Premature Adult Mortality Falls but Gender Gap Widens from MedPage Today

(Editor's note: US specific information is at the end of this post)

By Todd Neale, Staff Writer, MedPage Today

Although worldwide adult mortality rates have been dropping overall for the past four decades, the gap between men and women, who have lower mortality risk, has widened, researchers found.

From 1970 to 2010, the probability that a 15-year-old would die before turning 60 dropped by 19% for men and 34% for women, according to Christopher Murray, MD, director of the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, and colleagues.

During that period, the difference between mortality risk in men and women grew from 63 per 1,000 to 80 per 1,000, the researchers reported online in The Lancet.

"I think the widening gap between males and females is brought about to a large extent by the bigger impact of the Soviet Union collapse -- social dysfunction, high alcohol use -- on males than females," Murray told MedPage Today.

Also contributing is the HIV epidemic's disproportionate effect on males in certain parts of the world, he said.

Murray and his colleagues set out to evaluate worldwide trends in premature adult mortality from 1970 to the present, a topic that has not received as much attention as child health.

They argued, however, that "the prevention of premature adult death is just as important for global health policy as the improvement of child survival," noting that declining child mortality and aging populations lead to a larger proportion of deaths occurring among adults.

The researchers compiled 3,889 measurements of adult mortality for 187 countries using vital registration data, census data, and information on deaths in the household and among siblings.

Using the data, the Murray and his colleagues calculated yearly estimates of the probability of a 15-year-old dying before reaching 60.

Aside from the widening gap between male and female mortality, Murray said one of the most dramatic findings was the growing disparity between the best-off and worst-off countries since 1970.

Mortality probabilities for men ranged from 182 to 413 per 1,000 in 1970 and from 77 to 579 per 1,000 in 2010, an increase in the intercountry spread of 117%. A similar phenomenon was seen among women as well.

The drivers, Murray said, were worsening mortality risks in eastern Europe, central Asia, and many parts of Africa, accompanied by dramatic improvements in other parts of the world.

In southern Africa in particular, the mortality risks in 2010 for men (578 per 1,000) and women (446 per 1,000) exceed those seen in Sweden in the middle of the 18th century (493 per 1,000 for men and 437 per 1,000 for women).

Differing trends in tobacco and alcohol use, the spread of HIV, and the prevalence of key risk factors for noncommunicable disease, such as obesity and physical inactivity, are the main factors contributing to the disparity between nations.

Among high-income countries, in the U.S. the rate of decline in mortality risk was less than 1.5% per year from 1970 to 2010, much slower than in many other developed countries.

In 1990, the U.S. ranked 34th in female mortality and 41st in male mortality. Those ranks dipped further in 2010, to 49th for women and 45th for men, trailing all of Western Europe and several other countries.

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