RT Journal Article
SR Electronic
T1 Sex differences in mortality: results from a population-based study of 12 longitudinal cohorts
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E361
OP E370
DO 10.1503/cmaj.200484
VO 193
IS 11
A1 Wu, Yu-Tzu
A1 Niubo, Albert Sanchez
A1 Daskalopoulou, Christina
A1 Moreno-Agostino, Dario
A1 Stefler, Denes
A1 Bobak, Martin
A1 Oram, Sian
A1 Prince, Martin
A1 Prina, Matthew
YR 2021
UL http://www.cmaj.ca/content/193/11/E361.abstract
AB BACKGROUND: Women generally have longer life expectancy than men but have higher levels of disability and morbidity. Few studies have identified factors that explain higher mortality in men. The aim of this study was to identify potential factors contributing to sex differences in mortality at older age and to investigate variation across countries.METHODS: This study included participants age ≥ 50 yr from 28 countries in 12 cohort studies of the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) consortium. Using a 2-step individual participant data meta-analysis framework, we applied Cox proportional hazards modelling to investigate the association between sex and mortality across different countries. We included socioeconomic (education, wealth), lifestyle (smoking, alcohol consumption), social (marital status, living alone) and health factors (cardiovascular disease, diabetes, mental disorders) as covariates or interaction terms with sex to test whether these factors contributed to the mortality gap between men and women.RESULTS: The study included 179 044 individuals. Men had 60% higher mortality risk than women after adjustment for age (pooled hazard ratio [HR] 1.6; 95% confidence interval 1.5–1.7), yet the effect sizes varied across countries (I2 = 71.5%, HR range 1.1–2.4). Only smoking and cardiovascular diseases substantially attenuated the effect size (by about 22%).INTERPRETATION: Lifestyle and health factors may partially account for excess mortality in men compared with women, but residual variation remains unaccounted for. Variation in the effect sizes across countries may indicate contextual factors contributing to gender inequality in specific settings.