midlife cohort compared with 57.8% (55.0% to of exponential growth using additional information on 60.6%) in the later life cohort. Only 38.5% of women the age distribution of elderly people living in nursing compared with 72.0% of men aged 75-85 had a partner The key personal characteristics in the midlife and later The prevalence of sexual activity in the midlife cohort life cohorts were similarly distributed and closely declined across age groups for both sexes, but more so matched those from the 1995 and 2002 current popu- for women (table 3). By age 75, 16.8% of women com- lation surveys, respectively.1 9 Men were more likely pared with 38.9% of men were sexually active (table 4).
than women to be married; women were more likely For respondents having a partner, however, these gen- than men to be widowed (table 2). The distribution of der differences were much smaller and not statistically self rated health was similar for men and women; the significant. Among sexually active respondents, the prevalence of poor or fair health was higher in the later proportion engaging in sex once or more weekly declined across age groups but was similar amongmen and women in both cohorts (tables 3 and 4).
Tables 3 and 4 show the distributions of partnership, sexual behaviour, and sexual attitudes, by age and gen- Among sexually active middle aged respondents, der, in MIDUS and NSHAP. Most men reported hav- about two thirds of men (69.7%) and women (65.6%) ing a current partner: 79.8% (95% confidence interval reported a good quality sex life (table 3). Only 51.8% 77.6% to 82.0%) in the midlife cohort and 79.9% of women in the later life cohort reported a good Table 2 | Population distributions across demographic subgroups and self rated health in national survey of midlifedevelopment in the United States (MIDUS, 1995-6) and national social life, health and ageing project (NSHAP, 2005-6)cohorts, by gender. Values are numbers (percentages) Values are weighted to account for differential probabilities of selection and differential non-response.
*57-64 years in NSHAP.
Table 3 | Partnership status and characteristics of sexuality among participants of national survey of midlife development in the United States (MIDUS), byage. Values are percentages (95% confidence intervals) unless stated otherwise Have sex once or more weekly among sexually active Overall good quality of sexual life among sexually active Have sex once or more weekly among sexually active Overall good quality of sexual life among sexually active Numbers and percentage estimates are weighted to account for differential probabilities of selection and differential non-response.
*Number who answered question affirmatively of total number of respondents to question. Numbers of respondents varies within survey as some declined to answer some questions.
quality sexual life compared with 71.1% of men, and health (table 5). Among sexually active respondents, this difference was statistically significant (table 4).
good health was significantly associated with frequent Men were significantly more likely to report being sex (once or more weekly) in men (adjusted odds ratio interested in sex compared with women (66% v 53% 1.6 to 2.1) and with a good quality sex life among men in the midlife cohort and 62% v 21% in the later life and women in the midlife cohort (1.7). People in very cohort). For men, interest in sex was relatively stable good or excellent health were 1.5 to 1.8 times more across all age groups and did not vary by partner status.
likely to report an interest in sex than those in poorer For women, interest in sex dropped off significantly in the middle of the sixth decade and was much loweramong those without partners.
Table 6 summarises gender differences in sexually active life expectancy and the estimated proportion of Both the midlife and the later life cohort included peo- remaining sexually active life at age 30 years (based on ple aged 57-64 and 65-74. When these age groups were the midlife cohort) and age 55 years (based on the mid- compared across the cohorts, surveyed 10 years apart, life and later life cohorts). Among all people at age 30, the distributions of prevalence estimate for partner- including those without a partner, sexually active life ship, sexual activity, sexual frequency, and good qual- expectancy was about 10 years lower than demo- ity of sex life (among sexually active individuals) were graphic life expectancy for men (34.7 v 44.8 years) highly consistent. Interest in sex among women in this and nearly 20 years lower for women (30.7 v 50.
age group surveyed 10 years apart was also stable 6 years). This translated to significant gender differ- (17.5% in 1995, 19.1% in 2005-6). In contrast, a signifi- ences in the proportion of remaining lifetime spent as cantly higher proportion (75.3%) of men aged 57-64 in sexually active: 78% for men versus 61% for women. In the later life cohort reported an interest in sex com- contrast, among those with a partner at age 30, sexually pared with only 44.6% of men of the same age sur- active life expectancy was higher for women compared veyed 10 years earlier (midlife cohort; tables 3 and 4).
with men (38.2 v 36.7 years). Regardless, women with apartner were estimated to spend a smaller proportion of their remaining lifetime as sexually active as men Health was strongly associated with having a partner, owing to women’s longer life expectancy. Both men particularly for women, in the later life cohort (table 5).
and women reporting very good or excellent health Sexual activity, particularly for men and for women in had more years of sexually active life expectancy com- the later life cohort, was also positively associated with pared with people reporting fair or poor health. At age 30, men in very good or excellent health were pro- women reporting poor or fair health were similar. In jected to gain more years of life as sexually active (6.4 contrast, in all but the oldest age group, men in very additional years) compared with women (4.8 years).
good or excellent health had significantly higher sexu- At age 55, sexually active life expectancy was ally active life expectancy than similarly healthy 15 years for men and 10.6 years for women; the two datasets generated nearly identical estimates. For menat age 55, sexually active life expectancy was 8-9 years less than demographic life expectancy (14.9 v 23 years This study used two nationally representative, popula- for the midlife cohort and 15.3 v 24.6 years for the later tion based cohorts to deepen an understanding of the life cohort); for women this difference was 17-18 years relation between health and sexuality in middle and (10.6 v 27.4 years for the midlife cohort and 10.6 v 28.
later life and to project population estimates of sexually 3 years for the later life cohort). Sexually active life active life expectancy, a new measure to quantify expectancy was similar for men and for women with expectations about future sexual life. Using two data- a partner at age 55 (15.9 to 16.9 and 15.6 to 16.2 years, sets, the study affirmed a positive association between respectively). At age 55, men in very good or excellent later life health and both sexual partnership and any health were projected to gain on average 5-7 years of sexual activity. In addition, a consistently strong asso- life as sexually active compared with their peers in ciation was found between good health and other poor or fair health; women in very good or excellent domains of sexuality not previously linked to health health were projected to gain 3-6 years (table 5).
in later life, including the frequency of sexual activity Figures 1 and 2 show the age pattern of life expec- (weekly or more often) in men, a good quality sex life, tancy and sexually active life expectancy for men and and a higher interest in sex. Sexual activity, a good women in the United States. Women had consistently quality sex life, and interest in sex were higher for higher demographic life expectancy at all ages, men than for women and this gender gap widened whereas men had consistently higher values for sexu- with age. Sexually active life expectancy was longer ally active life expectancy. Wider differences were for men, but men lost more years of sexually active shown in sexually active life expectancy by health sta- life as a result of poor health than women.
tus for men compared with women at all age groups.
Partnership drives sexual activity, particularly in The sexually active life expectancy curves for men and later life. Between 70% and 80% of men across all age Table 4 | Partnership status and characteristics of sexuality among participants of national social life, health and ageing project (NSHAP), by age. Values arepercentages (95% confidence intervals) unless stated otherwise Numbers and percentage estimates are weighted to account for differential probabilities of selection and differential non-response.
*Number who answered question affirmatively of total number of respondents to question. Numbers of respondents varies within survey as some declined to answer some questions.
groups reported having a partner, compared with 67.5% of women aged 25-54 and fewer than 40% of women aged 75 and older. This finding reflects the Sexually active life expectancy in menSexually active life expectancy in women longer life span of women, the age structure of mar- riage in the United States and other countries whereby men tend to marry younger women, and the higherproportion of older men with much younger partners.1 27 28 As found by others, men and women with partners in middle and later life were equallylikely to be sexually active, but the frequency of sexual activity declined across age groups for women more than for men.29 Many sexually active people in thisstudy rated the quality of their sex life as less than Fig 1 | Life expectancy and sexually active life expectancy in good, including about half of sexually active older US men and women. Based on data from national survey of women. Particularly little has been known about the midlife development in the United States (MIDUS) quality of older women’s sexual lives.
Sexually active life expectancy was calculated as a function of gender and health. Overall, the study found that men live a significantly greater proportionof their adult life as sexually active (due at least in partto more years of partnership than women) yet lose sig- Table 5 | Association with self rated health for selected measures of sexuality. Values are age nificantly more years of sexually active life as a result of adjusted odds ratios (95% confidence intervals) poor health than do women. This resonates with find- ings from a previous analysis using the NSHAP data- set, showing that men’s physical health problems were most commonly cited by both sexes as the reason for sexual inactivity in later life.1 The stronger association between sexually active life expectancy and health 1.7** (1.26 to 2.39) 2.2*** (1.60 to 2.97) found in men may be explained in part by the effects of common chronic illnesses (for example, diabetes, cardiovascular disease, prostate cancer) and their treat- ments on erectile function.30-34 Loss of erectile function diminishes or prohibits penetrative intercourse and is often accompanied by a decline in or cessation of a man’s sexual activity and sexual satisfaction.3536 In contrast, the effects of illness or drug use on sexual function in women are poorly understood. Sexual pro- blems, including low desire, vaginal dryness, difficul- ties with orgasm, and pain with intercourse are Having sex once or more weekly among sexually active prevalent among sexually active older women,1 are associated with decreased sexual satisfaction,35 but typically do not render a woman physically incapable Overall good quality sex life among sexually active of sexual intercourse. Women’s sexual interest or motivation may be more resilient to illness or sexual problems than men’s,37 may be more contextually dependent on the partner or situational factors,38 or, as seen in younger populations, older women may have less agency over their sexual activity than Interest in sex among women of the same age in the two nationally representative cohorts surveyed 10 years apart was relatively stable. In contrast, signifi- cantly more men aged 57-64 in the later life cohort reported an interest in sex than men of the same age surveyed 10 years earlier. This was true for men with MIDUS=national survey of midlife development in the United States; NSHAP=national social life, health and and without a partner in both cohorts and corroborates a positive secular trend in attitudes about sex found *P<0.05; **P<0.01; ***P<0.001.
Age adjusted odds ratios (95% confidence intervals) are based on logistic regression, with age and self rated among older men surveyed 30 years apart in a 2001 health status included as covariates. Estimates are obtained separately for men and women. The group study of 70 year olds in Gothenburg, Sweden.28 The reporting poor or fair health was used as the reference. Confidence intervals are based on inversion of the Wald difference may partly reflect the introduction of the test constructed with use of design based standard errors.
†Respondents who were married or cohabiting at time of survey, even if they were not sexually active, were highly effective and widely promoted male erectile dysfunction drugs to the US and European markets, Table 6 | Gender differences in sexually active life expectancy and proportion of remaining sexually active life, by partnershipstatus and self rated health. Based on age specific prevalence estimates of sexual activity in national survey of midlifedevelopment in the United States (MIDUS) and national social life, health and ageing project (NSHAP) survey Proportion of remaining sexually active life (95% CI) *Prevalence for age group 55-59 years was estimated using data for 57-59 age group.
beginning with sildenafil in 1998.39 40 More than 14% of partners), and increased only for women with a partner US men surveyed in 2005-6 by NSHAP reported that they had taken prescription or non-prescription drugsor supplements to improve sexual function in the pre- vious 12 months.1 With this secular increase in sexual Although the data were collected by separate research interest among older men, the gender gap in later life groups using different sexuality measures, the use of interest in sex has also increased: among men aged 57- two generally comparable population based probabil- 64 with partners, 76.7% reported an interest in sex ity samples for these analyses shows external validity of compared with 35.9% of women with partners (only the study findings and made it possible to create the 12% of women without partners compared with 68% new sexually active life expectancy measure. Preva- of men without partners were interested). Consistent lence estimates for partnership, sexual activity, sexual with this finding, sexually active life expectancy at frequency, and good quality sex life were highly con- age 55 was longer for men surveyed in 2005-6 com- sistent when the overlapping age groups in the two stu- pared with men surveyed 10 years earlier (4.8 months dies were compared and are consistent with previous longer overall, 12 months longer for men with findings for men41 and younger women.42 43 In addi-tion, use of the two datasets allowed examination ofsecular trends in various aspects of sexuality measured 10 years apart. Comparison with the 1971 and 2001 Swedish studies of 70 year olds provides additional evi- dence of external validity of the cross sectional andsecular trend findings. For example, the 2001 Swedish study found similar frequencies of sexual activity andsatisfaction among women with and without partners as found in the 2005-6 US cohort. These frequencieswere higher than those found in the 1995-6 US cohort of 65-74 year olds and notably higher than in the1971 Longitudinal data are needed to determine whether regular sexual activity, a good sex life, or high sexual Fig 2 | Sexually active life expectancy in US men and womenby health status. Based on data from national survey of interest promote health or whether good health pro- midlife development in the United States (MIDUS) motes these positive sexual attributes; this study relies In this study we assumed the same mortality for people with different health and partnership statuses. This assumption might underestimate sexually active life Partnership and sexual activity have been positively associated with health in middle age expectancy for those with very good or excellent health or for those with a partner and might overesti-mate sexually active life expectancy for those with Knowledge about patterns of sexual activity in the population informs public health policy poor or fair health owing to the possibility of differen- tial survival among people with different health sta- tuses and partnership.48 49 Our analytical approachused official life tables to predict mortality accurately Frequency of sexual activity, a good quality sex life, and interest in sex are positively but was limited by the lack of accessible and reliable associated with health in middle age and later life age and gender specific estimates of survival by health Interest in sex among middle aged and older men in the United States has increased since About half of sexually active older women report a poor quality sex life At age 55, sexually active life expectancy is 15 years for men and 10.6 years for women; Sexual partnership, frequency of sexual activity, a good although the period is longer for men, they lose more years of sexually active life as a result of quality sex life, and interest in sex are positively asso- ciated with health among middle aged and older adultsin the United States. Interest in sex among middle agedand older men in the United States has increased since2000. Overall, the study found that men have a longer on cross sectional data. In addition, measures of sexu- sexually active life expectancy and that most sexually ality were not identical in the two studies (table 1).
active men report a good quality sex life. In contrast, NSHAP used a 12 month time frame to define cur- only about half of sexually active women reported a rently “sexually active” people, whereas MIDUS good quality sex life. This disparity, and its implication used a six month time frame. This difference could for health, requires further exploration.
result in a relative overestimate of the prevalence of Men lose more years of sexually active life as a result sexual activity in the NSHAP cohort, although preva- of poor health than women. The estimation of sexually lence for the overlapping age groups in the two studies active life expectancy is a new life expectancy tool that was nearly identical. Both studies included both regu- can be used for projecting public health and patient lar and casual or intermittent partners in these defini- needs in the arena of sexual health. Projecting the tions, limiting comparisons between various kinds of population patterns of sexual activity in later life is use- sexual relationships. Interpretation of comparisons ful for anticipating need for public health resources, across the two studies must also take into account dif- expertise, and medical services. Translation of expec- ferences in the wording of some questions, such as tations about the duration and quality of sexually those pertaining to quality of sex life and sexual inter- active life may, at the individual level, influence impor- est. Although overall non-response to items was low in tant health behaviours to promote or prolong sexual both surveys, older respondents and women were functioning, such as adherence to medical treatment more likely than others to refuse to answer questions or maintenance of a healthy lifestyle. One study on sexuality. It is unclear from previous research found that parents of children with cancer exhibited whether such refusals would tend to underestimate or different medical decision making and healthcare uti- overestimate sexual activity in these groups.44 45 lisation when they had more accurate expectations of Because of the study population, these findings may their child’s life expectancy.50 Further research is be limited in relevance to lesbian, gay, and other peo- needed to evaluate the potential impact of sexually ple who do not identify as heterosexual, and to non- active life expectancy projection on individual health Western cultures. Further research is needed; the pub- lic availability of the instruments used for NSHAP andMIDUS provides an opportunity for adaptation of this We thank Andreea Mihai, Jessica Schwartz, and Katherine Githens forresearch assistance. Their effort was supported by funding received for the Center on Demography and Economics of Aging Chicago Core on The calculation of the sexually active life expectancy Biomarkers in Population-Based Health and Aging Research from the measures used the Sullivan method, which generally National Institutes of Health/National Institute on Aging (5P30 AG012857) and institutional resources from the University of Chicago.
provides a good measure of the current composition Contributors: Both authors originated and designed the study, interpreted of a population but is not based on transition rates the results, commented on drafts of the article, and act as guarantors. NG between sexually active and non-active states.46 The carried out the statistical analyses and calculations.
Sullivan method has been shown to produce estimates Funding: This study was partially supported by the National Institute onAging/Rutgers University pilot award, the University of Chicago of health expectancy comparable to more advanced Population Research Centre pilot grant (NIH/NICHD R24 HD051152-01), multistate approaches for populations with smooth the University of Chicago Centre on Demography and Economics of Aging and gradual changes in disability and morbidity, as is pilot grant (NIH/NIA 5P30 AG 012857), and Population Research Centre the case in the US population.47 Similarly, the distribu- grant from the National Institute of Child Health and Human Development(R24 HD051152-04). NG was supported by, and STL partially supported tion of sexual activity by age group across the two by, the National Institutes of Health, National Institute on Aging University cohorts surveyed 10 years apart was noticeably similar.
of Chicago—NORC Centre on Demography and Economics of Aging Core on Biomarkers in Population-Based Health and Aging Research (5 P30 AG 17 Cambois E, Robine JM, Hayward MD. Social inequalities in disability- 012857). STL was also supported by 1K23AG032870-01A1. The funders free life expectancy in the French male population, 1980-1991.
had no role in the study design. The authors retained full independence in the collection (NSHAP), analysis, and interpretation of the data (NSHAP 18 Guralnik JM, Land KC, Blazer D, Fillenbaum GG, Branch LG.
Educational status and active life expectancy among older blacks and MIDUS), the writing of this report, and in the decision to submit this and whites. N Engl J Med 1993;329:110-6.
article for publication. The authors were not involved in the collection of 19 Hayward MD, Heron M. Racial inequality in active life among adult Americans. Demography 1999;36:77-91.
Competing interests: All authors have completed the Unified Competing 20 Nusselder WJ, Looman CW, Mackenbach JP, Huisman M, van Oyen H, Interest form at http://www.icmje.org/coi_disclosure.pdf (available on Deboosere P, et al. The contribution of specific diseases to request from the corresponding author) and declare that (1) no company educational disparities in disability-free life expectancy. Am J Public has had involvement in the submitted work; (2) no authors have relationships with any companies that might have an interest in the 21 Wilkins R, Adams OB. Health expectancy in Canada, late 1970s: submitted work in the previous 3 years; (3) their spouses, partners, or demographic, regional, and social dimensions. Am J Public Health1983;73:1073-80.
children have no financial relationships that may be relevant to the 22 Jagger C. Health expectancy calculation by the Sullivan method: a submitted work; and (4) no authors have any non-financial interests that practical guide. European concerted action on the harmonization of may be relevant to the submitted work.
health expectancy calculations in Europe. Nihon University Ethical approval: The NSHAP data analysis was carried out under Population Research Institute research paper series No 68. NUPRI, expedited approval from the University of Chicago institutional review board (No 16950A, 4/24/09). The MIDUS data analysis was carried out 23 Sullivan DF. A single index of mortality and morbidity. HSMHA Health under exempt protocol from the University of Chicago institutional review board (No 13996E, 6/2/05). This research was carried out with 24 Human Mortality Database. 2008. www.mortality.org.
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are available at www.icpsr.umich.edu/NACDA/news.html#nshap. Data 28 Beckman N, Waern M, Gustafson D, Skoog I. Secular trends in self for the MIDUS study are available to researchers at webapp.icpsr.umich.
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