Abstract
BackgroundEthiopia has experienced great improvements in life expectancy (LE) at birth over the last three decades. Despite consistent increases in LE for both males and females in Ethiopia, the country has simultaneously witnessed an increasing discrepancy in LE between males and females.MethodsThis study used Pollard’s actuarial method of decomposing LE to compare age- and cause- specific contributions to changes in sex differences in LE between 1995 and 2015 in Ethiopia.ResultsLife expectancy at birth in Ethiopia increased for both males and females from 48.28 years and 50.12 years in 1995 to 65.59 years and 69.11 years in 2015, respectively. However, the sex differences in LE at birth also increased from 1.85 years in 1995 to 3.51 years in 2015. Decomposition analysis shows that the higher male mortality was consistently due to injuries and respiratory infections, which contributed to 1.57 out of 1.85 years in 1995 and 1.62 out of 3.51 years in 2015 of the sex differences in LE. Increased male mortality from non-communicable diseases (NCDs) also contributed to the increased difference in LE between males and females over the period, accounting for 0.21 out of 1.85 years and 1.05 out of 3.51 years in 1995 and 2015, respectively.ConclusionsWhile injuries and respiratory infections causing male mortality were the most consistent causes of the sex differences in LE in Ethiopia, morality from NCDs is the main cause of the recent increasing differences in LE between males and females. However, unlike the higher exposure of males to death from injuries due to road traffic injuries or interpersonal violence, to what extent sex differences are caused by the higher male mortality compared to female mortality from respiratory infection diseases is unclear. Similarly, despite Ethiopia’s weak social security system, an explanation for the increased sex differences after the age of 40 years due to either longer female LE or reduced male LE should be further investigated.
Highlights
Ethiopia has experienced great improvements in life expectancy (LE) at birth over the last three decades
Despite a few existing studies on age- and cause- specific contributions to sex differences in LE in sub-Saharan African countries, their age- and cause- decomposition analyses have only focused on relatively short periods [14], which are unable to explain the role of age and cause specific mortality in the Ushaped patterns of sex differences in LE over the decades
Trends of life expectancy and age -standardised mortality rates in Ethiopia Figure 2 shows changes in LE with 95% uncertainty ranges for both males and females and the sex differences in LE between 1995 and 2015 in five-year intervals
Summary
Ethiopia has experienced great improvements in life expectancy (LE) at birth over the last three decades. The sex differences in LE in many sub-Saharan African countries have remained consistently low in past decades, generally decreasing until around 2000, but have stared increasing in recent times, creating a U-shaped curve [8]. Despite a few existing studies on age- and cause- specific contributions to sex differences in LE in sub-Saharan African countries, their age- and cause- decomposition analyses have only focused on relatively short periods [14], which are unable to explain the role of age and cause specific mortality in the Ushaped patterns of sex differences in LE over the decades. To the best of our knowledge, this is the first paper to investigate age- and cause- specific contributions to changes in sex differences in LE of a sub-Saharan African country over several decades. Identifying sex-, age- and cause- specific LE differences can provide an in-depth insight into why sex differences in LE have changed over and what to be prepared for in response to imminent public health threats, such as civil unrest and Ethiopia’s high road traffic accidents in pursuit of improved health outcomes, including sustainable improvements in LE for both men and women
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