The Sex Differential in Morbidity, Mortality, and Lifestyle

In the United States women live longer than men, and they have lower death rates at virtually every age and for most causes of death. Similar relationships prevail in most developed nations. The sex differential in mortality has been increasing since the early 1900s , especially for those 15-24 and 55-64 years of age. Since 1970, however, that trend has slowed for persons 45-74, and in 1980 the sex differential was actually lower than in 1970 among those 55-64. Although the female sex advantage in respect to most causes of death has been increasing, the differential for coronary heart disease has recently stabilized; and the lung cancer mortality rate among women is now increasing faster than that among men. Recent statistics for these two important causes of death may indicate that the previous, more favorable trend in women than in men may be reversing in response to changes in lifestyle. Women's health may be improving at a slower rate because they are exposed to more job stresses and other risk factors, such as cigarettes, than before; alternatively, men's health may be improving at a faster rate because they are exercising more, smoking cigarettes less, and following healthier diets in recent decades. Despite their continuing mortality advantage, women experience more illness than men. This may reflect women's greater utilization of medical services, and physicians' diagnostic patterns, as well as women's greater willingness to acknowledge and report illness. Sex differences in illness persist, however, when physical examinations are used for assessment in population-based samples. Women appear to have higher rates of conditions that rarely cause death, for example, rheumatoid arthritis; whereas men tend to have more fatal conditions, such as coronary heart disease. At least two categories of lifestyle characteristics are associated with male-female differences in health: (a) social roles, such as marriage, parenthood, and employment; and (b) behaviors, such as cigarette smoking and Type A behavior. Preliminary evidence indicates that some of these lifestyle characteristics may act synergistically on health. Several aspects of lifestyle thus underlie sex differences in morbidity and mortality. There is also evidence that biological factors influence male/female mortality differences, particularly in infancy and prenatal life. A substantial sex differential remains, however, even after adjusting for numerous lifestyle and biological variables. This is especially true for heart disease mortality.(ABSTRACT TRUNCATED AT 400 WORDS)