INTRODUCTION:
The morbidity-mortality paradox is a phenomenon where females live longer with poor health compared to males who live shorter but in good health. India made significant improvements in life expectancy, but whether achievements in life expectancy are translating into corresponding benefits in health remains understudied. This study aimed to assess: (i) the sex gap in healthy life expectancy among older adults aged 60 and above by rural-urban location and geographical region in India; and (ii) the morbidity-mortality paradox by rural-urban location and geographical region in India.

METHODS:
Using nationally representative ‘mortality’ and ‘disability’ data from ‘India’s Sample Registration System (SRS)’ and ‘Longitudinal Ageing Study in India (LASI)’, respectively, the life expectancy, disability-free life expectancy, and life expectancy with disability were computed employing Sullivan’s method. The sex gap in healthy life expectancy was decomposed through the stepwise replacement decomposition technique.

RESULTS:
The findings indicate a female mortality advantage where females aged 60 lived longer than males in India and its geographical regions, both in rural and urban locations. In contrast, disability prevalence indicated females’ disadvantage because females suffered more from disability than males. On combining disability prevalence rates with life tables, it was found that despite living longer, females spent a higher proportion of their remaining lives at age 60 in disability compared to males, indicating the existence of the morbidity-mortality paradox. The findings further revealed the consistent presence of the morbidity-mortality paradox across rural and urban areas and across geographical regions in India.

CONCLUSIONS:
As the morbidity-mortality paradox was found in India and its geographical regions, there is a need for targeted efforts to reduce disability among females aged 60 and above, enabling them to live longer, healthier, and more productive lives.