The Mortality Gap

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Although people around the world are living longer overall, men are still dying before women—regardless of race, environment and socioeconomic status.

Women live an average of five years longer than men in the United States.

In 2016, life expectancy at birth was 78.6 years for the total U.S. population, according to the National Center for Health Statistics. For males, life expectancy shifted from 76.3 years in 2015 to 76.1 years in 2016—a slight decrease. For females, life expectancy remained the same at 81.1 years in 2016. Researchers and doctors from the Texas Medical Center (TMC) advise that there is no one reason for this gender divide, but rather multiple factors that give men a shorter life expectancy.

“The main thing I would focus on is testosterone versus estrogen,” said Carmel Dyer, M.D., executive director of The University of Texas Health Science Center at Houston Consortium on Aging. “Testosterone lowers your good cholesterol and raises your bad cholesterol, where estrogen does just the opposite.”

Cardiovascular disease is the leading cause of death in both men and women, Dyer continued, and both cholesterol and cardiovascular disease can be mediated, in part, by sex hormones. But testosterone also unleashes other challenges.

“A very prominent cancer in men is prostate cancer—that is mediated by testosterone,” Dyer said. “In fact, men who are hypogonadal, who have low levels of testosterone, when they take testosterone, it increases their risk for prostate cancer.”

Testosterone has also been linked to an increased risk in stroke because it makes blood thicker. Dyer explained that men are more prone to infection than women because estrogen has an antioxidant effect that absorbs the toxic free radicals that can lead to cell damage.

“Testosterone puts you at risk for infections, cancer and accidents,” Dyer said. “For instance, men are more adventurous. … They have more drowning deaths, they take more chances, they have more hazardous jobs than women—climbing on skyscrapers and all of that.”

Men are, in fact, more likely than women to have dangerous occupations. In 2015, the U.S. Bureau of Labor Statistics reported 4,836 fatal work injuries, a total that does not include active members of the U.S. military. Among the top industries that saw the highest rate of deaths per 100,000 full-time workers—including logging, fishing and piloting aircraft—most of jobs were done by men.

Behavior also plays a major role in mortality rates.

“Many of the factors are simply behavioral and, often, what make men, men,” said Brian Duncan, director of human performance at Memorial Hermann Ironman Sports Medicine Institute. “We encourage boys to be rough and tumble and adventurous and unafraid, probably disproportionately to females.”

Most male fatalities between ages 15 and 24 years are caused by reckless behavior or violence, including motor vehicle accidents and drowning, according to research reported by Scientific American.

“Those kind of adventurous behavioral things tend to trickle over into smoking or consumption of alcohol and then, in turn, accidents—whether it’s a car accident, guns, a four-wheeler or ATV accident,” Duncan said. “A lot of it has more to do with our psychology and not our genetics.”

Stephen Klineberg, Ph.D., professor of sociology at Rice University and founding director of the Kinder Institute for Urban Research, identified one particular subset of the male population whose life expectancy is shrinking.

“There is this whole phenomenon of middle-aged, white men with high school educations or less who are dying prematurely from the diseases of despair—suicide, drug addiction, sclerosis of the liver, smoking, obesity,” Klineberg explained. “It’s the one demographic in America whose life expectancy has shrunk in the last 10 years and it is because of the tremendous stress of losing a job—not being able to find a new job because you only have a high school education in a world where education is the minimum for a decent job.”

Yet one recent global study suggests that the divide between life expectancy for men and women may be shrinking. Scientists from Imperial College London, collaborating with the World Health Organization, considered long-term mortality rates and behavior trends to predict how life expectancy will change in more than 30 countries by 2030.

Because men traditionally smoked and drank more than women and were involved in more traffic accidents and homicides, their life expectancy was shorter. But if male behavior continues to trend closer to female behavior, longevity rates for men are expected to improve, researchers found.

Men can increase their chances for living longer if they focus on a healthier lifestyle, TMC experts said.

“The good news in all of this is, if testosterone raises your cholesterol, you can watch your diet—and exercise improves just about everything,” Dyer said.

Duncan echoed Dyer’s sentiment by adding that very slight changes to daily routine can have a huge impact on overall life expectancy.

“Generally, the thing is if we just stop smoking and drinking so much, we could do a world of good. Walking has been shown to be the best medicine for anything, for anyone,” Duncan said. “And if you can run, even better. You don’t have to run a marathon or do an Ironman—you can do moderate to vigorous walking or running for 30 minutes a day. You will increase your life expectancy and reduce your risk of death. Your quality and quantity of life goes up.”

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