The contribution of specific causes of death to sex differences in mortality

Objective. Men have higher mortality rates than women for most causes of death. This study was conducted to determine the contribution of specific causes of death to the sex difference in years of potential life lost (YPLL). Methods. The authors examined data from the National Health Interview Survey with linked mortality data through 1997. Using survival analysis estimates a stochastic simulation model to simulate death events for cohorts of white, African American, and Latino adults was created. Results. YPLL from all causes were greater among men than women. Homicide, motor vehicle accidents, and suicide accounted for 33% of YPLL sex difference among whites, 36% among African Americans, and 52% among Latinos. For all three racial/ethnic groups, cardiovascular disease (principally ischemic heart disease) was the second largest contributor to the sex difference in YPLL (29% among whites, 23% among African Americans, and 25% among Latinos). Lung cancer was also important among whites and African Americans, accounting for 15% and 17% of the sex difference in YPLL from all causes, respectively. Conclusions. Ischemic heart disease, lung cancer, and traumatic deaths account for as much as three-quarters of the excess YPLL among men, suggesting that a few modifiable behaviors such as the use of tobacco, alcohol, and drugs and violence may account for much of the shorter life expectancy among men. 1- While mortality rates have dropped for both men and women over the last century, women have consistently had longer life expectancy In 1900, women lived on average two more years than men,(1) and most recent estimates from 2002 indicate this gap is now just over five years.(2) The sex differential in life expectancy appears to be attributable to a broad range of causes. Specifically, men have higher relative death rates from ischemic heart disease, cancer, stroke, diabetes, liver disease, kidney disease, pneumonia, and accidents.' This suggests that a variety of biologic and behavioral mechanisms might be involved in the different health trajectories of men and women. Studies examining specific causes of death can be useful in identifying the relative impact of various diseases on sex differences in life expectancy. This information is important because it can suggest which mechanisms are more likely to account for sex differences in life expectancy and also help direct future studies toward those diseases that have the biggest impact. However, previous studies examining sex differences in cause-specific mortality are limited because they have largely examined mortality rates and mortality rate ratios, 4 which do not completely account for the burden of premature death.(5) Vital statistics reports have examined years of potential life lost (YPLL) for men and worried(6), but these reports estimated YPLL occurring over a one-year period rather than for a cohort of individuals followed over their lifetime. This "cross-sectional" estimate of YPLL is potentially misleading, (7) In the present study, we examined death data from a nationally representative sample of adults in the U.S. and estimated the sex differences in YPLL over a lifetime. We also examined whether sex differences in YPLL vary by race or ethnicity.