Sex differentials in health and mortality.

Abstract

Data on physical health and mortality in the US, centered near the 1980 Census year, are presented, focusing on sex differentials in mortality followed by sex differentials in health. The discussion covers possible explanations for these sex differentials and the apparent contradiction of why there is excess female morbidity but excess male mortality. In 1980, the estimated life expectancy at birth was 70.0 years for men and 77.5 years for women. Age-adjusted death rates in the US were 777 deaths/100,000 for men and 433 deaths/100,000 for women, yielding a sex ratio of 1.79. Thus, in 1980, men had nearly an 80% higher age-adjusted death rate than women. Further, for every 100,000 people, 200 more men than women died. The age-adjusted figure was 345. In the US in 1980 the age-adjusted mortality rate for each of the 12 leading causes of death was higher for men than women. The sex mortality ratios demonstrate that relative to women, men had higher mortality rates particularly between the ages of 15-34. The sex ratio of life expectation increases with age. A women over age 60 in 1980 could expect to live nearly 30% longer than a man her age. Accidents are the main contributor to the sex differential at young ages; heart disease is the primary contributor at older ages. Regardless of how health interviews word the questions, women consistently report worse health status than men. In interview data, females tend to have more acute conditions per year than males -- about 17% more in 1980, and with a similar excess in other years. The female excess appears for infective and parasitic diseases, respiratory conditions, digestive system conditions, and "all other acute conditions." The last group includes problems due to pregnancy and childbirth, yet, even when these are removed, female rates for "all other acute conditions" exceed male rates. Only for injuries do males have higher rates than females. The available data suggest that women have greater morbidity than men. After early childhood, females have both higher rates of acute conditions and more restricted activity per condition. Females are more likely to have a chronic condition, to have more doctor and dentist visits, and to use more drugs. These relationships remain even after pregnancy-related events are removed. Yet, men have higher prevalence for many "killer" chronic conditions, higher prevalence rates of heart disease at younger ages, and higher injury rates at all ages. Sex differences in 4 areas provide possible explanations as to why women tend to have poorer health but men tend to have shorter lives: inherited risks; acquired risks; illness and prevention orientations; and health and death reporting behavior.