Social factors and the gender difference in mortality

doi:10.1016/0277-9536(86)90154-1

Social Science & Medicine

Volume 23, Issue 6, 1986, Pages 605-609

https://doi.org/10.1016/0277-9536(86)90154-1 Get rights and content

Abstract

The effect of social factors on the male/female difference in mortality in Finland was studied by comparing age-adjusted mortality of males and females by social class and marital status. 44,548 death certificates (years 1969–1971) and 1970 census data for 25–64-years olds were analysed. The gender differences was 2.8-fold: 5.3-fold for violent causes and 2.3-fold for natural causes. The greatest gender differences from violent causes was found in accidental poisonings (18.7-fold) and drownings (12.8-fold), and from natural causes in mental disorders (mainly alcoholism: 5.7-fold) and in ischemic heart disease (4.5-fold). The gender difference was most prominent in unskilled workers, divorced and widowed and less prominent in married and upper professionals. The great variation of gender difference of mortality by social class and marital status seems to indicate that mortality difference between males and females is associated to external factors rather than biological differences between men and women. This conclusion is also supported by the progressive increase of gender difference of mortality from 1.4 to 2.8 during the last 80 years in working-aged Finns.

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This paper analyses cause-specific mortality in ages 15–30 years in Finland, using longitudinal population register data that covers the period 1970–2004. The aim is to see how mortality risks interrelate with living conditions in the parental home and with regional confounders, in order to understand why the two native population groups of the country differ in mortality. Results based on Cox proportional hazard models reveal that, in young men, socio-economic circumstances interrelate with external causes of death excluding suicides, probably because of social class differences in hazardous lifestyles. Thus injuries and accidents, but not suicides, depend on socio-economic background. For suicides, we find a regional mortality pattern that is highly similar to variation in overall mortality at higher ages, whereas for all other external causes of death such differences cannot be observed. These results suggest that hereditary factors cannot be ruled out as an explanation to the population-group mortality gradient.
Marital status and cancer risk in Italy
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Background. Marital status has long been related to cancer incidence and mortality rates. However, only few analytical studies have been conducted on this issue considering known or potential confounding factors.
Methods. We systematically examined the relation between marital status and cancer risk using data from a network of case-control studies conducted between 1983 and 2001, including a total of 17,976 incident cases with the following cancer sites: oral cavity and pharynx, esophagus, stomach, colon, rectum, liver, gallbladder, pancreas, larynx, breast, endometrium, ovary, prostate, bladder, kidney, thyroid, Hodgkin's disease, non-Hodgkin's lymphomas, multiple myelomas, and sarcomas. Controls were 15,345 patients admitted to the hospital for non-neoplastic conditions.
Results. As compared to married subjects, never married ones were at significantly increased risk of oral cavity and pharyngeal cancers and at reduced risk of cancer of the colon, liver, bladder, kidney, and thyroid. However, for other cancer sites considered, most odds ratios were close to unity. Likewise, there was no consistent excess risk for divorced or widowed subjects.
Conclusions. Despite some significant associations, our study suggests that marital status is not materially associated with cancer risk. Thus, the evidence that married subjects are at lower risk of several other major diseases may not be applicable to cancer.
Causes of death after total hip arthroplasty: A nationwide cohort study with 24,638 patients
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Citation Excerpt :
Although we do not have any detailed information about the cardiovascular status of these patients before or after operations or about the exact extent of consumption of these drugs, it seems evident that this mechanism cannot be neglected as a possible explanatory factor for the low SMRs for diseases of the cardiovascular or cerebrovascular system. A particular feature of mortality in Finland has been the large difference between that of men and women [34,40]. During the follow-up period, 21.7% of the men and 16.9% of the women died.
Based on the nationwide registration of the total hip arthroplasties (THAs) in Finland since 1980, a cohort of 24,638 patients with primary THA was gathered and followed for causes of death until December 31, 1996. The causes of death were divided into 20 main categories according to the classification of diseases ICD-10. The number of person-years was 153,410, and the mean length of follow-up of a person was 6.2 years. During the follow-up, 4,626 patients died; the expected number was 6,746. The standardized mortality ratio (SMR) was 0.69 (95% confidence interval; 0.67–0.70), without any difference between men and women. The total risk increased during the follow-up, with the highest being 0.84 (95% confidence interval, 0.81–0.87). Among the ICD categories, there were significantly low SMRs for cancers (0.54), accidents (0.74), cardiovascular diseases (0.70), and respiratory diseases (0.46). Among the diseases, there was a constant and significant decline of the SMR for dementia and Alzheimer's disease (0.50), diabetes (0.40), myocardial infarction (0.73), hypertension (0.68), other ischemic diseases (0.70), other heart diseases (0.57), and cerebrovascular diseases (0.70). The explanation for the decreased SMRs seems to be attributed to factors other than the THA per se, such as preoperative patient selection, more active lifestyle after THA, and possibly the use of anti-inflammatory drugs.
Hyperglycemia as a risk factor of mortality in a middle-aged Finnish population
2001, Journal of Clinical Epidemiology
In 1990–1992, a population-based study was carried out in the city of Oulu in northern Finland, to assess the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in a middle-aged population. We report the mortality of the study population until 31 December 1998. Altogether 831 subjects (82%) (369 men) participated in the baseline examinations, in which the prognostic risk factors were determined. Special attention was given to the effect of hyperglycemia on mortality. The WHO 1985, ADA 1997 and WHO 1999 criteria for diabetes, IGT and impaired fasting glucose (IFG) were used. Forty-one subjects (32 men) died during the average follow-up of 6.7 years, and the mortality rate was hence 7.7/1000 person-years. The results suggest that both fasting and post-load hyperglycemia are important predictors of mortality. Estimated by the Cox proportional hazards regression, the unadjusted hazard ratio (HR) for death was 2.5 (95% CI 0.9–6.6) in the subjects classified as diabetic according to the WHO 1999 criteria compared to normoglycemic subjects. The corresponding HR of the subjects with IFG was 2.5 (95% CI 0.7–8.8) and that of the subjects with IGT 1.5 (0.6–3.7). In addition, a high mortality was predicted by smoking (HR 4.2, 95% CI 2.0–8.8), male gender (HR 3.5, 95% CI 1.6–7.9) and hypertension (HR 2.3, 95% CI 1.1–5.1).
Marital status and mortality: The National Longitudinal Mortality Study
2000, Annals of Epidemiology
PURPOSE: To examine the effect of marital status (married, widowed, divorced/separated, and never-married) on mortality in a cohort of 281,460 men and women, ages 45 years and older, of black and white races, who were part of the National Longitudinal Mortality Study (NLMS).
METHODS: Major findings are based on assessments of estimated relative risk (RR) from Cox proportional hazards models. Duration of bereavement for the widowed is also estimated using the Cox model.
RESULTS: For persons aged 45–64, each of the non-married groups generally showed statistically significant increased risk compared to their married counterparts (RR for white males, 1.24–1.39; white females, 1.46–1.49; black males, 1.27–1.57; and black females, 1.10–1.36). Older age groups tended to have smaller RRs than their younger counterparts. Elevated risk for non-married females was comparable to that of non-married males. For cardiovascular disease mortality, widowed and never-married white males ages 45–64 showed statistically significant increased RRs of 1.25 and 1.32, respectively, whereas each non-married group of white females showed statistically significant increased RRs from 1.50 to 1.60. RRs for causes other than cardiovascular diseases or cancers were high (for white males ages 45–64: widowed, 1.85; divorced/separated, 2.15; and never-married, 1.48). The importance of labor force status in determining the elevated risk of non-married males compared to non-married females by race is shown.
CONCLUSIONS: Each of the non-married categories show elevated RR of death compared to married persons, and these effects continue to be strong after adjustment for other socioeconomic factors.
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Coronary artery disease is the most common cause of death in the Western world, and being married decreases the risk of death from cardiovascular causes. We aimed to determine whether marital status was a predictor of the duration of chest pain endured by patients with acute myocardial infarction before they sought care and whether the patient's sex modified the effect.
We conducted a retrospective, population-based cohort analysis of patients with acute myocardial infarction admitted to 96 acute care hospitals in Ontario, Canada, from April 2004 to March 2005. We excluded patients who did not experience chest pain. Using multivariable regression analyses, we assessed marital status in relation to delayed presentation to hospital (more than six hours from onset of pain), both overall and stratified by sex. In patients who reported the exact duration of chest pain, we assessed the effect of marital status on the delay in seeking care.
Among 4403 eligible patients with acute myocardial infarction, the mean age was 67.3 (standard deviation 13.6) years, and 1486 (33.7%) were women. Almost half (2037 or 46.3%) presented to a hospital within two hours, and 3240 (73.6%) presented within six hours. Overall, 75.3% (2317/3079) of married patients, 67.9% (188/277) of single patients, 68.5% (189/276) of divorced patients and 70.8% (546/771) of widowed patients presented within six hours of the onset of chest pain. Being married was associated with lower odds of delayed presentation (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.30–0.71, p < 0.001) relative to being single. Among men, the OR was 0.35 (95% CI 0.21–0.59, p < 0.001), whereas among women the effect of marital status was not significant (OR 1.36, 95% CI 0.49–3.73, p = 0.55).
Among men experiencing acute myocardial infarction with chest pain, being married was associated with significantly earlier presentation for care, a benefit that was not observed for married women. Earlier presentation for medical care appears to be one reason for the observed lower risk of cardiovascular death among married men, relative to their single counterparts.

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Social factors and the gender difference in mortality

Abstract

J. chron. Dis.

Soc. Sci. Med.

Soc. Sci. Med.

Soc. Sci. Med.

Soc. Sci. Med.

J. chron. Dis.

Miesten Ylikuolevuus Suomessa

Kuolleisuus Suomessa ja muissa pohjoismaissa

Duodecim

Mortality Trends in Finland in the 1960s

Occupational Mortality

Social class and ischaemic heart disease: use of the male:female ratio to identify possible occupational hazards

J. Epidem. Commun. Hlth

Causes of death responsible for recent increases in sex mortality differentials in United States

Milbank Mem. Fund Q.

Sex differences in declining cohort death rates from heart disease

Am. J. publ. Hlth