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Abstract
The degree to which biological factors contribute to the existence and the widening of mortality differences by sex remains unclear. To address this question, a mortality analysis for the years 1890 to 1995 was performed comparing mortality data on more than 11,000 Catholic nuns and monks in Bavarian communities living in very nearly identical behavioral and environmental conditions with life table data for the general German population. While the mortality differences between women and men in the general German population increased considerably after World War II, they remained almost constant among the members of Bavarian religious orders during the entire observation period, with slight advantages for nuns. Thus, the higher differences observable in the general population cannot be attributed to biological factors. The different trends in sex-specific mortality between the general and the cloistered populations are caused exclusively by men in the general population who were unable to follow the trend in mortality reduction of women, nuns, and especially monks. Under the special environmental conditions of nuns and monks, biological factors appear to confer a maximum survival advantage for women of no more than one year in remaining life expectancy at young adult ages. Copyright 2003 by The Population Council, Inc..
... In fact, the female life expectancies are higher than male life expectancies across almost all the world (Barford et al., 2006). The gender gap has been widening in the period 1950-1970 and declining afterwards (Schünemann et al., 2017;Luy, 2003). Luy (2003) provides a review of the potential explanations of the male 2 Chapter 1 Introduction excess mortality in the literature, which can be divided broadly into two basic categories: the biological approach and the non-biological approach. ...
... The gender gap has been widening in the period 1950-1970 and declining afterwards (Schünemann et al., 2017;Luy, 2003). Luy (2003) provides a review of the potential explanations of the male 2 Chapter 1 Introduction excess mortality in the literature, which can be divided broadly into two basic categories: the biological approach and the non-biological approach. The biological approach states that women are less prone to disease due to physiological and genomic reasons (Smith and Warner, 1989;Waldron, 1985;Lopez, 1983), while the non-biological attempts to explain the sex differences based on behavioral factors such as smoking and alcohol consumption (Oksuzyan et al., 2008;Waldron, 1985). ...
... Sex differences in mortality exist even among infants and children, where the higher male mortality rates could not have been caused by behavioral differences, hence confirming the biological contribution to the female mortality advantage. It is concluded that sufficient explanation should be based on both biological and non-biological factors (Schünemann et al., 2017;Oksuzyan et al., 2008;Luy, 2003). Nonetheless, it is evident that there exists a sex differential in mortality, in particular, female mortality is lower than male mortality, which is a fundamental assumption used in the thesis and a key criteria that is used to assess the reasonableness of the mortality estimates. ...
In this thesis we propose models for estimating and projecting mortality rates using adaptive splines. Mortality modelling has various applications from social planning to insurance. However, raw mortality data often exhibits irregular patterns due to randomness. The data at the oldest ages are also very scarce and unreliable as there are only very little survivors at these ages, adding difficulty to estimation. Graduation refers to the act of smoothing crude mortality rates, during which extrapolation to older ages where data is non-existent is usually also performed. We first propose a flexible and robust model for mortality graduation of static life tables using adaptive splines. Male and female mortality rates are graduated jointly, as opposed to previous English Life Tables (ELTs) where they were smoothed independently. Therefore our model borrows information across sexes, which is especially helpful at the oldest ages. Often
when male and female mortality rates are estimated independently, implausible age patterns may occur, such as intersecting male and female mortality schedules. This has been addressed using rather ad hoc procedures in previous ELTs, for example, by calculating the weighted average of the estimated mortality rates starting at the age where they intersect or by discarding data at the oldest ages. By utilising the locality of B-spline basis, constraints can be imposed effectively such that female mortality rates are always lower than or equal to male mortality rates at all ages, even at extrapolation ages, hence does not involve subjective adjustments.
We then extend the model to forecast mortality rates. Building upon models by Dodd et al. (2020) and Hilton et al. (2019), we jointly model and project male and female mortality rates of England Wales and Scotland. The joint sex model produces more reasonable long term male and female mortality projections that are non intersecting. Information is borrowed at the highest ages where exposures are small. By doing so the extrapolation to higher ages beyond data range gives more plausible estimates, especially for the mortality improvement rates for females at the oldest ages where a worsening mortality is otherwise projected. We also jointly model mortality rates of the same sex across the two countries, as they are expected to have similar mortality structures for the same sex. England Wales populations have a wider age range with available
data, therefore the joint country model provides a way for the smaller Scottish populations to
borrow information and learn from the bigger English Welsh populations. The joint country
model is able to produce non-divergent long term projections between the countries for both
males and females.
Finally, a joint model for all of the four populations is proposed. The model combines features
of the joint sex and joint country models, and borrows strength across sexes and countries.<br/
... Key evidence comes from a study comparing 11,000 German male and female cloister inhabitants from Catholic communities with the general population. A maximum survival disadvantage of about 1 year of life expectancy from a young adult age (25 years) was found in the male cloister inhabitants compared with women from the cloister communities and the general population [18]. Men from the general population had a lower life expectancy from a young adult age compared with the cloister inhabitants. ...
... Men from the general population had a lower life expectancy from a young adult age compared with the cloister inhabitants. It was also proposed that these males were unable to decrease their mortality risk, in contrast to the female general population, nuns, and monks [18]. The protected environment of the cloister seemed to have positive effects on life expectancy on male inhabitants. ...
... The protected environment of the cloister seemed to have positive effects on life expectancy on male inhabitants. Modifiable risk factors, such as smoking, alcohol, unhealthy food choices, excess body weight, and lack of physical inactivity, were more prevalent in the male general population [18]. ...
Purpose of Review
This narrative review makes the case for greater efforts to reduce cardiovascular disease (CVD) risk in women with diabetes.
Recent Findings
In a recent meta-analysis including five CVOTs of diabetes medications with 46,606 subjects, women (vs men) with type 2 diabetes had a higher relative risk for stroke (RR 1.28; 95% CI 1.09, 1.50) and heart failure (1.30; 1.21, 1.40). Prior studies found higher “within-gender” RR for CVD mortality in women with diabetes although men have an absolute higher risk. Women with prior gestational diabetes mellitus (GDM) have a 2-fold higher CVD risk than the background population. Worse CVD and CVD risk factor management in women, as well as lower female therapy adherence, contribute further to these disparities.
Summary
The mechanism behind this excess risk includes biological, hormonal, socioeconomic, clinical, and behavioral factors that still require further investigation. The need for more intensive CVD reduction in women now includes more attention to screening for both incident diabetes and CVD risk factors among high-risk women.
... The second component in sex ratios is the difference in mortality between the sexes. Excess mortality of males to females is observed in historical data (Beltrán-Sánchez, Finch, and Crimmins 2015), in selected groups of the population (Luy 2003), in times of extreme stress (Zarulli et al. 2018), and in current populations (Zarulli, Kashnitsky, and Vaupel 2021). Thus, as cohorts age, a male-biased infant population eventually becomes female-biased in old age (Hollingshaus et al. 2019). ...
... We approximated three types of quantities: the demographic function at an exact time point (i.e., midpoint), the derivative for a demographic function, and the relative derivative of change. We implemented previously published standard approximations Canudas-Romo 2002 and2003). ...
... The disparity in health between men and women has been well established, but the causes of this inequality are still being investigated. Several studies suggest that the origins of these inequalities are gender instead of sex (Danaei et al., 2011;Forouzanfar et al., 2016;Heinz et al., 2020;Luy, 2003). On the other hand, studies show that childhood circumstances, including child labor, affect a broad range of health outcomes in adulthood (Almond et al., 2018;Fassa et al., 2005;Ibrahim et al., 2019;Lenka, 2014;Van Ewijk, 2011). ...
... We focus on the height of children, which is well established as a measure of health (Case & Paxson, 2008;Dadgar, Noferesti, Vesal, et al., 2020;Karimi et al., 2020;Neale et al., 2020;Satyanarayana et al., 1986;Schick & Steckel, 2015). More specifically, there is much evidence on child labor's adverse effects on height (Batomen Kuimi et al., 2018;Hawamdeh & Spencer, 2003;Satyanarayana et al., 1986) and height adjusted for age (Ambadekar et al., 1999;Hawamdeh & Spencer, 2002, 2003. However, there are no or even positive effects on height growth in the region in India (Mohan et al., 2015) and no associations in rural areas in Vietnam (O'Donnell et al., 2002). ...
Even though children are legally required to attend school, many do not, especially in the developing world. This study uses rich microdata from Iran to investigate out-of-school children aged 7 to 18. The first finding shows that adolescent out-of-school boys are involved in child labor eight times more than girls. To determine whether this large labor gap between boys and girls is associated with health inequalities, the height adjusted for age and sex (HAZ) of children is examined. Out-of-school boys have lower HAZ despite coming from similar socioeconomic backgrounds and parents. Several statistical tests, like the difference-in-differences method and a large set of controls, could not explain why boys' HAZ is lower. The finding suggests that child labor would be a source of health differences between boys and girls in childhood, especially in countries with a large gender gap in child labor.
... The author attributes the remaining sex differences in life expectancy in the general population to differences in lifestyle and socioeconomic burden. 7 However, even among populations where men and women differ less in terms of key lifestyle factors, such as Mormons, sex differences in life expectancy still exist. 8 In 2019, the sex difference in life expectancy was 4.4 years on average worldwide, with large variation across countries. ...
... The increase and decrease in sex differences in life expectancy were mainly attributed to the smoking epidemic and other behavioural differences between sexes. 7 13 42 The φ values are generally higher in low/middle-income countries. However, this should not be interpreted as a sign of greater gender equality in survival. ...
Objective
To measure sex differences in lifespan based on the probability of males to outlive females.
Design
International comparison of national and regional sex-specific life tables from the Human Mortality Database and the World Population Prospects.
Setting
199 populations spanning all continents, between 1751 and 2020.
Primary outcome measure
We used the outsurvival statistic ( φ ) to measure inequality in lifespan between sexes, which is interpreted here as the probability of males to outlive females.
Results
In random pairs of one male and one female at age 0, the probability of the male outliving the female varies between 25% and 50% for life tables in almost all years since 1751 and across almost all populations. We show that φ is negatively correlated with sex differences in life expectancy and positively correlated with the level of lifespan variation. The important reduction of lifespan inequality observed in recent years has made it less likely for a male to outlive a female.
Conclusions
Although male life expectancy is generally lower than female life expectancy, and male death rates are usually higher at all ages, males have a substantial chance of outliving females. These findings challenge the general impression that ‘men do not live as long as women’ and reveal a more nuanced inequality in lifespans between females and males.
... The females outlive males is a well-known phenomenon which can be observed in every country of the world today (Barford, Dorling, Smith, & Shaw, 2006). Research into the sex difference in mortality suggests that social, environmental, biological, genetic, and behavioural factors and their interactions influence sex disparity in survivorship (Lindahl-Jacobsen et al., 2016;Luy, 2003;Madigan, 1957;Preston & Wang, 2006;Waldron, 1983Waldron, , 1995Wingard, 1982Wingard, , 1984. The main causes of sex differential mortality in this corpus of research can be summarised into two factors: biological and behavioural . ...
... Applying to Australian mortality data, the results suggest that when the sex gap widens (from 1945-1949 to 1975-1979), the driving component is the sex difference in mortality improvement; but when the sex gap narrows (from 1975-1979 to 2010-2014) Based on the results, this study also provide the evidence on the biological difference between females and males (Koellhoffer & McCullough, 2013;Luy, 2003;Xing, Nozell, Chen, Hage, & Oparil, 2009), because the total contributions from changing of the sex differences in most causes (except the neoplasms) tend to zero over time and the sex gap in life expectancy at birth exists and is still large. ...
... One hypothesis to explain these results is that gender inequality, in terms of parity of education, representation, and healthcare access, may be associated with the differences in how gender norms, stereotypes and inequalities have affected men and women historically [2]. While reduction of gender inequalities improves living conditions and health status among women, these gendered stereotypes and inequalities across life are thought to exacerbate premature mortality, disease burden, and years lived with disability among men [1,8,19,20,26]. Gender stereotypes of masculinity linked with risky behaviors, violence and help-seeking conducts are expectedly challenged in more gender-equal societies. Therefore, reducing gender inequality could benefit both men and women. ...
... Interestingly, our analysis suggests that improving equity may have a greater impact on the health of men than women, and that the gap between sexes decreases under the assumption of gender equity (Fig. 1A,BÀD). This finding supports the concept that social constructs may play a greater role than biological factors in the gaps between men and women that are observed in most countries for parameters such as life expectancy [17,20,21,28,29]. ...
Background
Gender plays a well-recognized role in shaping health inequities. However, the population-level health consequences of gender inequalities have not been measured comprehensively. The goal of this study was to evaluate the association between gender inequality and health indicators in organization for Economic Co-operation and Development (OECD) countries.
Methods
Ecological study based on 1990–2017 panel data for OECD member countries. Gender inequality was measured using the Gender Inequality Index (GII). The population health parameters evaluated were life expectancy (LE), healthy life expectancy (HALE), years of life lost (YLL), years lived with disability (YLD), disability-adjusted life years (DALYs), and specific-cause mortality. Two-way fixed-effects linear models were used to assess the relationship between gender inequality and health outcomes. Models included potential mediating and confounding factors such as health spending, political model, and income inequalities.
Findings
Greater gender inequality was associated with lower LE (-0·49%; CI95 -0·63%– -0·31%; p-value < 0·0001), HALE (-0·47%; CI95 -0·63%– -0·31%; p-value < 0·0001) and with increased premature mortality YLL (6·82%; CI95 3·63%–10·75%; p-value < 0·0001) and morbidity measured in DALYs (1·50%; CI95 0·48%–2·46%; p-value = 0·0028) and YLD (2·59%; CI95 0·67%–4·77%; p-value = 0·0063) for each 0·1 increments on the GII. The sensitivity analysis indicated that the results were robust to the various specifications of the causal models.
Interpretation
Our results suggest that gender inequality pose a sizable impact on population health outcomes. Promoting gender equality as part of public policies is vital for optimizing health on a population scale.
Funding
Agencia Nacional de Investigación y Desarrollo (ANID)/Programa Becas/Magister Becas Chile/2017- 22,170,332
... Research data indicate that the biological component of the difference in life expectancy is small, probably amounting to less than a year. The rest of the difference in life expectancy is due to differences in health-related behavior and in the use of medical care services (28,29) (eBox 2). The result is that more YLL are documented for men, who on average die earlier, than for women. ...
... Here, this approach is adjusted to the German context by using the life expectancies in the federal states. In demographic research it is assumed that the purely biological difference in life expectancy is small (less than 1 year; see [28,29]). The major part of the difference in life expectancy is therefore amenable to (external) influence and can be attributed, for instance, to health-related behavior or uptake of care. ...
Open access: https://www.aerzteblatt.de/int/archive/article/218061/Years-of-life-lost-to-death-a-comprehensive-analysis-of-mortality-in-Germany-conducted-as-part-of-the-BURDEN-nbsp-2020-project.
Background:
Knowing which diseases and causes of death account for most of the years of life lost (YLL) can help to better target appropriate prevention and intervention measures. The YLL in Germany for specific causes of death were estimated as part of the BURDEN 2020 project at the Robert Koch Institute.
Methods:
Data from cause-of-death statistics were used for the analysis. ICD codes were grouped into causes of death categories at different levels of disaggregation. The YLL were estimated by combining each cause of death with the remaining life expectancy at the age of death. Deaths and YLL were compared by sex, age category, and regional distribution.
Results:
Approximately 11.6 million years were estimated to be lost in Germany in 2017, of which 42.8% were lost by women and 57.2% by men. The largest number of YLL were due to (malignant) neoplasms (35.2%), followed by cardiovascular diseases (27.6%), gastrointestinal diseases (5.8%), and neurological diseases (5.7%). Deaths at younger ages had a greater impact on population health if expressed in YLL: the death share of persons under age 65 was 14.7%, but the years of life lost in this age group amounted to 38.3% of all YLL. The most common causes of death in this group include accidents, self-injury and violence, malignant neoplasms, and alcohol-related diseases.
Conclusion:
A large proportion of YLL is borne by young and middle-aged persons. These findings emphasize the need to introduce preventive strategies early in life to reduce the YLL at younger ages, as well as to prevent risk factors for diseases in older ages.
... The existing literature about gender and health is quite notable (Bird and Rieker, 1999;Courtenay, 2000;Denton and Walters, 1999;Doyal, 2000;Kandrack, Grant and Segall, 1991;Luy, 2003;Luy and Wegner-Siegmundt, 2014;Macintyre, Hunt and Sweeting, 1996;Matthews, Manor and Power, 1999;McDonough and Walters, 2001;Moss, 2002). ...
... Focusing on male excess mortality, Luy (2003) points out the existence of two different approaches addressing this issue: ...
The thesis uses data from the English Longitudinal Study of Ageing (ELSA) to investigate the topic of health behaviours change as associated with life events, with a particular attention on their timing. By reviewing the extensive literature on the health of the elderly people, the health inequalities and the health behaviours according to a life course approach, three research questions are addressed. Is there any relationship between the occurrence of certain life events and the change(s) in health related behaviours? Is there any association between the age when experiencing certain life events and the change(s) in health-related behaviours? Are there any differences by gender? In particular, three studies, presented in three separated chapters, and focusing on different behaviours and events, are conducted in order to explore this fascinating area of research. Each analysis concerns a particular stage of life, i.e. adult age, mid-life and adult/old age. Chapter 3 deals with smoking cessation as associated with two events usually happening in early adulthood, i.e. the birth of the first child and the first marriage, by a gender perspective. It uses Life History Interview, which provides retrospective information on several life domains and, in particular, on when people started and stopped smoking. Chapter 4 focuses on women and on the menopause as related to changes in frequency level of alcohol intake and physical activity engagement. A multilevel longitudinal analysis employing four couples of ELSA waves is conducted in order to examine changes in behaviours as associated with menopausal process stages. Chapter 5 investigates the transition into retirement as associated with changes in smoking, drinking and physical activity, and use waves 4-8. Overall, results suggest that selected life events and, in particular, specific phases of the transition to the event, as well as the age at experiencing them may play a role in the context of behaviours change. Further research is needed to assess whether the association between changes in health behaviours and timing of life events is verified in other settings, for other behaviours, and by using other analytic approaches.
... It should, however, be noted that the most recent literature has painted a more complex picture involving several additional mechanisms, such as cellular senescence, protein synthesis, and epigenetic alterations (Hägg and Jylhävä 2021). The role of biological differences in the sex gap in life expectancy has been empirically demonstrated by studies showing that even in conditions where the lifestyles of males and females are similar -such as in convents of nuns and cloistered monks (Luy 2003) or in adverse situations, such as famines and epidemics (Zarulli et al. 2018)-survival rates are, on average, higher for females than males. ...
Much less is known about the sex gap in lifespan variation, which reflects inequalities in the length of life, than about the sex gap in life expectancy (average length of life). We examined the contributions of age groups and causes of death to the sex gap in lifespan variation for 28 European countries, grouped into five European regions. In 2010-15, males in Europe displayed a 6.8-year-lower life expectancy and a 2.3-year-higher standard deviation in lifespan than females, with clear regional differences. Sex differences in lifespan variation are attributable largely to higher external mortality among males aged 30-39, whereas sex differences in life expectancy are due predominantly to higher smoking-related and cardiovascular disease mortality among males aged 60-69. The distinct findings for the sex gap in lifespan variation and the sex gap in life expectancy provide additional insights into the survival differences between the sexes.
... In Germany, life expectancy at live birth has changed from a constant female advantage of three years before the World War I, to the current level of over six years. In most industrialised countries, the disparity in mortality by sex started to increase after the World War I, especially in the United States, England, and Wales (Luy, 2003). Between 1950 and 1995, the European pattern of life expectancy underwent significant transformations. ...
... However, the magnitude of this gap is variable and it is mainly shaped by complex interactions between biological and environmental factors that in humans also include sociocultural aspects (Lemaître et al., 2020). Data from German cloistered populations collected for the years 1890 to 1995 showed how peculiar sociocultural conditions such as enclosure and monastic life may influence the magnitude of this gap (Luy, 2003). ...
Sex differences in human survival have been extensively investigated in many studies that have in part uncovered the biological determinants that promote a longer life in females with respect to males. Moreover, researches performed in the past years have prompted increased awareness about the biological effects of environmental factors that can modulate the magnitude of the sex gap in survival. Besides the genetic background, epigenetic modifications like DNA methylation, that can modulate cell function, have been particularly studied in this framework. In this review, we aim to summarize the role of the genetic and epigenetic mechanisms in promoting female advantage from the early in life (“INNATE” features), and in influencing the magnitude of the gap in sex differences in survival and ageing (“VARIABLE” features). After briefly discussing the biological bases of sex determination in humans, we will provide much evidence showing that (i) “innate” mechanisms common to all males and to all females (both genetic and epigenetic) play a major role in sex differences in lifespan; (ii) “variable” genetic and epigenetic patterns, that vary according to context, populations and exposures to different environments, can affect the magnitude of the gap in sex differences in survival. Then we will describe recent findings in the use of epigenetic clocks to uncover sex differences in biological age and thus potentially in mortality. In conclusion, we will discuss how environmental factors cannot be kept apart from the biological factors providing evidence from the field of human ecology.
... The COVID-19 pandemic has started to alter the regular mortality rates, and an end is just recently observed, certainly due to vaccination that has begun in February of 2021. The occurrence of excess mortality frequently appears during usually short periods of time, such as in the aftermath of a strong earthquake, an outbreak of seasonal diseases, or other unusual but given circumstances like armed conflicts (Ansart et al., 2009;Vandoros et al., 2020;Luy., 2003;Wheatcroft et al., 1984;Walsh et al., 2017;De Waal et al., 1989). Although clear excess mortality has existed in Ecuador since the declaration of the pandemic, however, when calculating the average mortality rates prior to the pandemic and adding the official death rate by the COVID-19 virus, a high discrepancy exists (Table 2). ...
The global COVID-19 pandemic has shocked the world. Since the virus gave rise to health problems and often ended in deaths, the count of the contagion and the deceased has been an open issue. Such statistics are vital for every nation and even every city or district and suburb as these numbers decide the level of intervention and the subsequent reduction of its given spread. Worldwide data show a mortality rate of around two percent prior to successful vaccination campaigns. However, Ecuador’s statistical data indicate an abnormal amount of excess mortality, which is officially denied in each of the studied countries. These numbers have been projected on a monthly basis and exceed up to 300% of the official COVID-19 deaths. In particular, the average mortality rate in Ecuador, prior to and close to the pandemic, has been about 6083.4±234.6, while in the worst month during the sanitary crisis, deaths piled up to 21,000 people, and only 1180 were recognized as deceased by COVID-19. The reasons are widespread but based on an insufficient financed health sector, political incompetence, lack of leadership, and a long-lasting economic crisis. Therefore, premature endings of confinements or lockdowns have contributed to an accelerated contagion and seem to even counteract the vaccination phase, in middle 2021, shortly before excess mortality ceased completely.
... It is important to note, however, that extant literature is replete with evidence of mortality differences by sex (Case & Paxson, 2005;Ross et al., 2012) and socioeconomic status (Brown, 2012;Leopold, 2018;Montez, 2019). Generally, females have lower mortality and higher life expectancy than males (Case & Paxson, 2005;Luy, 2003); thus, it is conventional to conduct formal demographic analyses by sex (Preston, Heuveline, & Guillot, 2000). The literature also highlights the association between socioeconomic status and health, particularly the role of educational attainment as a robust predictor of mortality (Byhoff, 2017;Case & Deaton, 2021;Montez, 2019). ...
This article advances differential racialization as a lens to frame health disparity trends within the Asian racial category. Using formal demographic methods, I analyzed data from the Multiple Cause of Death File and the American Community Survey to examine the trends in life expectancy and life disparity among Chinese, Asian Indians, and Filipinos in the United States between 2005-2019. While Chinese, Asian Indian, and Filipino life expectancy oscillated between each period under study, those oscillations contributed to an overall widening advantage for Chinese over their Asian Indian and Filipino counterparts. I posit that widening inequalities between the three groups are suggestive of their increasingly disparate racial statuses. These findings underscore the importance of contextualizing disaggregated health data within the social conditions that produce inequalities, namely race/racialization/racism.
... For example, among white collar men in Sweden, especially among health professionals, there was a mortality disadvantage, but not among religious professionals. It is contested whether the clergy may have had a better lifestyle than the general population (Debiasi, 2020), as Bavarian monks had no survival advantage over non-cloistered men before the 1950s (Luy, 2003). More likely, the difference in mortality rates between doctors and religious professionals can be explained by exposure to infectious disease due to the nature of their occupation. ...
A century after the Spanish Flu, the COVID-19 pandemic has brought renewed attention to socioeconomic and occupational differences in mortality in the earlier pandemic. The magnitude of these differences and the pathways between occupation and increased mortality remain unclear, however. In this paper, we explore the relation between occupational characteristics and excess mortality among men during the Spanish Flu pandemic in the Netherlands. By creating a new occupational coding for exposure to disease at work, we separate social status and occupational conditions for viral transmission. We use a new data set based on men’s death certificates to calculate excess mortality rates by region, age group, and occupational group. Using OLS regression models, we estimate whether social position, regular interaction in the workplace, and working in an enclosed space affected excess mortality among men in the Netherlands in the autumn of 1918. We find some evidence that men with occupations that featured high levels of social contact had higher mortality in this period. Above all, however, we find a strong socioeconomic gradient to excess mortality among men during the Spanish Flu pandemic, even after accounting for exposure in the workplace.
... These approaches forecast males and females independently. Pascariu, Canudas-Romo, and Vaupel (2018) further include the well-documented female advantage on longevity (Luy 2003) to forecast life expectancy for both sexes simultaneously. Although the use of life expectancy as an indicator to forecast is appealing, estimating age-specific death rates is needed to analyse patterns of mortality at different ages and to calculate other indicators, such as lifespan inequality, as well as for estimating insurance pricing and pension liabilities. ...
Background: Life expectancy is one of the most informative indicators of population health and development. Its stability, which has been observed over time, has made the prediction andforecasting of life expectancy an appealing area of study. However, predicted or estimatedvalues of life expectancy do not tell us about age-specific mortality. Objective: Reliable estimates of age-specific mortality are essential in the study of health inequalities, well-being and to calculate other demographic indicators. This task comes with several difficulties, including a lack of reliable data in many populations. Models that relate levels of life expectancy to a full age-specific mortality profile are therefore important but scarce. Methods: We propose a deep neural networks (DNN) model to derive age-specific mortality fromobserved or predicted life expectancy by leveraging deep-learning algorithms akin to demography's indirect estimation techniques. Results: Out-of-sample validation was used to validate the model, and the predictive performanceof the DNN model was compared with two state-of-the-art models. The DNN model provides reliable estimates of age-specific mortality for the United States, Italy, Japan, and Russia using data from the Human Mortality Database. Contribution: We show how the DNN model could be used to estimate age-specific mortality for countries without age-specific data using neighbouring information or populations with similar mortality dynamics. We take a step forward among demographic methods, offering a multi-population indirect estimation based on a data driven-approach, that can be fitted to many populations simultaneously, using DNN optimisation approaches.
... Anyway, all the evidence up to date consistently shows that CFS = 0 is associated with lower survival than CFS = 1 and, to a lesser extent, 2. This seems to suggest that part of the reversal observed in the evolution of female extra survival may also depend on the recent increase in the proportion of nulliparous women (see also Luy, 2003). However, if a link between poor health in late life and childlessness seems plausible for the past, when childlessness was mostly involuntary, it is hard to tell whether the same holds among recent cohorts, who increasingly choose not to have children (Sobotka, 2017). ...
In Italy, at least in the cohorts born up to the beginning of the twentieth century, women’s mortality in post-reproductive ages was influenced by fertility, with large progenies (and, to a lesser extent, childlessness) leading to markedly lower survival chances. This relationship proved strong enough to affect the female-to-male ratio in old age as fertility declined. In this paper, we show that various measures of extra female survival at high ages are closely connected to the fertility transition in Italy, and to its peculiar historical and geographical evolution.
... In other words: health inequity (measured by life expectancy at district level) in contemporary Germany crystallizes quite clearly when life expectancy is operationalized as remaining life expectancy at older ages. Thus it comes to no surprise at all that the well-known 'gender gap in life expectancy' [84][85][86][87] can also be found when regarding remaining life expectancy at older ages. ...
Remaining life expectancy at age 60 (in short: RLE) is an important indicator of the health status of a population’s elders. Until now, RLE has not been thoroughly investigated at the district level in Germany. In this study we analyzed, based on recent publicly available data (2015–2017), and for men and women separately, how large the RLE differences were in Germany across the 401 districts. Furthermore, we examined a wide range of potential social determinants in terms of their bivariate and multivariate (i.e., partial) impact on men’s and women’s RLE. Men’s district-level RLE ranged between 19.89 and 24.32 years, women’s district-level RLE between 23.67 and 27.16 years. The best single predictor both for men’s and women’s RLE at district level was ‘proportion of employees with academic degree’ with standardized partial regression coefficients of 0.42 (men) and 0.51 (women). Second and third in rank were classic economic predictors, such as ‘household income’ (men), ‘proportion of elder with financial elder support’ (women), and ‘unemployment’ (men and women). Indicators expressing the availability of medical services and staffing levels of nursing homes and services had at best a marginal partial impact. This study contributes to the growing body of evidence that a population’s educational level is a decisive determinant of population health resp. life expectancy in contemporary industrialized societies.
... In most countries, women currently show higher survival rates than men (United Nations, 2019c). This is caused, among other things, by biological factors (Luy, 2003), different health behaviours of males in relation to females-related to alcohol consumption, smoking, and differences in diet (Beltrán-Sánchez et al., 2015), greater adult male vulnerability to cardiovascular diseases (Preston, 1976), and violence (Canudas-Romo and Aburto, 2019). Among the related causes of death, significant excess male mortality is observed in young adulthood (15-24) (Nathanson, 1984) due to external causes and in late adulthood (50-70) (Preston, 1976;Nathanson, 1984) due to cardiovascular diseases and lung cancer, among other factors. ...
The production, compilation, and publication of death registration records is complex and usually involves many institutions. Assessing available data and the evolution of the completeness of the data compiled based on demographic techniques and other available data sources is of great importance for countries and for having timely and disaggregated mortality estimates. In this paper, we assess whether it is reasonable, based on the available data, to assume that there is a sex difference in the completeness of male and female death records in Peru in the last 30 years. In addition, we assess how the gap may have evolved with time by applying two-census death distribution methods on health-related registries and analyzing the information from the Demographic and Health Surveys and civil registries. Our findings suggest that there is no significant sex difference in the completeness of male and female health-related registries and, consequently, the sex gap currently observed in adult mortality estimates might be overestimated.
... The COVID-19 pandemic has started to alter the regular mortality rates, and an end is just recently observed, certainly due to vaccination that has begun in February of 2021. The occurrence of excess mortality frequently appears during usually short periods of time, such as in the aftermath of a strong earthquake, an outbreak of seasonal diseases, or other unusual but given circumstances like armed conflicts (Ansart et al., 2009;Vandoros et al., 2020;Luy., 2003;Wheatcroft et al., 1984;Walsh et al., 2017;De Waal et al., 1989). Although clear excess mortality has existed in Ecuador since the declaration of the pandemic, however, when calculating the average mortality rates prior to the pandemic and adding the official death rate by the COVID-19 virus, a high discrepancy exists (Table 2). ...
The global COVID-19 pandemic has shocked the world. Since the virus gave rise to health problems and often ended in deaths, the count of the contagion and the deceased has been an open issue. Such statistics are vital for every nation and even every city or district and suburb as these numbers decide the level of intervention and the subsequent reduction of its given spread. Worldwide data show a mortality rate of around two percent prior to successful vaccination campaigns. However, Ecuador's statistical data indicate an abnormal amount of excess mortality, which is officially denied in each of the studied countries. These numbers have been projected on a monthly basis and exceed up to 300% of the official COVID-19 deaths. In particular, the average mortality rate in Ecuador, prior to and close to the pandemic, has been about 6083.4±234.6, while in the worst month during the sanitary crisis, deaths piled up to 21,000 people, and only 1180 were recognized as deceased by COVID-19. The reasons are widespread but based on an insufficient financed health sector, political incompetence, lack of leadership, and a long-lasting economic crisis. Therefore, premature endings of confinements or lockdowns have contributed to an accelerated contagion and seem to even counteract the vaccination phase, in middle 2021, shortly before excess mortality ceased completely.
... Relative to men and women in the general population, there are fewer differences between monks and nuns with regards to many of the social factors thought to contribute to gender differences in depressive symptoms. Specifically, nuns and monks have similar material living standards, occupations and family obligations (all are unmarried without children) and are similarly embedded in stable social networks (Luy, 2003). Analysis of the order population thus offers the unique opportunity for assessing whether there is a gender difference in depressive symptoms when many of the social and lifestyle differences between men and women in the general population are held relatively constant. ...
Objectives: I compare the depressive symptoms of older (50+) Catholic order members (i.e., monks and nuns) and their peers in the general population to gain insight into the extent to which (gender differences in) depressive symptoms in later life are related to modifiable social and lifestyle factors. Order life is characterized by less exposure to a number of risk factors and more exposure to a number of protective factors related to depressive symptoms. Relative to men and women in the general population, there are fewer differences between male and female order members with regards to a number of social factors thought to contribute to gender differences in depressive symptoms. Method: Linear and logistic regression were used to compare mean level and prevalence of clinically-relevant depressive symptoms in a sample of order members aged 50+ years (N=515) with a sample of same aged, same nationality, same religion peers in the general population (N=875). Results: The mean level and prevalence of clinically-relevant depressive symptoms were higher in the order population. Women had higher depressive symptoms in both populations. There was no indication that the magnitude of gender differences in the order population differed from the magnitude of gender differences in the general population. Conclusion: Higher depressive symptoms amongst order members may be linked with the different developmental tasks (spiritual growth) of order versus secular life. The results provide further evidence that social factors alone do not explain gender differences in depressive symptoms.
... Regarding the first issue, we compare female and male Catholic order members with their counterparts of the general population. Our previous studies revealed that order members live longer than worldly women and men (Luy 2002, Luy 2003. What makes this quasi-experimental setting interesting for testing the CroHaM hypothesis is that the extent of these differences in LE differs between women and men: the advantage of monks against worldly men is larger than the advantage of nuns against worldly women. ...
... Biological determinants alone make the average life expectancy of males shorter than that of females by one to two years (Luty, 2003;Ram, 1993). Larger differences are already conditioned by non-biological factors (e.g. ...
The aim of the article is to find patterns in the gender gap in life expectancy at birth in European post-communist countries. The analysis covers the years 1990-2018. Larger differences occur in the countries of the former USSR, smaller ones on the Balkan Peninsula. Belonging to the USSR (larger gap) and the Ottoman Empire (smaller gap) in the past has a great influence of the gender gap. In half of the analysed countries, the gender gap decreased. In a quarter, after an initial increase, there was also a decrease in the gender gap (some countries of the former USSR). Moreover, in a quarter of the countries, these changes were ambiguous (some countries on the Balkan Peninsula). One can see here the impact of an improving economic situation of the population. An attempt to link the gender gap and life expectancy with the 'homo-sovieticus' requires further research.
... (M. Luty, 2003;B. Ram, 1993). ...
Głównym celem książki jest omówienie wybranych wad danych zastanych opisujących szeroko rozumianą sytuację społeczną oraz przestawienie ich wpływu na wyniki monitoringu. Ostatecznie wyodrębniono sześć grup problemów opisanych w kolejnych rozdziałach:
• czasowe związane z dopływem danych;
• będące pochodną małej częstotliwości lub wyraźnej specyfiki monitorowanego procesu;
• wynikające z trudności w jednoznacznym definiowaniu wskaźników;
• będące wynikiem trudności w delimitacji jednostek;
• powstałe w następstwie kłopotów z dostatecznie jednoznacznym delimitowaniem
populacji;
• inne (których nie zakwalifikowano do żadnej z powyższych grup).
Nie ograniczono się tylko do zdiagnozowania grup problemów, ale
także podano ich przykłady (najczęściej z terenu województwa pomorskiego).
Samo sformułowanie i wyjaśnienie na przykładach zagrożeń dla monitoringu
wynikających z charakteru gromadzonych danych zastanych – byłoby
rozwiązaniem ułomnym. Dlatego na końcu każdego rozdziału przedstawiono
podpowiedzi, jak można te problemy przezwyciężyć, albo przynajmniej
zminimalizować ich negatywny wpływ.
... Life expectancy is driven by both intrinsic (biological) factors, such as genetic and physiological traits, and extrinsic (contextual) factors, such as environmental and behavioural traits [10][11][12]. The reasons that men die younger than women can be driven by either set of factors, or their interaction [2,13,14]. For example, oestrogen has been argued to aid in female longevity because of its effects on serum lipids which likely have protective influences on cardiovascular diseases [15]. ...
A consistent finding from contemporary Western societies is that women outlive men. However, what is unclear is whether sex differences in survival are constant across varying socio-ecological conditions. We test the univers-ality of the female survival advantage with mortality data from a nineteenth century population in the Baja California peninsula of Mexico. When examined simply, we find evidence for a male-biased survival advantage. However, results from Cox regression clearly show the importance of age intervals for variable survival patterns by sex. Our key findings are that males: (i) experience significantly lower mortality risk than females during the ages 15-30 (RR = 0.69), (ii) are at a significantly increased risk of dying in the 61+ category (RR = 1.30) and (iii) do not experience significantly different mortality risk at any other age interval (0-14, 31-45, 46-60). We interpret our results to stem from differing intrinsic and extrinsic risk factors for sex-biased mortality across age intervals, highlighting the relevance of a life-course approach to the study of survival advantage. Ultimately, our results make clear the need to more broadly consider variability in mortality risk factors across time and place to allow for a clearer understanding of human survival differences.
... Similarly, given that the gap between male and female life expectancy is narrowing in many countries, separate longterm forecasts by sex are likely to show a crossover in mortality rates. This seems similarly implausible given evidence that there may be some biological basis for difference in male and female mortality and ageing (Luy 2003). By identifying common trends across populations and allowing individual populations to converge towards such trends, coherence is ensured. ...
Mortality rates differ across countries and years, and the country with the lowest observed mortality has changed over time. However, the classic Science paper by Oeppen and Vaupel (2002) identified a persistent linear trend over time in maximum national life expectancy. In this work, we look to exploit similar regularities in age-specific mortality by considering for any given year a hypothetical mortality ‘frontier’, which we define as the lower limit of the force of mortality at each age across all countries. Change in this frontier reflects incremental advances across the wide range of social, institutional and scientific dimensions that influence mortality. We jointly estimate frontier mortality as well as mortality rates for individual countries. Generalised additive models are used to estimate a smooth set of baseline frontier mortality rates and mortality improvements, and country-level mortality is modelled as a set of smooth, positive deviations from this, forcing the mortality estimates for individual countries to lie above the frontier. This model is fitted to data for a selection of countries from the Human Mortality Database. The efficacy of the model in forecasting over a 10-year horizon is compared to a similar model fitted to each country separately.
... W krajach rozwiniętych gospodarczo poziom umieralności wśród kobiet jest niższy niż wśród mężczyzn, a co za tym idzie, przeciętna dalsza oczekiwana długość życia dla kobiet jest wyższa niż dla mężczyzn. Uwarunkowania biologiczne powodują, że przeciętne dalsze trwanie życia mężczyzny jest krótsze niż kobiety o rok do dwóch lat 9 (Abdulraheem, Jimom, Oladipo, 2011;Luty, 2003;Ram, 1993). Większe różnice są już warunkowane przez czynniki pozabiologiczne. ...
... W krajach rozwiniętych gospodarczo poziom umieralności wśród kobiet jest niższy niż wśród mężczyzn, a co za tym idzie, przeciętna dalsza oczekiwana długość życia dla kobiet jest wyższa niż dla mężczyzn. Uwarunkowania biologiczne powodują, że przeciętne dalsze trwanie życia mężczyzny jest krótsze niż kobiety o rok do dwóch lat 9 (Abdulraheem, Jimom, Oladipo, 2011;Luty, 2003;Ram, 1993). Większe różnice są już warunkowane przez czynniki pozabiologiczne. ...
... This pattern of longer-lived women is consistent from the mid-18th century (when the first accurate birth records became available) until now (2,4) and explains why about 90% of supercentenarians (i.e., people reaching 110 y old or more) are women. While social factors reinforce the gender gap in longevity (1), the greater survival prospects of women over men are observed even when both sexes share the same social habits (5). The female advantage in lifespan has thus been labeled as one of the most robust features of human biology (2). ...
Significance
In human populations, women live longer than men. While it is commonly assumed that this pattern of long-lived females vs. short-lived males constitutes the rule in mammals, the magnitude of the sex differences in lifespan and increase of mortality rate with advancing age remain to be quantified. Here, we demonstrate that, in the wild, mammalian females live longer than males but we did not detect any sex differences in aging rates. Contrary to a widespread hypothesis, we reveal that sex differences in life history strategies do not detectably influence the magnitude of sex differences in either lifespan or aging rates. Instead, our findings suggest these differences are predominantly shaped by complex interactions between local environmental conditions and sex-specific reproductive costs.
... The benefit of women in the animal kingdom is largely explained by two X-chromosomes and sex hormones (testosterone and estrogen ;Fischer ea., 2015;Libert ea., 2010). 230 Studies of cloistered nuns and monks (Luy, 2003), who lived in nearly identical circumstances and behaviors, indicate that biology only explains about one year of the human sex difference in life expectancy, thus that lifestyle plays a substantial role. It has indeed been shown that the gender difference in life expectancy decreased substantially over the recent decennia because women adopted smoking and drinking (Janssen ea., 2015). ...
Novel coronavirus (SARS-CoV-2) disease (COVID-19) became a pandemic early 2020 and a salient public health emergency and psychosocial shock event. From Wuhan in China the virus spread around the globe and significantly influenced the lives of almost all humans on their planet, if only via indirect (economic) consequences and government control. This study synthesizes the events to describes the timescape 2020-23. Within two years >663 million humans were infected and >21.3 million had died due to Covid and secondary excess mortality, and >70% of all humans were subjected to various societal restrictions and lockdowns, such as ~4.5 billion humans over may 2020 alone. The societal lockdowns and major socioeconomic perturbations over 2020-23 coincided with a collective drop in life expectancy and mental health and well-being, especially more anxiety, depression, suicides, and domestic violence against children and women. Coronavirus exploited social contact and transport, urbanization, liberalism, anxiety, and societal lockdowns, and elicited the strongest global economic perturbation in a century (-3% world GDP). Humans showed marked emotional, cognitive, physical, social, and societal responses over 2020-23, and the collective focused on virus mutations, vaccines, breakthrough infections, long-Covid, and more stress, loneliness, polarization, demonstrations, riots, violence, and conspiracy theories, with more authoritarianism and government coups around the globe (e.g., US Insurrection, 2021). When Russia invaded Ukraine (≥22w8) war returned to Europe and globally there were more refugees than observed since the second world war (WW2). The timescape 2020-23 showed major individual, sociocultural, geopolitical, and technological changes, from the rise of TikTok and Artifical Intelligence to #BLM and second wave of #MeToo, which affected the collective psyche and discourse, and coronavirus and overt nuclear threat coincided with an unprecedented series of natural disasters and record heatwaves that confirmed humans had created a #ClimateCrisis of planetary proportions. In 2023 the planetary climate ventured into uncharted territory driven by the human industrial revolution (>1830). Most humans described the pandemic years 2020-22 as the hardest and most stressful years they had experienced in their lifetime, which affected a generation of young humans. Over 2023 the collective return to “normalcy” was hampered by Ukranian and Israelian wars, cost-of-living crisis, and climate disasters that made humanity realize the world had changed. The pandemic timescape 2020-23 was an unique period in time to learn about human psychology and collective preparedness (a natural experiment), as engagement with natural hazards is a master task of civilizations. Psychological theories could be examined across contexts and in diverse samples, who were often exposed to comparable collective stressors of personal significance. Such perturbations can help to study human stress dynamics and complex social systems, beyond what can be learned from more stable periods. The collective changes and interconnected consequential events over 2020-23 including the global rise in military spending made this timescape a mini "Axial-period" that shapes the decades ahead.
... Additionally, they affect the design of formal institutions and policies, constraining or incentivising individuals' choices throughout the life course (Bonsang et al. 2017;Bird and Rieker 2008). Social explanations for gender inequalities in health stress the relevance of health behaviours, such as tobacco and alcohol consumption, dietary habits, physical activity, and healthcare utilisation (Oksuzyan et al. 2010;Mahalik et al. 2007;Luy 2003), socio-economic factors, such as financial resources and working conditions (Read and Gorman 2011), and psychosocial factors, such as critical life events, social network characteristics, and coping styles (Thoits 2011;Lachman et al. 2011). From this point of view, gender differences in health arise from a gendered access to protective resources (e.g. ...
FULL TEXT (OPEN ACCESS): https://rdcu.be/b1PtB We provide a systematic country and age group comparison of the gender gap in several generic health indicators and more specific morbidity outcomes. Using data from the Survey of Health, Ageing and Retirement (SHARE), we examined the gender gap in the prevalence of poor self-rated health, chronic health conditions, activity limitations, multimorbidity, pain, heart attacks, diabetes, and depression in three age groups (50–64, 65–79, and 80+) based on linear probability models with and without adjustment for covariates. While women were typically disadvantaged regarding poor self-rated health, chronic health conditions, activity limitations, multimorbidity, pain, and depression, men had a higher prevalence of heart attacks and diabetes. However, the gender gap’s magnitude and sometimes even its direction varied considerably with some age trends apparent. Regarding some health indicators, the gender gap tended to be higher in Southern and Eastern Europe than in Western and Northern Europe. All in all, the presence of a gender health gap cannot be regarded as a universal finding as the gap tended to widen, narrow or even reverse with age depending on the indicator and country.
The scope of this paper is to analyse mortality regimes and classify 39 populations using data from the Human Mortality Database. After utilising the life tables of these populations, several parameters will be studied: life expectancy at birth, Gini Coefficient, average life years lost because of deaths (e†), interquartile range (IQR), age separating early and late deaths, modal age at death and length of the old age heap. Afterwards, PCA analysis will produce uncorrelated components, which will be used in the subsequent cluster analysis to identify the homogeneous groups of populations, i.e., their segmentation. The study’s results indicate the existence of two mortality patterns in both genders. In males, these two major clusters are divided into three sub-clusters showing different transitional levels: one of more advanced, one of moderate and one of less advanced mortality transition. In females, four sub-clusters are formed, with several dissimilarities among them. The first two subclusters are of advanced mortality transition, and the second two are of less advanced. Details of this classification can be seen in the text. The segmentation of the populations differs in the two genders, signifying the differential patterns in their mortality regimes.KeywordsLife tablese0Gini coefficientE-daggerInterquartile rangeAge separating early and late deathsModal age at deathLength of the old age heapPCACluster analysis
Background:
Evaluating the impact of health systems on premature mortality across different countries is a very challenging task, as it is hardly possible to disentangle it from the influence of contextual factors such as cultural differences. In this respect, the German-speaking area in Central Europe (Austria, Germany, South Tyrol and large parts of Switzerland) represents a unique 'natural experiment' setting: While being exposed to different health policies, they share a similar culture and language.
Methods:
To assess the impact of different health systems on mortality differentials across the German-speaking area, we relied on the concept of avoidable mortality. Based on official mortality statistics, we aggregated causes of death below age 75 that are either 1) amenable to health care or 2) avoidable through primary prevention. We calculated standardised death rates and constructed cause-deleted life tables for 9 Austrian, 96 German, 1 Italian and 5 Swiss regions from 1992 to 2019, harmonised according to the current territorial borders.
Results:
There are strong north-south and east-west gradients in amenable and preventable mortality across the studied regions to the advantage of the southwest. However, the Swiss regions still show significantly lower mortality levels than the neighbouring regions in southern Germany. Eliminating avoidable deaths from the life tables reduces spatial inequality in life expectancy in 2017/2019 by 30% for men and 28% for women.
Conclusions:
The efficiency of health policies in assuring timely and adequate health care and in preventing risk-relevant behaviour has room for improvement in all German regions, especially in the north, west and east, and in eastern Austria as well.
Epidemiologie als Grundwissenschaft von Public Health beschäftigt sich mit vielfältigen Daten zu Gesundheit und Krankheit, sodass Entscheidungen auf Evidenz gestützt werden können. Zu den wichtigsten Determinanten von Gesundheit zählen soziale und ökonomische Faktoren wie Bildung, Beruf und Einkommen. Auch in der Verteilung umweltbezogener Belastungen lassen sich auf allen Ebenen sozioökonomische Muster erkennen, die eine ungerechte Verteilung von Risiken und damit auch Chancen auf nachhaltige und gesunde Lebensweisen aufzeigen. Der vorliegende Beitrag gibt nach einer Einleitung (Abschn. 1) zu den epidemiologischen Konzepten und Themenschwerpunkten in diesem Bereich im Abschn. 2 einen Überblick zu Zusammenhängen zwischen sozialer Ungleichheit und Gesundheit. Unterkapitel 3 beschreibt die vielfältigen Indikatorensysteme zur Darstellung und Analyse sozialer und gesundheitlicher Ungleichheit. Zusammenhänge zwischen Umwelt, Gesundheit und Nachhaltigkeit aus einer Umweltgerechtigkeitsperspektive werden in Abschn. 4 betrachtet. Unterkapitel 5 umreißt anhand von konkreten Beispielen eines gezielten Monitorings die engen Bezüge zwischen sozial- und umweltepidemiologischer Forschung, Umweltgerechtigkeit und Nachhaltigkeit – hier insbesondere mit Bezug auf die ökologische und soziale Dimension nachhaltiger Entwicklung – und betont die Rolle der Umweltepidemiologie für Entscheidungsprozesse. Abschließend wird in Abschn. 6 auf die Bedeutung partizipativer und integrativer Forschung in diesem Feld eingegangen, bevor ein Fazit den Beitrag beschließt, das die Synergien zwischen den Handlungsfeldern Umweltgerechtigkeit und Nachhaltigkeit hervorhebt.
Objectives
Previous meta-analyses suggested that mindfulness-based interventions (MBIs) may have beneficial effects on telomere length (TL) and telomerase activity (TA), two biological markers of cellular aging and cell stress. The present review aimed to provide the most comprehensive synthesis of the available evidence to date and tested a number of important effect moderators.
Method
Twenty-five studies (18 RCTs, 1 RCT and cohort study, 6 non-randomized studies) with 2099 participants in total were obtained with a systematic literature search, 10 studies had not been included in any previous meta-analysis. Effect sizes were aggregated with random-effects models, the risk of bias was evaluated with standardized checklists, and the most influential moderators were identified with a machine-learning approach.
Results
On average, MBIs had small-to-medium effects on TL ( g = 0.23, 95% CI = [0.07, 0.39], p = 0.006) and TA ( g = 0.37 [0.01, 0.73], p = 0.046), which, however, were driven by retrospective case–control studies with experienced meditators (TL) and by studies without control interventions and studies from Asia (TA). Most studies had an unclear risk of bias and low analytic power, and there was an indication of publication bias among the TL studies.
Conclusions
TL may not be a useful outcome to assess the efficacy of common MBIs. Effects on TA were smaller than previously assumed and may not be specific for MBIs; TA likely is increased by other active interventions as well. More high-quality and high-powered studies, which also apply open-science practices, are needed to move the field forward.
The purpose of this paper is to explain the role of socioeconomic development, economic, employment, and demographic factors on gender gap in life expectancy at birth (LEAB) in 24 South and East European countries. Aggregated yearly time series mainly from the UN and World Bank database for the period 1991-2020 were used. The generalized method of moments/dynamic panel data (GMM/DPD) model, a dynamic panel model, was used to explore the role of socioeconomic development, economic, employment, and demographic factors on sex differences in LEAB. The study shows that in these countries, a narrowed gender gap in LEAB is associated with a higher percentage of urban population in total population. There was found a significant impact of GDP per capita with a 2-year lag and Gini index with a 2-year lag as well as to LEAB on the gender gap in LEAB. There was not found a significant relationship between employment and education variables on gender gap in LEAB. However, the findings are important for policy discussions in terms of population health, labor policy, etc. The results are supported by the number of studies which show the relationship between socioeconomic development, economic, and demographic indicators and employment issues with gender gap in LEAB.
Keywords: Gender gap; Life expectancy at birth; Generalized method of moments/
dynamic panel data; South-East Europe; Panel data
Obwohl das höchste erreichbare Maß an Gesundheit seit langem als Menschenrecht anerkannt ist, finden sich erhebliche Unterschiede in der Gesundheit zwischen Bevölkerungsgruppen. Gesundheitliche Ungleichheit bezeichnet systematische Unterschiede in der Gesundheit zwischen sozialstrukturellen Gruppen, die potenziell vermeidbar und ungerecht sind. In diesem Beitrag wird das Konzept der gesundheitlichen Ungleichheit vorgestellt sowie die zentralen Mechanismen, welche soziale Ungleichheit und Gesundheit verbinden. Es wird ein Überblick über einzelne Dimensionen gesundheitlicher Ungleichheit geben. Neben der sozioökonomischen Position sind dies das Geschlecht, der Migrationsstatus, die Wohnregion und die Zugehörigkeit zu einer sexuellen Minderheit. Abschließend wird auf die theoretischen Perspektiven der Intersektionalität und Superdiversität eingegangen, welche die Verschränkungen der einzelnen Ungleichheitsdimensionen untersuchen.
The health disparity associated with gender has raised attention on the rampant health inequity issues in China. This gender-health disparity is further complicated by the contrasting evidence in several substantive demographic phenomena such as the female survival paradox and female morbidity paradox. The current study proposes a theoretical model to reveal the counterbalancing mechanisms contributing to gender-health disparity in China. Specifically, health behaviors and labor market disadvantages are two sets of counterbalancing factors that, when considered altogether, reveal the true extent of gender-health disparity. Using a 2020 survey in the poverty counties in two provinces of China, the current study investigates the counterbalancing mechanisms in gender-health disparity through mediation and suppression effects. With painful feeling and the number of chronic illnesses as dependent variables, this study showed that health behaviors and labor disadvantages are indeed counterbalancing mechanisms. The gender disparity in pain/ chronic illnesses disappeared after labor disadvantages were controlled for, but reemerged in greater magnitude after health behaviors were controlled were. For chronic illnesses, the previously non-existent gender disparity emerged after health behaviors were controlled for. Were it not for women’s salubrious health behaviors, they would suffer worse pain and chronic illnesses than men’s. This study informs the literature of the hidden counterbalancing mechanisms in gender-health disparity, and women’s inferior position in formal and informal labor domains blocks the goal of eradicating health inequity in China.
Many women in developing countries are dying from preventable causes related to pregnancy and childbirth. These maternal deaths are attributed to the poor coverage of reproductive health services and high fertility levels. A holistic review of the reproductive health is necessary to reflect the country’s situation and progress of reproductive health and provide recommendations for areas that need an improvement. The aim of this paper is to provide an overview of the historic development of maternal mortality and fertility in Myanmar during the past 25 years, focusing on the antenatal care (ANC) coverage, deliveries attended by skilled persons, and contraceptive use. All published nationally representative data were compiled, and trend analysis was performed. The maternal mortality ratio declined significantly by 9.1 (95%CI: 4.0-14.1) maternal deaths per 100,000 live births/year between 1990 and 2015, but it failed to achieve the target of Millennium Development Goals 5. There was no significant improvement in ANC coverage and care during delivery. Contraceptive use increased significantly, leading to a reduction in the total fertility rate. Nevertheless, overall reproductive health failed to reach a satisfactory level. Maternal mortality still remains high. Thus, there is a need to improve service coverage and more so in the regions with poor performance to reduce the high maternal mortality.
As we approach the final discussion of the fear system, it is best to begin with a functional account of how these mechanisms work together as an integrated system. Inspection of sex differences across the components of the fear system discussed in the previous chapters ( 2– 6) has provided differential support for their candidacy as targets of selection in enhancing women’s reproductive success. Studies of risky decision-making (including laboratory paradigms as well as personal decisions) reveal that women are more risk averse, assigning a greater weight to potential costs compared to men and modifying their behaviour more than men in response to punishment (but not reward; Cross, Copping, & Campbell, 2011). Women also report subjectively experiencing fear more frequently and more intensely than men do. This greater self-reported fear in women is likely to be underpinned by two connected components of the fear system: strength and time course. Neuropsychological studies have provided persuasive evidence for a stronger and better integrated response across components of the fear system in women especially in response to angry faces and direct threat. When danger is encountered, this stronger aversive neural response will strongly motivate attempts to avoid or escape. The more extended time course of fear enhances women’s ability to anticipate danger and take precautionary measures. Women’s slower extinction of acquired fears means that learned fears are more resistant to replacement and this conservative bias errs on the side of mother and offspring survival. Greater sustained fear in women (the protracted watchfulness associated with detecting possible danger) together with evidence from potentiated startle studies (which effectively ‘cue’ and thereby extend phasic fear) afford a longer duration to engage frontal regions in avoidance planning, rather than a reliance on periaqueductal grey control mediated automatic fight-and-flight responses.
The aging process in OECD countries calls for a better understanding of the future disease prevalence, life expectancy (LE) and patterns of inequalities in health outcomes. In this paper we present the results obtained from several dynamic microsimulation models of the Future Elderly Model family for 12 OECD countries, with the aim of reproducing for the first time comparable long‐term projections in individual health status across OECD countries. We provide projections of LE and prevalence of major chronic conditions and disabilities, overall, by gender and by education. We find that the prevalence of main chronic conditions in Europe is catching‐up with the United States and significant heterogeneity in the evolution of gender and educational gradients. Our findings represent a contribution to support policymakers in designing and implementing effective interventions in the healthcare sector.
The different life cycles and lifestyles of men and women in human society have always led to significant gender differences in the mortality. So far, the studies on the gender gap in mortality are mostly carried out in western countries, and it is under research in Iran. The present study examines the patterns of cause-by-age gender gap in mortality in Iran over the last decades. Data of this research were adopted from the Ministry of Health and Medical Education and have been used after evaluation by the modified Brass-Trussell method and the Bennett-Horrurichi method. The findings show that the gap in life expectancy between male and female was about 3.5 years in 2006. This value is decreased to 2.9 and 3.0 years in 2011 and 2015, respectively. During the study period, about 80% of the gender gap in mortality was due to mortality differences between male and female aged 20-64 years old. The unintentional events in all three periods played a dominant role in the mortality of sex differences, but its share has declined significantly over time, with its contribution from 60% to around 42% between 2006 and 2015. By contrast, during this period, the role of cardiovascular disease has increased from 9% to 20% in explaining the mortality gap and the role of cancer rose from 10% to 15%. Examining the sex differences in death causes, in addition to showing the capacity to reduce men death, can be used to identify the critical points of women mortality by age and cause. By focusing on health planning and disease prevention in a specific direction, the sex differences in mortality can be decreased and also the life expectancy increased for both m,en and women.
Objetivo:
O objetivo deste artigo é analisar a distribuição espacial da mortalidade feminina por acidente de motocicleta nos municípios brasileiros entre 2005 e 2015, bem como a variação das taxas no mesmo período.
Métodos:
Estimaram-se as taxas de mortalidade femininas para os anos de 2005, 2010 e 2015 considerando-se a média móvel de três anos ao redor do ano base e padronizadas pelo método direto. Em seguida, utilizou-se o estimador bayesiano empírico para reduzir o efeito da flutuação aleatória. Analisou-se, também, a variação percentual das taxas padronizadas por diferentes portes populacionais (menor que dez mil, menor que 50 mil, maior que 100 mil e maior que um milhão de habitantes).
Resultados:
As taxas bayesianas mostraram clara ampliação da mortalidade feminina por acidente de motocicleta, especialmente nas regiões Norte, Nordeste e Centro-Oeste. Nos municípios das regiões Sul e Sudeste, principalmente no período entre 2010 e 2015, houve aparente diminuição da mortalidade. A variação percentual das taxas mostrou redução do indicador analisado no período entre 2010 e 2015 para os municípios de maior porte das regiões Sul e Sudeste. Para quase todas as regiões e portes populacionais, o período entre 2010 e 2015 apresentou desaceleração do crescimento das taxas.
Conclusões:
A análise deixa claro que há concentrações de municípios com mortalidade mais elevada, ao mesmo tempo que mostra ter havido crescimento do fenômeno para maior número de municípios. O recorte temporal estudado possibilita identificar diferentes dinâmicas na mortalidade feminina, em um período de importante variação da mortalidade por acidente de motocicleta.
Purpose
The paper explores gender inequalities between 45 countries across 10 health indicators among adolescents and whether those differences in health correlate with gender inequality in general.
Methods
Data from 71,942 students aged 15 years from 45 countries who participated in the 2018 Health Behaviour in School-aged Children survey were analyzed. For this purpose, 10 indicators were selected, representing a broad spectrum of health outcomes. The gender differences in the countries were first presented using odds ratios. Countries with similar risk profiles were grouped together using cluster analyses. For each of the 10 indicators, the correlation with the Gender Inequality Index was examined.
Results
The cluster analysis reveals systematic gender inequalities, as the countries can be divided into seven distinct groups with similar gender inequality patterns. For eight of the 10 health indicators, there is a negative correlation with the Gender Inequality Index: the greater the gender equality in a country, the higher the odds that girls feel fat, have low support from families, have low life satisfaction, have multiple health complaints, smoke, drink alcohol, feel school pressure, and are overweight compared with boys. Four indicators show a divergence: the higher the gender equality in a country in general, the larger the differences between boys and girls regarding life satisfaction, school pressure, multiple health complaints, and feeling fat.
Conclusions
Countries that are geographically and historically linked are similar in terms of the health risks for boys and girls. The results challenge the assumption that greater gender equality is always associated with greater health equality.
Obwohl das höchste erreichbare Maß an Gesundheit seit langem als Menschenrecht anerkannt ist, finden sich erhebliche Unterschiede in der Gesundheit zwischen Bevölkerungsgruppen. Gesundheitliche Ungleichheit bezeichnet systematische Unterschiede in der Gesundheit zwischen sozialstrukturellen Gruppen, die potenziell vermeidbar und ungerecht sind. In diesem Beitrag wird das Konzept der gesundheitlichen Ungleichheit vorgestellt sowie die zentralen Mechanismen, welche soziale Ungleichheit und Gesundheit verbinden. Es wird ein Überblick über einzelne Dimensionen gesundheitlicher Ungleichheit geben. Neben der sozioökonomischen Position sind dies das Geschlecht, der Migrationsstatus, die Wohnregion und die Zugehörigkeit zu einer sexuellen Minderheit. Abschließend wird auf die theoretischen Perspektiven der Intersektionalität und Superdiversität eingegangen, welche die Verschränkungen der einzelnen Ungleichheitsdimensionen untersuchen.
Although cigarette smoking has been extensively researched, surprising little knowledge has been produced by demographers using demographic perspectives and techniques. Thus, this paper contributes to the literature by extending a demographic framework to an important behavior for mortality research: cigarette smoking. In earlier works, the authors used nationally-representative data to show that cause of death patterns varied by smoking status and that multiple causes of death characterized smokers moreso than non-smokers. The present work extends previous analysis by estimating smoking status mortality differentials by underlying and multiple causes of death and by age and sex. Data from the 1986 National Mortality Followback Survey are related to data from the 1985 and 1987 National Health Interview Survey supplements to assess the smoking-related mortality differentials. We find that cigarette smoking is associated with higher mortality for all population categories studied, that the smoking mortality differentials vary across the different smoking status categories and by demographic group, and that the mortality differentials vary according to whether underlying cause or multiple cause patterns of death are examined. Moreover, the multiple cause analysis highlights otherwise obscured smoking-mortality relations and points to the importance of respiratory diseases and cancers other than lung cancer for cigarette smoking research.
Mise en évidence de l'évolution dans le temps de la surmortalité des femmes à certains âges dans quelques pays européens. Analyse des tables nationales de mortalité disponibles en longue période. Eléments d'explication.
A number of industrialized nations have recently experienced some degrees of constriction in their long-standing sex differentials in life expectancy at birth. In this study we examine this phenomenon in the context of Canada’s regions between 1971 and 1991: Atlantic (Newfoundland, Nova Scotia, New Brunswick, Prince Edward Island); Quebec, Ontario, and the West (Manitoba, Saskatchewan, Alberta, British Columbia, Yukon and Northwest Territories). Decomposition analysis based on multiple decrement life tables is applied to address three questions: (1) Are there regional differentials in the degree of narrowing in the sex gap in life expectancy? (2) What is the relative contribution of major causes of death to observed sex differences in average length of life within and across regions? (3) How do the contributions of cause-of-death components vary across regions to either widen or narrow the sex gap in survival? It is shown that the magnitude of the sex gap is not uniform across the regions, though the differences are not large. The most important contributors to a narrowing of the sex gap in life expectancy are heart disease and external types of mortality (i.e., accidents, violence, and suicide), followed by lung cancer and other types of chronic conditions. In substantive terms these results indicate that over time men have been making sufficient gains in these causes of death as to narrow some of the gender gap in overall survival. Regions show similarity in these effects.
This book is an outcome of a workshop organized by the Scientific Committee on Anthropological Demography of the International Union for the Scientific Study of Population. When the committee began its term in 1992, it felt that it needed to first make some formal attempt to define the scope of anthropological demography and develop not so much a manual as a guiding text to attract more demographers to this relatively new but potentially rich sub-discipline. This was especially necessary because interested demographers have nowhere to turn to for an exposition of the methods of anthropological demography; and even the kind of substantive research that is discussed in this volume and that will surely provoke further research, has until recently been unavailable in the standard demography journals, which have traditionally been biased towards more quantitative analyses.
X inactivation makes females mosaics for 2 cell populations, usually with an approximate 1:1 distribution. Skewing of this distribution in peripheral blood cells is more common among elderly women.1–3 The depletion of hematopoietic stem cells followed by random differentiation may explain the acquired skewing with age.4 However, an animal model suggests that selection processes based on X-linked genetic factors are involved.5 We studied peripheral blood cells from 71 monozygotic twin pairs aged 73 to 93 years and from 33 centenarians, and we found that with age, 1 of the cell populations becomes predominant for most women. We also observed a strong tendency for the same cell line to become predominant in 2 co-twins. This suggests that X-linked genetic factors influence human hematopoietic stem cell kinetics. The fact that females have 2 cell lines with different potentials could be one of the reasons women live longer than men.
After decades of widening, the difference in mortality from lung cancer between men and women has begun to narrow in recent years. Recognizing that the increase in smoking among women relative to men is the proximate cause of the changing sex difference in rates of lung cancer, I analyzed two approaches to identify the more distant sources of the changes. A gender-equality argument suggests that the difference is related to the more general equalization of women and men work and family roles, which also encourages the adoption of harmful behaviors, such as smoking by women. An alternative explanation suggests that the convergence in mortality from lung cancer among men and women is the byproduct of a lag in the adoption, diffusion, and abatement of smoking by. women. Using mortality data on 21 nations from 1955 to 1996, an analysis of logged rates of men and women lung cancer mortality and the logged ratio of the rates demonstrated little relationship between the sex difference and gender equality. However I found a strong and consistent relationship between the sex difference and the stage of diffusion of the use of cigarettes.
The relation of menopause to cardiovascular disease incidence was examined in women less than 55 years old from the cohort of 2873 women in the initial Framingham examination. Although the number of person-years of experience during the 20 years of observation was nearly the same for premenopausal and postmenopausal status, there were only 20 cardiovascular events among the premenopausal women in this age group whereas 70 events occurred among the postmenopausal women of the same age. In each specific age group studied incidence rates were lower in premenopausal than postmenopausal women. This was also true for coronary heart disease. Contrast for "hard" diagnoses of cardiovascular disease (excluding diagnoses of angina pectoris and intermittent claudication) was in the same direction. Although cholesterol and hemoglobin did rise somewhat more steeply in women undergoing the menopause, this greater incidence of cardiovascular disease in postmenopausal women could not be explained by the influence of the menopause on the usual cardiovascular risk factors.
This is a report on the results of a comparative investigation into the influence of nutrition and other ways of life on the general condition, serum cholesterol and prevalence of hypertension, atherosclerotic (coronary) heart disease and angina pectoris among 181 Trappist monks who lived on a frugal vegetarian diet, and 168 Benedictine monks who lived on a mixed "western" diet. The average blood cholesterol level was significantly higher among the Benedictine monks than among the Trappist monks. However, there was no difference in prevalence of myocardial infarcts, angina pectoris, hypertension and electrocardiographic signs of diffuse atherosclerotic (ischemic) heart disease between the two groups. It appeared as if myocardial infarction, the result of an occlusion of one of the major coronary arteries, was more rare among both orders than among other groups of The Netherlands and Belgian population; whereas the frequency of electrocardiographic signs of diffuse myocardial damage (possibly due to coronary sclerosis) and angina pectoris among both groups were not found to be markedly different from that of the general population.
These results seem to support the hypothesis that acute occlusion of a major coronary artery, leading to a macroscopic myocardial infarct, is less related to nutrition and blood cholesterol than to certain psychosocial factors in the western ways of life, against which the members of both the Trappist and Benedictine Orders seem to be more or less protected. What these factors are exactly requires further investigation. Against angina pectoris and diffuse ischemic heart disease due to coronary sclerosis, this protection appeared to be less evident.
La première table de mortalité correcte a été établie en France par Deparcieux qui utilisa à cet effet le registre des Bénédictins de Saint-Maur (ou matricule) en 1746. On reprend ici le travail de Deparcieux pour la matricule complète et l'on calcule les tables de mortalité et les espérances de vie des Bénédictins au XVIIe et au XVIIIe siècles. Cette mortalité est très particulière lorsqu'on la compare aux tables de l'époque: elle se caractérise par une sous-mortalité des adultes et une surmortalité des vieillards. On montre qu'il ne peut s'agir là d'un biais des tables de l'époque mais qu'il faut y voir un trait spécifique de la mortalité des Bénédictins et de tous les religieux de l'époque: à partir de 50 ou 60 ans ils ne se défendaient plus contre la mort, tandis que plus jeunes ils jouissaient de meilleures conditions de vie. /// The first correct life table in France was constructed by Deparcieux who used the register (or roll) of the Benedictine monks of Saint-Maur in 1746. We have checked Deparcieux's work against the complete register and have calculated tables of mortality and life expectancies for the Benedictine monks during the 17th and 18th centuries. This mortality differs from that shown in other contemporary tables: it is characterized by lower mortality of adults and excess mortality of old men. It is demonstrated in the paper that this difference cannot have been caused by bias in the contemporary tables, but that it must have been due to specific factors in the mortality of the Benedictines and all monks of that period: from the age of 50 or 60 onwards they could no longer defend themselves against death whereas they enjoyed better living conditions when they were younger. /// La primera tabla de mortalidad correcta fue calculada en Francia por Deparcieux, quien utilizó para este objeto el registro (o matricula) de los Benedictinos en 1746. Se retoma aquí el trabajo de Deparcieux, pero en este caso se utiliza el registro completo y se calculan tablas de mortalidad y esperanzas de vida de los Benedictinos en los siglos XVII y XVIII. Esta mortalidad es muy particular cuando se la compara con las tablas de la época y se caracteriza por una mortalidad más baja en la edad adulta y por una sobre mortalidad en la vejez. Se muestra que no se puede tratar de un error de las tablas de la época, sino que es preciso ver en ellas un rasgo específico de la mortalidad de los Benedictinos y de todos los religiosos de la época: desde los 50 o 60 años ya no resistían los efectos de la edad, mientras que cuando jóvenes gozaban de mejores condiciones de vida.
This study endeavors to illuminate the relations between marital status and length of life among 36,142 individuals between the ages of 25 and 64 from two combined national data sets. Case-control methodology is used to compare individuals who died in 1986 with those who survived the year. Specific causes of death are also examined. Results from logistic regression analysis indicate that marital status differentially affects mortality, but not in a social vacuum. Instead, marital status and income both influence mortality. In addition, sex is found to interact with marital status and with both overall mortality and cause-specific mortality. The findings reveal variations by sex and by marital status for social pathologies such as homicide and cirrhosis of the liver.
The difference between the ages at which male and female rates of mortality are equal (called the female advantage) is proposed as a measure of comparison of the mortality of the sexes. The female advantage is calculated for various periods of time in a number of different countries. The application of the female advantage method to cause of death figures is briefly considered. A study of the pattern of the female advantages for ages over 40 leads to an approximate empirical relationship between the ages at which the mortality rates for the sexes are equal.
Whereas relative social equality used to exist in the face of death, major differences appeared between various groups within the population during the 19th Century Industrial Revolution in Europe. In spite of medical and economic progress, this inequality has not disappeared. We can undoubtedly demonstrate the harmful effects of certain behaviors, e.g., the abusive use of tobacco, and the consequences of different attitudes that individuals have with regard to sickness. Nevertheless, the deep causal origins are still not very clear. French statistics on social mortality lead the observer to look into the tie between work and lifespan. Society does not draw any conclusions about this inequality; at least, it has not adopted appropriate social measures which would sufficiently attenuate the effects. /// Despuès de la relativa igualdad social frente a la muerte que se observaba antaño, aparecieron durante la época de la revolución industrial posibilidades de fallecimiento muy diferentes para todos los grupos de la población. A pesar de los progresos médicos y económicos, no ha desaparecido aún esa desigualdad que se instaló durante el siglo XIX en Europa. Se pudo denunciar como efectos nocivos para la supervivencia de ciertos comportamientos, el uso abusivo del tabaco o las consecuencias de actitudes diferentes de ciertos induviduous para con la enfermedad o aún modos diferentes de percibio de los diversos estados mórbidos; sin embargo quedan inciertas las médidas y la imputación causal profunda. Los datos franceses que se poseen acerca de la mortalidad social conducen a interrogarse sobre el papel que desempeña la elección de un oficio en el determinismo de la duración de la vida. Por lo menos se puede notar que la sociedad no recibe aviso de esas desigualdades atenuando suficientemente los efectos por medidas sociales apropiadas. /// Auf die relative soziale Gleichheit vor dem Tode, die früher festgestellt werden konnte, folgten zur Zeit der industriellen Revolution, grosse Unterschiede zwischen den Sterberisiken innerhalb der verschiedenen Bevölkerungsgruppen. Trotz den medizinischen und wirtschaftlichen Fortschritten, ist diese im Verlauf des 19. Jahrhunderts in Europa aufgebaue Ungleichheit dennoch nicht verschwunden. Zweifellos konnte man feststellen. dass gewisse Verhaltensweisen eine schädliche Wirkung auf das Fortleben hatten, wie übermässiges Tabakgenuss, oder die Folgen unterschiedlicher Einstellungen des einzelnen in Bezug auf die Krankheit oder sogar eine unterschiedliche Wahrnehmung der verschiedenen Krankheitszustände. Es besteht jedoch eine gewisse Unsicherheit, was die Massstäbe und die tiefliegenden Gründe angeht. Die vorliegenden französischen Angaben zu sozialen Sterblichkeitsraten führen zu Prüfung der Rolle, die die Berufswahl spielt als bestimmender Faktor der Ungleichheit in der Lebensdauer. Zumindest kann festgestellt werden, dass die Gesellschaft nicht die Lehre aus diesen Ungleichheiten zieht und die Auswirkung durch angemessene soziale Massnahmen abschwächt. /// Раньше было относительное социальное равенство перед смертью. Эпоха индустриальной революции связана с значительными разницами между рисками предполагаемой смертности различных групп населения. Несмотря на прогресс в медицине и экономике это неравенство установившееся в Европе в XIX веке не исчезло до сих пор. Несомненно, что вредные последствия для долговечности удалось обнаружить при некотором роде поведения, как надмерное употребление табака или скажем последствия многообразного поведения индивидума в обличии болезни, или еще скажем, манеры различного восприятия при разных патологических состояниях. Несмотря на это, нет никакой уверенности на уровне мер и в предпосылках для обнаружения глубоких причинностей. французские статистические данные о социальной смертности, которые неходятся в нашем распоряжении, приводят к размышлению над ролью которую играет селекция как последствие выбора профессии в детирминации неравенства для продолжительности жизни. По крайней мере, делая из этого вывод, можно сказать, что общественность не обращает внимания на это неравенство не принимая никаких соответственных социальиых мер для удовлетворительного смягчения егоэффектов.
An attempt is made to summarize the chief generalizations that can be drawn from available evidence on world mortality developments during the last hundred years. Past and prospective trends are compared for three broad groups of populations or approximately those in the West, Eastern and Southern Europe, and Latin America, Africa, and Asia. Two major points of emphasis are that the usual methods of comparing regional changes can usefully be supplemented by other approaches, and that the mortality history of Western nations may prove a highly unsatisfactory guide to future trends elsewhere. The study is based on a nearly complete compilation of the national life tables on record.
Most mortality studies have explored the characteristics that contribute to early death. This article instead examines factors that lead to longer lives, to determine whether healthy practices contribute years of life synergistically, additively, or partially, and to show age and sex differences in cause-specific mortality. The results indicate that life expectancies in the United States for healthy agers approach 83 years for males and 93 for females. Even among healthy agers a large sex gap in mortality persists. These life expectancies and, concomitantly, specific causes of death are affected by demographic, socioeconomic, and health factors, especially by functional status. How adeptly we eliminate or reduce disability and disease and improve self-perceived health status determines the length and quality of life.
The processes of the title have frequently been used to represent situations involving numbers of individuals in different categories or colonies. In such processes the state at any time is represented by the vector n = ( n 1 , n 2 , …, n k ), where n t is the number of individuals in the i th colony, and the random evolution of n is supposed to be that of a continuous-time Markov chain. The jumps of the chain may be of three types, corresponding to the arrival of a new individual, the departure of an existing one, or the transfer of an individual from one colony to another.
REVIEW
Evolutionary conflict occurs when the deterministic spread of an allele lowers the fitness either of its bearer or of other
individuals in the population, leading to selection for suppressors. Sex promotes conflict because associations between alleles
are temporary. Differing selection on males and females, sexual selection, and differences in transmission patterns between
classes of nuclear and cytoplasmic genes can all give rise to conflict. Inert Y chromosomes, uniparental inheritance of cytoplasmic
genes, mating strains and sexes, and many features of sexual behavior may have evolved in part as a result of evolutionary
conflict. Estimates of its quantitative importance, however, are still needed.
The author calls this book a compilation, because he has brought together the findings and thoughts of many scientists on the nature and measurement of senescence, its distribution in man, animal life and protozoa, the influence of genetic factors, the role of growth and rate of living, senescence in cells and in the endocrines. A great deal of factual information is still needed before senescence will be really understood. 733-item bibliography. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Life expectancy at birth is often used to index the relative welfare of various populations. But within this framework male/female longevity differentials are anomalous. Women have been and are still less privileged than men, yet they live longer. This situation has encouraged the belief that females have timeless biological advantages over males. But historical data can be used to show that in the age range 3 to 55 pronounced mortality crossovers have occurred in male/female age-specific death rates. Accounting for this historical variability requires that simple, timeless theories of welfare and longevity be replaced by more complex ones, which consider how culturally influenced, gender-characteristic behaviour patterns, unfolding in different disease environments, are biologically translated into age-specific death rates. When biological and cultural complexity are given their due, it becomes possible to explain how lower levels of relative welfare can generate lower levels of mortality for some disadvantaged populations in some disease environments. -Author
A comparison between secular hospitals and monastic infirmaries introduces a discussion of the duration and seasonality of the illnesses of the monks of Westminster in two periods: 1297/8 to 1354/5 and 1381/2 to 1416/17. A change in the duration of illnesses is related to change in the conventions of treatment after the Black Death of 1348/9. The resemblance between the seasonal pattern of morbidity in this sample and that of mortality among male adults in the early modern period is discussed. It is suggested that the latter pattern may extend into the late middle ages.
A combination of special studies and official statistics permits an evaluation of the health of the clergy over the past century.
The mortality experience of clergymen has been consistently more favorable than that of the general male population. It also
has been favorable in comparison with the experience of men in the legal and medical professions although this differential
has been diminishing. The initially favorable position of the clergy relative to teachers has been reversed. There is some
evidence of mortality differentials within the clerical profession by major faith, denomination, or ministerial specialty.
Clergymen have a relatively high mortality rate from cardiovascularrenal diseases and malignancies, but a very low rate for
non-degenerative diseases and suicide. Morbidity statistics for the clergy are fragmentary. They may be over-represented among
persons hospitalized for conditions that are emotional in origin. The clergy has some special advantages for studies of health,
primarily that both membership in the study population and mortality can be determined with comparative ease. Several areas
of future research are suggested.
Explanations for the consistentfemale mortality advantage have ranged from thebiological, through the behavioural to thesocial, but we are still far from asatisfactory explanation. The current mortalityadvantage, which women enjoy in almost allsocieties and age groups, is not a historicaluniversal. Indeed, it may even be a uniquedevelopment of the 20th century. Even ifthis is the case, however, this does not makeit a necessary corollary of low mortality.Human mortality reflects the pattern of socialrelationships, standards of living, livingarrangements, and patterns of power andinequality in the society, and althoughmortality levels are similar for men and forwomen, they nonetheless display importantdifferences. These differences, in their turn,reflect the pattern of relationships betweenmen and women in the society. The presentanalysis looks at mortality levels anddifferences between men and women in Belgium.We focus on aggregate effects at themunicipality level (the smallest level oflocal government), and show that mortality isnegatively associated with high standards ofliving; familial solidarity; immigrantconcentration and a stable, locally born,population. It is positively associated with ahigh tendency to cohabitation. Male mortalityis more sensitive to social conditions than isfemale mortality so that as conditions improvethe female mortality advantage declines. Wealso show that net of these conditions thereremains a mortality disadvantage inWallonia, and this can only partly be explainedin terms of social differences between the twomajor regions of the country.
Ever since mortality has been measured, the existence of a female survival advantage is well known. This topic reached particular interest with the widening of the male-female survival gap during the general decline of mortality in the 20th century to an extent of seven years. Only in the last 20 years has a slight narrowing of this gap been observed. The numerous examinations of these sex differences in mortality can be classified into two main explanation categories: the biological and the behavioral or environmental explanations. While in the past, scientists searched for the responsible factors solely in one of these complexes, it is obvious today that the cause of this phenomenon can only be found in a multi-causal context. This article describes the current knowledge and summarizes the most important of them inside the framework of more current research which has enabled researchers to exclude the non-biological factors in comparing female and male survival patterns. Those indicate the existence of a female biological advantage, which however should not exceed a difference of 1–2 years. Consequently, the rest should be due to behavioral and environmental factors. But the additional existence of a cohort effect of people born between 1930 and the mid 1940s with a significant higher male excess mortality often remains unrecognized. This effect could lead again to a widening of this mortality gap in the near future. However, in the long term, we should expect a further decline of sex differences in mortality closer to the biological level due to the continuous approximation of female and male life styles and sex-specific mortality risks.
This paper advances the hypothesis that the future of sex mortality differentials in industrialized countries may depend on the future mortality rates of blue collar men. Data are presented to support the argument that mortality rates from ischemic heart disease for this population subgroup play a significant role in current differentials and, furthermore, that sexsocial class-mortality differentials correspond to social structural differences in protection against and/or exposure to health risks. Research and policy implications of this argument are addressed briefly.
The relationship between poverty and several health-related characteristics in West Germany was investigated. Data were derived from the National and Regional Health Surveys conducted in West Germany from 1984 to 1992. 25,544 males and 25,719 females with German nationality aged 25-69 years were examined. Poverty was defined as a household income of 50% less than the mean for West Germany. Multiple logistic regression analysis was used to analyze the relationship between poverty and four health variables: individual health behavior, subjective assessment of health status, cardiovascular disease risk factors, and self-reported prevalence of lifetime chronic diseases. 10.2% of males and 12.8% of females were classified as being below the poverty line. For most but not all health parameters, less favourable results were found for the segment of the population with a household income below the poverty line. The most striking poverty-related differences were observed for lack of regular sport activities, subjective health satisfaction, obesity and myocardial infarction/stroke. Significantly lower prevalence rates for study subjects below the poverty line were observed for hypercholesterolemia in females only. Allergic disorders were the only chronic diseases reported significantly less often in males and females below the poverty line. Poverty has strong effects on individual health status and the prevalence of chronic diseases. Due to the rising unemployment rates in Germany in the last years it is very likely that the strong negative consequences of poverty for health are increasing.
Using a macro-sociological model, this paper argues that the status of women is an important determinant of sex mortality differences. This is done first by examining data from India which is known to have an excessively high level of female mortality. The examination is further extended by a pooled cross-section and time series analysis of the excess of female life expectancy over male life expectancy for 83 countries.
In this paper, we examine the macro-level relationship between female labour force activity and the sex differential in mortality among developed nations. Discrimination, protection, and null relationship hypotheses are tested using aggregate data for 18 high income nations over seven time points from 1950 to 1980. High levels of female labour force activity — controlling for a variety of general social conditions — increase the longevity advantage women have over men. In some models the effects are immediate; in other models the effects occur after a substantial lag; but in no cases are there harmful effects for women's longevity. Also important for the differential are consumption of cigarettes and alcohol, and the level of income inequality in a society.On examine dans cet article les relations globales entre l'activit fminine et les diffrences de mortalit selon le sexe pour un certain nombre de pays dvelopps. Les hypothses portant sur des relations de discrimination, de protection ou de non slectivit selon le sexe sont testes en utilisant des donnes agrges de 18 pays dvelopps portant sur sept dates situes entre 1950 et 1980. Une fois limin l'effet de diverses caractristiques gnrales, une activit fminine importante dans un pays augmente la longvit des femmes par rapport aux hommes. Dans certains modles l'effet est immdiat; dans d'autres l'effet apparat aprs un certain dlai; mais dans aucun pays l'activit n'a un effet ngatif sur la longvit des femmes. Egalement la consommation de cigarettes et d'alcool, ainsi que les diffrences de revenus entre individus d'un pays, jouent un rle important sur ces diffrences de mortalit.
Comments are given on controversial problems of interpretation of quantum mechanics and quantal measurements.
In the United States, the risk of coronary heart disease is twice as great in men as in women. Men's excess vulnerability may be due in part to hormonal factors, but cultural factors appear to play a very important role. In the U.S. men smoke more than women and more often develop the hard-driving Type A Behavior Pattern, and these behavioral differences are major causes of men's higher rates of coronary heart disease. These sex differences in behaviour are strongly influenced by culture and socialization. Sex differences in socialization might be expected for the Type A behavior pattern, since this behavior pattern appears to contribute significantly to success in traditional male roles, but not to success in traditional female roles.
In the contemporary U.S., mortality is 60% higher for males than for females. Forty percent of this sex differential in mortality is due to a twofold elevation of arteriosclerotic heart disease among men. Major causes of men's higher rates of arteriosclerotic heart disease include greater cigarette smoking among men and probably a greater prevalence of the competitive, aggressive Coronary Prone Behavior Pattern among men. Men who do not develop the Coronary Prone Behavior Pattern may have as low a risk of coronary heart disease as comparable women. Oopherectomy of young women may increase the risk of coronary heart disease, but administration of female hormones generally does not reduce the risk.One third of the sex differential in mortality is due to men's higher rates of suicide, fatal motor vehicle and other accidents, cirrhosis of the liver, respiratory cancers and emphysema. Each of these causes of death is related to behaviors which are encouraged or accepted more in males: using guns, drinking alcohol, smoking, working at hazardous jobs and being adventurous and acting unafraid.Thus the behaviors expected of males in our society make a major contribution to their elevated mortality. This analysis leads to suggestions for the reduction of male mortality, for example, by changing the social conditions which foster in men the behaviors which elevate their mortality.
Abstract Empirical expressions derived by Coale and Demeny accurately characterized the relationships among death rates of different age groups for each sex during an extended period of time in Western nations. However, the relationships have changed in recent years, as the mortality of older persons has increasingly exceeded the level expected on the basis of these expressions. The recent disruption is relatively small for females and may be due to very rapid declines in maternal mortality. Among males, the change has been quite pronounced, and it is suggested that increases in cigarette consumption are largely responsible.
Zusammenfassung
Der vorliegende Beitrag präsentiert empirische Ergebnisse zu den sozialen Determinanten der aktiven Lebenserwartung in der Bundesrepublik. Das Konzept der aktiven Lebenserwartung bezieht sich auf die Analyse der Pflegebedürftigkeit, wobei sich die Unterscheidung zwischen aktiver und inaktiver Lebenserwartung in dem vorliegenden Beitrag an der sozialen Handlungsfähigkeit orientiert. Die Analyse basiert auf Mehrzustandssterbetafeln, die mit dem Sozio-ökonomischen Panel berechnet wurden. Unter den Ergebnissen ist insbesondere von Bedeutung, daß Männer keineswegs stärker von einer Ehe profitieren als Frauen: Bei Frauen wirkt sich die Ehe sogar deutlich stärker lebensverlängernd aus als bei Männern.
In the United States, men are more likely than women to die of coronary heart disease regardless of age. In this paper I attempt to explain the sex differential in coronary heart disease by controlling for levels and impacts of six of the most important known clinical risk factors-serum cholesterol, systolic and diastolic blood pressure, left-ventricular hypertrophy by electrocardiogram, cigarette smoking, and glucose intolerance. Using published data from the Framingham Heart Study, I find the results are largely negative. Among those over fifty-four years old, women have lower probabilities of developing coronary heart disease in spite of higher levels of the most important risk factors. The article concludes with a discussion of possible theoretical approaches to these surprising results.
The relation of menopause to cardiovascular disease incidence was examined in women less than 55 years old from the cohort of 2873 women in the initial Framingham examination. Although the number of person-years of experience during the 20 years of observation was nearly the same for premenopausal and postmenopausal status, there were only 20 cardiovascular events among the premenopausal women in this age group whereas 70 events occurred among the postmenopausal women of the same age. In each specific age group studied incidence rates were lower in premenopausal than postmenopausal women. This was also true for coronary heart disease. Contrast for "hard" diagnoses of cardiovascular disease (excluding diagnoses of angina pectoris and intermittent claudication) was in the same direction. Although cholesterol and hemoglobin did rise somewhat more steeply in women undergoing the menopause, this greater incidence of cardiovascular disease in postmenopausal women could not be explained by the influence of the menopause on the usual cardiovascular risk factors.