We have known for more than a century that women outlive men. But new research led by the University of California, San Francisco and the Harvard TH Chan School of Public Health shows that, at least in the United States, the gap has been widening for more than a decade. The trend is being driven by the COVID-19 pandemic and the opioid overdose epidemic, among other factors.
In a research article published in JAMA Internal Medicine , the authors found that the difference between the life spans of American men and women increased to 5.8 years in 2021, the largest since 1996. This is an increase of 4.8 years in 2010, when the gap was the smallest in recent history.
The pandemic, which disproportionately affected men, contributed the most to the growing gap between 2019 and 2021, followed by unintentional injuries and poisonings (mainly drug overdoses), accidents and suicides.
"There has been a lot of research on declining life expectancy in recent years, but no one has systematically looked at why the gap between men and women has widened since 2010," said the paper’s first author, Brandon Yan, MD. , MPH, internal medicine resident physician at UCSF and research collaborator at the Harvard Chan School.
Life expectancy in the US fell in 2021 to 76.1 years, down from 78.8 years in 2019 and 77 years in 2020.
The shortening of American life expectancy has been attributed in part to so-called "deaths of despair" . The term refers to the increase in deaths from causes such as suicide, drug use disorders and alcoholic liver disease, which are often linked to economic hardship, depression and stress.
"While death rates from drug overdoses and homicides have increased for both men and women, it is clear that men make up an increasingly disproportionate share of these deaths," Yan said.
Interventions to reverse a deadly trend
Using data from the National Center for Health Statistics, Yan and other researchers across the country identified the causes of death that most reduced life expectancy. They then estimated the effects on men and women to see to what extent different causes contributed to the gap.
Before the COVID-19 pandemic, the biggest contributors were unintentional injuries, diabetes, suicide, homicide, and heart disease.
But during the pandemic, men were more likely to die from the virus. This was likely due to a number of reasons, including differences in health behaviors, as well as social factors, such as risk of exposure at work, reluctance to seek medical care, incarceration, and housing instability. Chronic metabolic disorders, mental illness and gun violence also contributed.
Yan said the results raise questions about whether more specialized care for men, such as mental health, should be developed to address the growing disparity in life expectancy.
"We have provided information on a worrying trend," Yan said. "Future research should help focus public health interventions on helping reverse this decline in life expectancy."
Yan and his co-authors, including senior author Howard Koh, MD, MPH, professor of public health leadership practice at the Harvard Chan School, also noted that more analysis is needed to see if these trends change after 2021.
"We need to closely monitor these trends as the pandemic recedes," Koh said. "And we must make significant investments in prevention and care to ensure that this growing disparity, among many others, does not take hold."
