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Edited by James W. Vaupel, Max Planck Institute for Demographic Research, Rostock, Germany, and approved June 5, 2015 (received for review November 19, 2014)
Significance
Female life expectancy now exceeds that of males in all countries. Although this gender difference has become accepted as normal, it is a relatively recent demographic phenomenon that emerged with the reduction of infections and the increase in the share of adult mortality attributed to cancer and cardiovascular disease. Heart disease is the main condition associated with increased excess male mortality, making the strongest contributions in birth cohorts of 1900–1935. Smoking behavior accounts for about 30% of male excess mortality at ages 50–70 for those born in 1900–1935. The remaining excess male mortality may be explained by underlying traits of vulnerability to cardiovascular disease that emerged with the reduction of infections and changes in diet and other lifestyle factors.
Abstract
Using historical data from 1,763 birth cohorts from 1800 to 1935 in 13 developed countries, we show that what is now seen as normal—a large excess of female life expectancy in adulthood—is a demographic phenomenon that emerged among people born in the late 1800s. We show that excess adult male mortality is clearly rooted in specific age groups, 50–70, and that the sex asymmetry emerged in cohorts born after 1880 when male:female mortality ratios increased by as much as 50% from a baseline of about 1.1. Heart disease is the main condition associated with increased excess male mortality for those born after 1900. We further show that smoking-attributable deaths account for about 30% of excess male mortality at ages 50–70 for cohorts born in 1900–1935. However, after accounting for smoking, substantial excess male mortality at ages 50–70 remained, particularly from cardiovascular disease. The greater male vulnerability to cardiovascular conditions emerged with the reduction in infectious mortality and changes in health-related behaviors.
Footnotes
- ↵1To whom correspondence should be addressed. Email: hirambeltran{at}gmail.com.
Author contributions: H.B.-S., C.E.F., and E.M.C. designed research; H.B.-S., C.E.F., and E.M.C. performed research; H.B.-S. contributed new reagents/analytic tools; H.B.-S. and E.M.C. analyzed data; and H.B.-S., C.E.F., and E.M.C. wrote the paper.
The authors declare no conflict of interest.
This article is a PNAS Direct Submission.
This article contains supporting information online at www.pnas.org/lookup/suppl/doi:10.1073/pnas.1421942112/-/DCSupplemental.
Twentieth century surge of excess male mortality
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