Widening Gender Gap in Life Expectancy in the US, 2010-2021

Brandon W. Yan; Elizabeth Arias; Alan C. Geller; Donald R. Miller; Kenneth D. Kochanek; Howard K. Koh

doi:10.1001/jamainternmed.2023.6041

Research Letter

November 13, 2023

Widening Gender Gap in Life Expectancy in the US, 2010-2021

Brandon W. Yan, MD, MPH^1,2; Elizabeth Arias, PhD³; Alan C. Geller, MPH, RN²; et al Donald R. Miller, ScD⁴; Kenneth D. Kochanek, MA³; Howard K. Koh, MD, MPH²

Author Affiliations Article Information

¹Department of Medicine, University of California, San Francisco School of Medicine, San Francisco
²Harvard T.H. Chan School of Public Health, Boston, Massachusetts
³Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
⁴Boston University School of Public Health, Boston, Massachusetts

JAMA Intern Med. 2024;184(1):108-110. doi:10.1001/jamainternmed.2023.6041

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As life expectancy at birth in the US decreased for the second consecutive year, from 78.8 years (2019) to 77.0 years (2020) and 76.1 years (2021), the gap between women and men widened to 5.8 years, its largest since 1996 and an increase from a low of 4.8 years in 2010.¹^,2 For more than a century, US women have outlived US men, attributable to lower cardiovascular and lung cancer death rates related largely to differences in smoking behavior.¹^,2 This study systematically examines the contributions of COVID-19 and other underlying causes of death to the widened gender life expectancy gap from 2010 to 2021.

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1 Comment for this article

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January 30, 2024

Seeking clarification – is it sex or gender?

Ilona Csizmadi, PhD | Community Health Sciences, Cumming School of Medicine, University of Calgary

Yan et al (1) report results demonstrating that from 2019 to 2021, COVID-19 became the leading contributor to the widening gender gap in life expectancy owing to the higher mortality among men. For reasons stated below, I believe that the reference to ‘gender’ in the title and throughout the paper is misleading with respect to the study methods, interpretation of findings and contributes to the confusion that persists around sex and gender terminology.
As stated by the authors, cause-specific mortality data from the National Center for Health Statistics (NCHS) (2) were analyzed. NCHS mortality data are based on death certificates which at present only collect sex assigned at birth data – e.g., biological sex (3). Indeed, in the NCIS paper cited by the authors (2), the data are described as including the variable ‘sex’ classified as ‘male’ or ‘female’, terminology generally recommended for binary biological sex (4). Yan et al (1), on the other hand use the terms man and woman, consistent with gender status – and attribute their findings to gender despite analyzing mortality data for biological sex.
Increasingly, there has been interest in distinguishing between the biological variable sex and gender in health-related research to better understand the causal nature of disease risk (4,5). While sex represents anatomy, physiology, and genetics, gender represents psychosocial components of identity, expression, roles, and institutional gender that may include experiences of gender-based stigma and discrimination (5). In recent years, evidence has emerged demonstrating that sex and gender can each have distinct independent associations with health-related outcomes. Hence, concurrently studying sex and gender and distinguishing between them may lead to a better understanding of targets for more effective disease prevention interventions. While a major challenge in this area of research can be attributed to the limited number of studies that have comprehensively studied both sex and gender in analyses, the conflation of sex and gender and the misuse of gender-related terminology is also a factor. The authors may have conceptualized the use of ‘gender’ to imply that their findings likely result from factors other than just biology – e.g., health behavior and social factors, as briefly mentioned in the paper’s discussion. If so, acknowledgment of the biological sex variable derived from death certificates as a proxy for the potential contributions of both biological and psychosocial factors to study findings would increase the transparency of the reporting and highlight the complexity of the issue at hand.

REFERENCES:
1. Yan BW, Arias E, Geller AC, Miller DR, Kochanek KD, Koh HK. Widening Gender Gap in Life Expectancy in the US, 2010-2021. JAMA Internal Medicine. 2024;184(1):108-110.
2. Arias E, Tejada-Vera B, Kochanek K, Ahmad F. Provisional life expectancy estimates for 2021. NVSS Vital Statistices Rapid Release. Report No. 23. August 2022. US Department of Health and Human Services; Centers for Disease Control and Prevention; National Center for Health Statistics; National Vital Statistics System (NVSS). https://www.cdc.gov/nchs/data/vsrr/vsrr023.pdf.
3. Haas AP, Lane AD, Blosnich JR, Butcher BA, Mortali MG. Collecting Sexual Orientation and Gender Identity Information at Death. Am J Public Health. 2019;109(2):255-259.
4. Clayton JA, Tannenbaum C. Reporting Sex, Gender, or Both in Clinical Research? JAMA. 2016;316(18):1863-1864.
5. Bauer GR. Sex and Gender Multidimensionality in Epidemiologic Research. Am J Epidemiol. 2023;192(1):

CONFLICT OF INTEREST: None Reported

Widening Gender Gap in Life Expectancy in the US, 2010-2021

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