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    • br Acknowledgment The data for this study was made

    2018-11-05


    Acknowledgment The data for this study was made available by another project investigating the ten-year treatment cost of breast cancer within the Norwegian Breast Cancer Screening Program. Funds from the Norwegian Research Council, Grant no. 189494, were used to establish the research database. I thank Tor Iversen and Tron Anders Moger for commenting on the study, as well as to two anonymous reviewers who helped clarify the study and its limitations.
    Introduction Decades of research have found that women generally outlive men in developed countries (Beltrán-Sánchez, Finch, & Crimmins, 2015; Kalben, 2002; Verbrugge, 2012; Waldron, 1976). More recently, it has become evident that not only do women have longer life expectancy from birth (e0) in such societies, but their mortality rates at every age are lower, starting in utero (Catalano & Bruckner, 2006). So pervasive are these observations that some demographers now equate the longevity of the human species, at any given time and place, with the highest observed LE of women (Horton & Lo, 2013; Oeppen & Vaupel, 2002). Yet sex differences in mortality vary widely over time and place. In this paper we explore this variation in search of insights into why women live longer. We are motivated by the hope such insights will reveal opportunities to reduce the excess mortality of men, although this paper only documents associations and stops short of examining causal pathways. The causal mechanisms underlying these associations, and appropriate interventions to address those mechanisms, fall outside the scope of this paper and merit future research. Efforts to explain sex differences in mortality are not new (Beltrán-Sánchez et al., 2015; Waldron, 1976; Kruger & Nesse, 2004; MacIntyre, Hung, & Sweeting, 1996; Møller, Fincher, & Thornhill, 2009; Taylor et al., 2009; Waldron, 1983; Yang & Kozloski, 2012), and can be briefly categorized into three broad schools of thought. First is the notion of selective female survival advantage on a “hard-wired” biologic basis, for example the direct pathophysiologic benefit of female ibuprofen msds on blood vessels (Drevenstedt, Crimmins, Vasunilashorn, & Finch, 2008; Mage & Donner, 2006). Second is the idea that socially mediated behavioral differences explain the gap—human males in virtually every society take more risks, are more violent and behave in ways that make them more prone to accidental injury, while females are more likely to be health-seeking (Bhattacharya, Gathmann & Miller, 2012; Case & Paxson, 2005; Concha-Barrientos et al., 2004; Cook, McGlynn, Devesa, Freedman, & Anderson, 2011; Cutler, Lange, Meara, Richards-Shubik, & Ruhm, 2011; Ezzati, Friedman, Kulkarni, & Murray, 2008; Gabel & Gerberich, 2002; Gillespie, Trotter, & Tuljapurkar, 2014; Hunter & Reddy, 2013; Kalben, 2002; McCartney, Mahmood, Leyland, Batty, & Hunt, 2011; Norström & Razvodovsky, 2010; Preston & Wang, 2011; Rahman, Strauss, Gertler, Ashley, & Fox, 1994; Tomkins et al., 2012). A third perspective views social difference as one manifestation of biologically driven behavioral difference, so-called sociobiology; by this perspective, biologic differences of greatest interest express themselves in different social behaviors which are mutable, at least in theory (Braveman, Egerter, & Williams, 2011; Chu & Lee, 2012; Gorman & Read, 2007; Ristvedt, 2014; Umberson & Montez, 2010). In this paper we do not attempt to weigh the causal evidence for each of these mutually compatible pathways; rather we describe and contrast patterns of sex differences in mortality across time and place with which any theory will ultimately have to contend. We begin our investigation with the data that is of highest quality: the contemporary developed world. We then study patterns using a wide swath of available mortality data, within and between developing and developed countries and over the time periods for which reasonably reliable data are available. Of particular interest is the observed relationship between sex differences in mortality and other changes related to the demographic and epidemiologic transition (Mooney, 2002; Omran, 1971), since this relationship facilitates comparison of changes in developed countries—from which almost all published work on this subject has emerged—to those presently evolving in developing countries at an earlier phase of transition. We limit quantitative analyses to correlations and basic regressions, using markers of socioeconomic condition within and between countries based on available measures; it is not our intent to test the causal relationship between any specific factor(s) and sex differences in mortality, but rather to identify patterns to encourage such testing in future research.