Widening Gender Gap in Life Expectancy Primarily Driven by COVID-19 and Drug Overdose Crisis, According to New Research

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The gender gap in life expectancy in the US has been widening for over a decade, primarily driven by the COVID-19 pandemic and the opioid overdose epidemic, among other factors, according to authors of a new research letter published in JAMA Internal Medicine.¹

“There’s been a lot of research into the decline in life expectancy in recent years, but no one has systematically analyzed why the gap between men and women has been widening since 2010,” said corresponding author Brandon W. Yan, MD, MPH, internal medicine resident physician, Harvard TH Chan School of Public Health, in a press release.²

To fill this gap in research, Yan and colleagues conducted the cross-sectional study to examine overall and gender-specific life expectancy, as well as contributors (eg, COVID-19 pandemic, unintentional injuries) to changes in life expectancy from 2010 to 2021, using data from the National Center for Health Statistics. They divided the data by pre-COVID-19 (2010-2019) and post-COVID-19 years (2019-2021).¹

“We used a decomposition technique to partition changes in the life expectancy gap between men and women into component additive parts that identify the causes of death having the greatest association, positive or negative, with changes in life expectancy,” wrote researchers in the study published online November 13, 2023.¹

“For further specificity, we partitioned changes in unintentional injuries into select components (unintentional poisoning [mostly drug overdose], unintentional transport-related injuries, and all other injuries),” continued Yan and coauthors.¹

FINDINGS

Results showed that the gender life expectancy gap increased 0.23 years from 2010 to 2019 and 0.7 years from 2019 to 2021, according to investigators.¹

The largest contributors to worsening life expectancy in men compared with women before the COVID-19 pandemic in 2020 included¹:

• unintentional injuries (‒0.23 years);
• diabetes (‒0.05 years);
• suicide (‒0.04 years);
• homicide (‒0.03 years); and
• cardiovascular disease (‒0.03 years).

These increases were offset by differential improvement for men vs women in mortality from cancer (0.12 years), Alzheimer disease (0.06 years), and chronic lower respiratory disease (0.04 years).¹

Investigators also noted that from 2019 to 2021, COVID-19 became the largest contributor to the increased gap in life expectancy in men compared to women (‒0.33 years), followed by unintentional injuries (‒0.27 years).¹

In addition, results showed that the absolute difference in age-adjusted death rates between men and women increased from 252 to 315 per 100 000 from 2010 to 2021, “with a persistent gap for heart disease and widening gaps for COVID-19, unintentional injuries, and several other causes,” wrote investigators.¹

From 2010 to 2021, unintentional poisonings—typically drug overdoses—and unintentional transport-related injuries contributed to 0.44 (86.3%) and 0.06 (11.8%) of the 0.51-year decline in life expectancy from unintentional injuries, respectively.¹

“While rates of death from drug overdose and homicide have climbed for both men and women, it is clear that men constitute an increasingly disproportionate share of these deaths,” said Yan.²

The increases in homicides, overdose deaths, and suicide “underscore twin crises of deaths from despair and firearm violence,” while cardiometabolic diseases and mental health are also factors in differential mortality, according to Yan and colleagues.¹

“We have brought insights to a worrisome trend,” said Yan. “Future research ought to help focus public health interventions toward helping reverse this decline in life expectancy.”²

References:

1. Yan BW, Arias E, Geller AC, et al. Widening gender gap in life expectancy in the US, 2010-2021.JAMA Intern Med. Published online November 13, 2023. doi:10.1001/jamainternmed.2023.6041
2. U.S. men die nearly six years before women, as life expectancy gap widens. News release. Harvard TH Chan School of Public Health. Published November 13, 2023. Accessed November 21, 2023. https://www.hsph.harvard.edu/news/press-releases/u-s-men-die-nearly-six-years-before-women-as-life-expectancy-gap-widens/