Deadly Habits

In developing countries, the gap in life expectancies between men and women has been shrinking for a long time—but it has not disappeared completely. In many cases, gender-related differences in mortality in the 45–69 age group account for almost half of this gap. However, in Eastern Europe, early mortality in men aged 50 and under accounts for over a third of it. Demographer Marina Vergeles examined the situation in more than 40 countries and shared her conclusions with IQ.HSE.

Living Differently

According to UN data, women live longer than men in every country in the world. However, the gap in life expectancies is insignificant in some countries, and very pronounced in others. The question is what factors influence this gap and which age groups make the biggest contributions to mortality.

The gender life expectancy gap in all developing countries has been shrinking for a long time. However, the point at which the gap started closing varies greatly, ranging from 1969 in the UK to 2009 in Greece. There is also a wide range in the maximum size of the gap: 13.7 years in Russia in 2005 to 4.4 years in Israel in 1999.

The disparity in how much certain age groups contribute to the gender life expectancy gap remains consistent over time between different countries and regions, notes Marina Vergeles, Research Assistant of the HSE University International Laboratory for Population and Health. There is also a wide disparity in the nature of the gender mortality gap in Europe. Unlike Western Europe, there is a high level of excess mortality among young and middle-aged men in Eastern Europe.

In Eastern European countries, up to 35% of the difference in life expectancy between men and women is linked to excess mortality in men aged 20–50. This figure is significantly lower in Western European countries: around 20%.

Marina Vergeles used the Human Mortality Database (an aggregator that standardises and collates indicators on mortality from different countries) to track the differences in life expectancies between men and women in 41 countries between 1959 and 2014 (the most recent year with a sufficiently complete set of data).

The countries were divided into seven groups based on the similarity of their geopolitical position and demographic makeup. The disparities between countries were analysed both by group and by individual country. The gender gap in life expectancy for these groups was calculated as the difference between the population-weighted average life expectancy of men and women. The contribution of different age groups to the maximum difference in life expectancy and its corresponding reduction was assessed using stepwise and contour decomposition.

Women Have an Advantage

Women’s advantage in terms of life expectancy is usually linked to epidemiological transition (starting from the mid-19th century), medical advances, and improvements in sanitary and hygiene conditions. These factors led to a reduction in maternal mortality and meant that the biggest contributor to mortality was no longer infections (which were largely brought under control), but pathologies that were largely age related: diseases of the circulatory system, heart attacks, strokes, hypertension, coronary heart disease, as well as cancer, neurological conditions and other non-infectious diseases. In other words, people started living longer (this has largely been more evident among women), and mortality shifted to older ages. In most developed countries, the gender gap in life expectancy started to grow significantly after the First World War.

The dynamics of the life expectancy gap between men and women and the specifics of individual countries can largely be explained by behavioural risk factors. Excess mortality in men is often related to:

 Smoking (in many countries, including high-income ones). Studies show that in the US, the gender mortality gap closely correlates with generational differences in the prevalence of smoking among men and women. In other words, the growth in the life expectancy gap between the sexes is explained by the fact that smoking became prevalent among men at an earlier stage. When women started to ‘catch up’ and smoking grew more widespread among women, the gap started narrowing. In Western Europe and English-speaking countries in the period 1950–2015, smoking accounted for up to half of the differences in mortality between the sexes in the 50–85 age group.

 Unhealthy alcohol consumption, including drinking strong drinks in large quantities, drinking substitutes that often lead to poisoning, etc. Alcohol abuse is both a direct cause of death (causing conditions such as circulatory diseases and cancer) and an indirect one (contributing to deaths by external causes such as murder, road traffic accidents, suicide, as well as death by fire, freezing, drowning, workplace accident, etc). This is particularly true of countries in Central and Eastern Europe. Notably, in Russia, there are significant gender differences in alcohol consumption, with men drinking more often, in greater quantities, and drinking hard alcohol more frequently.

 Poor diet.

 Risk-prone behaviour that leads to death by external causes.

 Stress. In the first half of the 1990s, stress causes by socioeconomic changes in the post-Soviet transition period (including unemployment and low wages) led to an increase in mortality in Russia, particularly among men.

 Aversion to seeking medical help and reluctance to follow treatment advice among men.

It is also worth noting that at the start of the 20th century, high child mortality in boys also seriously impacted the gender difference in mortality—only later did excess mortality in men of older ages overtake it.

Tobacco- and Alcohol-Related Mortality

The gender gap in life expectancy grew in the second half of the 20th century, then subsequently declined.

In the last hundred years, the gender life expectancy gap has decreased in almost all G7 countries. This is due to a reduction in the size of the gap in mortality from circulatory diseases and external causes in the 55–75 age group. In the early stages of this reduction process (in the 1970s–80s), a decrease in the gender mortality gap in the 20–59 age group played a significant role—particularly a decrease in male mortality. 

In English-speaking countries and those in Western Europe, smoking-related mortality in the 50+ age group was a major factor in the growth and subsequent decrease in the gender life expectancy gap (as smoking became more prevalent among women).

 

In Eastern Europe—particularly in former Soviet countries—there was a specific trend in life expectancy during the 20th and early-21st centuries. Decades of stagnation in life expectancy in the Soviet Union gave way to a period of fluctuation from the mid-1980s to the start of the 2000s. These fluctuations in life expectancy can largely be explained by changes in alcohol consumption.

As such, while the Gorbachev-era anti-alcohol campaign of 1985–1987 did save many lives, its end was followed by a rise in alcohol consumption and, accordingly, increased mortality.

Experts note that after the end of the anti-alcohol campaign, the number of people at a higher risk of death increased, while stress caused by socioeconomic changes also contributed to mortality.

In 2002, alcohol-related deaths in Russia accounted for over a third of deaths among men aged 20–44 and one fifth of those among women. Only in 2003 did the growth in life expectancy in Russia start to become statistically independent from the level of alcohol consumption. However, after 2003, the decline in alcohol-related mortality played a significant role in improving life expectancy.

It is worth noting that the gender gap in life expectancy in Russia and other former Soviet countries was influenced by excess mortality among men in the abovementioned 20–50 age group.

Finding Patterns

The countries being examined were divided into seven groups: the former-Soviet group (Russia, Ukraine, Belarus, Estonia, Latvia and Lithuania), the Central- and Eastern European group (Bulgaria, Hungary, the former East Germany, Poland, Slovakia, the Czech Republic, and others), the English-speaking group (the UK, the US, Canada, Ireland, and Australia), the Western European group (France, Switzerland, Austria, the Netherlands, and others), the ‘Asia’ group (Japan, Taiwan, South Korea, and Israel), the Southern European group (Italy, Spain, and Greece), and the Northern European group (Scandinavia and Finland).

The study found that by 2014, the gender life expectancy gap had started to narrow in almost every country examined. The final countries to join this trend were Belarus, Hong Kong (both in 2012), and Taiwan (in 2015). Despite the overall convergence of men’s and women’s life expectancies, the size of the disparity in life expectancy between the sexes was different in the past. The maximum gender gap was first reached by English-speaking countries, with a figure of 7.36 years in 1975. These countries were also the first to achieve a stable decrease in the gap, doing so in 1978. Ireland is somewhat of an exception, achieving a stable decrease in the gender life expectancy gap only in 2001. However, the size of the gap in the country was always fairly moderate—with a maximum of 5.9 years. Countries in northern and western Europe were faster than others in joining the trend of decreasing the gender life expectancy gap. The biggest disparity in life expectancy between the sexes was recorded in France (8.3 years), but this is more related to the long life expectancy of French women.

 

Figures for the southern European group are contradictory. Italy is similar to western European countries, while Spain and Portugal only passed the peak of the gender life expectancy gap in the mid-1990s. Greece too is unique, with a consistently small gap in life expectancy, but one that only started to narrow comparatively late (at the end of the 2000s).

The maximum gender life expectancy gap did not exceed 8.5 years in any group of countries, and in most countries did not exceed six or seven years. However, this is not the case for former Soviet countries.

Post-Soviet Life Expectancy

In the Central and Eastern Europe group, the maximum difference in life expectancy between the sexes occurred at the start of the 1990s. What’s more, the differences themselves were more significant than in other European countries. In Hungary, the maximum gap was 9.5 years. But in the Former Soviet group, the disparity reached 13 years in 2005.

All groups of countries—with the exception of Central and Eastern Europe—displayed a growth in the gender life expectancy gap followed by a decline. At the same time, there was a consistent increase in life expectancy for both men and women. The life expectancy gap remained the same (or increased) largely due to a quicker decrease in women’s mortality. However, overall, the situation improved for both sexes. But in former Soviet-bloc countries, the gap grew amid a stagnation or decrease in the life expectancy of men.

Once the life expectancy of men in former Soviet countries started to rise, the life expectancy gender gap started to decrease.

The maximum differences in life expectancy between men and women, the year of the maximum difference, and the first year of a consistent decrease
 

Group of countries	Maximum difference	Year of maximum difference	Start of stable decrease in difference
Former Soviet countries	13.04	2005	2006
Central and Eastern Europe	8.39	1992	1993
English-speaking countries	7.36	1975	1978
Western Europe	7.26	1980	1983
Asia	6.75	2004	2005
Southern Europe	6.85	1992	1994
Northern Europe	6.77	1979	1980

Source: article by Marina Vergeles

Age Group Contribution to the Disparity

The study found that the contributions made by different age groups to the size of the maximum life expectancy gap depend not only on the specifics of the country, but on the year of the ‘culmination’ of the differences. As such, the contribution of the earliest age group of 0–19 is the most noticeable (up to 10%) in English-speaking, Western European, and Northern European countries, where the life expectancy gap reached its maximum earlier than in others (in 1975–1980).

In almost all countries, the largest contribution to the gender life expectancy gap (40% to 58%) is made by the middle-aged group of 45–69 year-olds. However, the bigger the maximum gap, the more substantial the contribution of younger ages (20–44 years old) and the smaller the contribution of older ages (70+).

As such, in former Soviet countries, the contribution of younger ages is more significant. In Russia, this age group contributed 4.86 years to the lag in men’s life expectancy—over a third of the total difference. In the same countries, the contribution of older age groups is small—less than 20%.

Narrowing the Gap

Countries in which the life expectancy gap started to decrease earlier first displayed two peaks in the contributions made by the 0–4 and 65–69 (or 70–74) age groups. By 2014, infant mortality no longer made any contribution in any of these countries. The contribution of young and middle-aged groups was initially very small. The gender life expectancy gap was influenced more by mortality at older ages—the age group where the most changes occurred. The convergence in mortality in those aged 50+ led to a decrease in the gender life expectancy gap.

 

In the vast majority of countries, the contribution of all age groups has been decreasing for more than fifty years (apart from the oldest age group of 85+). This confirms that people are living longer on average, with mortality shifting to increasingly older age groups. However, overall, the age structure of the gender life expectancy gap has changed little in the years it has been decreasing. In Russia in 2014, the largest contribution was made by the 60–64 age group, while in 2005, it was made by the 50–54 age group. The absolute contribution of younger ages has fallen significantly, but ‘the 20–44 age group still accounts for more than 30% of the overall gap (3.47 years out of 11.2),’ notes Marina Vergeles.

A Change in Attitudes to Health

There is no single pattern in how the gender life expectancy gap has changed. Such changes are influenced by factors such as national history, gender roles, and attitudes towards health among men and women, explains the researcher.

In the US and Western Europe, smoking accounts for a large part of the gender life expectancy gap. However, the negative effect of smoking accumulates gradually and often becomes evident at older ages. In former Soviet countries, where mortality below the age of 45 makes a significant contribution to the gender life expectancy gap, smoking is a factor behind the disparity—but by no means the only one. ‘In Russia, the disparity between the numbers of men and women who smoke has been decreasing since at least 1996, specifically due to a decline in the prevalence of smoking among men,’ the researcher explains. ‘In this period, the life expectancy gap first grew, then decreased.’

Excess male morality in former Soviet countries is linked more to alcohol-related deaths, including those from circulatory illnesses. Fluctuations in mortality and in the gender life expectancy gap at the end of the 20th century are closely linked to fluctuations in the level of alcohol consumption.

Research in Russian regions demonstrates the significant role of alcohol abuse on the size of the gender mortality gap.

The question remains of which has a greater effect on men’s and women’s mortality: smoking or alcohol abuse. It is not easy to separate the effects of these two risk factors (particularly in people who both drink and smoke). Diseases of the circulatory system and cancer can be caused by smoking and alcohol abuse. Alcohol has a major influence on premature death, both by causing severe forms of circulatory diseases and by contributing to deaths from external causes. And while the effects of smoking become more evident with age, alcohol abuse increases the likelihood of dying young.

In any case, behavioural risk factors have a major impact on life expectancy. These can and must be addressed. ‘Despite the recent rise in life expectancy and decrease in the gender life expectancy gap in former Soviet and Eastern European countries, reducing the gap as much as possible requires serious changes in behaviour and attitudes to health, first and foremost in the male population,’ Maria Vergeles concludes. A change in habits could save many lives.
IQ
 

Author of the research:

Marina Vergeles, Research Assistant at the HSE University International Laboratory for Population and Health, doctoral student of the HSE University Vishnevsky Institute of Demography

 

Author: Olga Sobolevskaya, March 22, 2022