Why do women live longer than men?

Hypothesis: Multiple intervening factors from a biopsychosocial perspective are responsible for the male-female life expectancy disparity.

Null hypothesis: The male-female life expectancy disparity can be understood through a single discipline and does not require a biopsychosocial perspective

Women on average have a life expectancy (LE) of 4.6 years longer than men who have higher mortality rates at every age group (WHO, 2015; United Nations Statistics Division, 2012; Holden, 1987; Austad, 2006)

The necessity to investigate psychophysical, biological, economic, political, environment and social causalities requires ‘holistic modelling’ and the use of Engel’s (1989) biopsychosocial model allows for appropriate consideration of intervening factors (Freeman, 2005; Christine, 2008; Weiner & Freedheim, 2003).

Biological and genetics contribute to improved female LE (Ginter & Simko, 2013). Higher immunity (Hirokawa et al., 2013), the additional X chromosome and favourable hormonal balance reduce fatalities (Austad, 2006; Oksuzyan, Juel, Vaupel, Christensen, 2008). Cardiovascular disease (CVD) is a primary cause of male mortality (Beltrán-Sánchez, Finch, & Crimmins, 2015; Weiner & Freedheim, 2003; Ginter & Simko, 2013), biological causality is recognised (Eskes & Haanen, 2007), however behavioural and lifestyle choices additionally contribute. Violence, aggressiveness, homicide, suicide and substance abuse are psychosocial factors increasing male mortality and diseases accounting for one third of the LE disparity (Waldron, 1967; Oksuzyan et al., 2008; Holden, 1987; British Psychological Society, n.d; Batrinos, 2012; Holden, 1987).

The varying LE gap among countries implies social causality (United Nations Statistics Division, 2012). Scandinavia’s LE gap is closing, while others increase (Ginter & Simko, 2013). The ameliorating Scandinavian LE could correlate with their high social gender equality (Borchorst & Siim, 2008; Melby, Ravn & Wetterberg, 2009), supporting the theory that socially expected male behaviours contribute to mortality (Waldron, 1967).

Socioeconomically, gender inequality shows men acquiring greater wealth and status. Low socioeconomic status is linked to mortality (Kavanagh, Shelley & Stevenson, 2017; White, 2005), but despite this, women live longer suggesting psychological factors such as risk-taking may contribute (Oksuzyan et al., 2008). Evidence of risk taking is seen in 97% of job fatalities being male (Waldron, 1967; Health and Safety Executive, 2017).

Despite greater longevity women have more illness, known as the ‘male-female health paradox’ (Oksuzyan et al., 2009). Socially and historically women were more vigilant of family health, meaning women more often; report symptoms, take sick leave and utilise healthcare (Christine, 2008; Oksuzyan et al., 2008; Green, & Pope, 1999). Of reported conditions, men die more frequently indicating understated severity for which cultural disapproval of men appearing ill is possibly causal (Oksuzyan et al., 2008). However, selective bias and non-participation may contribute to data inaccuracy creating the ‘male-female health paradox’ (Oksuzyan et al., 2009).

The significance of social constructs and psychology are additionally seen psychosomatically. Men who are higher in ‘femininity’ and not stereotypically masculine have a lower risk of CVD (Hunt, Lewars, Emslie, Batty, 2007). Additionally, even being male is perceived psychologically as shortening one’s LE (Kobayashi, Beeken, Meisel, 2017).

The complexity of the male LE disparity cannot be understated and many of the numerous intervening factors have their own biopsychosocial causalities. Psychologically men care less for their health, smoke more, have higher obesity rates and poorer diets (Oksuzyan et al., 2008; Costanza, Salamun, Lopez, & Morabia, 2006; Wardle et al., 2004). However social expectations and biological factors are additionally casual. These combined biopsychosocial factors make being male the largest demographic risk factor for premature mortality in developed countries (Kruger & Nesse, 2004). Waldron (1966) suggests changing social expectations is paramount in remedying this phenomenon.

References:

Austad, S. N. (2006). Why women live longer than men: Sex differences in longevity. Gender Medicine,3(2), 79-92. https://doi.org/10.1016/S1550-8579(06)80198-1.

Batrinos, M. L. (2012). Testosterone and Aggressive Behavior in Man. International Journal of Endocrinology and Metabolism, 10(3), 563–568. http://doi.org/10.5812/ijem.3661

Beltrán-Sánchez, H., Finch, C. E., & Crimmins, E. M. (2015). Twentieth century surge of excess adult male mortality. Proceedings of the National Academy of Sciences of the United States of America, 112(29), 8993–8998. http://doi.org/10.1073/pnas.1421942112

Borchorst, A., & Siim, B. (2008). Woman-friendly policies and state feminism: Theorizing Scandinavian gender equality. Feminist Theory, 9(2)207–224 https://doi.org/10.1177/1464700108090411

British Psychological Society (n.d). Understanding and preventing suicide: A psychological perspective. Retrieved from: https://www.bps.org.uk

Christine, S. (2008). Health Promotion: A Psychosocial Approach. Maidenhead: Open University press. Retrieved from: https://books.google.co.uk

Costanza, M. C., Salamun, J., Lopez, A. D., & Morabia, A. (2006). Gender differentials in the evolution of cigarette smoking habits in a general European adult population from 1993-2003. BMC Public Health, 12(6) 130. https://doi.org/10.1186/1471-2458-6-130

Engel, G. L. (1981). The clinical application of the biopsychosocial model. Journal of Medicine & Philosophy, 6(2), 101-124.

Eskes, T., & Haanen, C. (2007). Why do women live longer than men? European Journal of Obstetrics and Gynecology 133(2), 126–133. https://doi.org/10.1016/j.ejogrb.2007.01.006

Freeman, J. (2005). Towards a definition of holism. The British Journal of General Practice, 55(511), 154–155.

Ginter, E., & Simko, V. (2013). Women live longer than men. Bratisl Lek Listy, 114(2):45-9. PMID: 23331196

Green, C. A., & Pope, C. R. (1999). Gender, psychosocial factors and the use of medical services: a longitudinal analysis. Soc Sci Med, 48(10), 1363-72. PMID: 10369437

Health and Safety Executive. (2017). Fatal injuries arising from accidents at work in Great Britain: Headline results 2016/17. Retrieved from: http://www.hse.gov.uk/statistics

Hirokawa, K., Utsuyama, M., Hayashi, Y., Kitagawa, M., Makinodan, T., & Fulop, T. (2003). Slower immune system aging in women versus men in the Japanese population. Immunity & Ageing, 10(19). https://doi.org/10.1186/1742-4933-10-19

Holden, C. (1987). Why do women live longer than men? Science, 238, 158-160. Retrieved from: http://go.galegroup.com

Hunt, K., Lewars, H., Emslie, C., Batty, G, D. (2007). Decreased risk of death from coronary heart disease amongst men with higher ‘femininity’ scores: a general population cohort study. Int J Epidemiol, 36(3), 612-20. DOI: 10.1093/ije/dym022

Kavanagh, S. A., Shelley, J. M., & Stevenson, C. (2017). Does gender inequity increase men’s mortality risk in the United States? A multilevel analysis of data from the National Longitudinal Mortality Study. SSM – Population Health, 3, 358-365. https://doi.org/10.1016/j.ssmph.2017.03.003.

Kobayashi, L. C., Beeken, R. J., Meisel, S. F. (2017). Biopsychosocial predictors of perceived life expectancy in a national sample of older men and women. PLoS One, 14;12(12). doi: 10.1371/journal.pone.0189245.

Kruger, D. J., & Nesse, R. M. (2004). Sexual selection and the Male:Female mortality ratio. Evolutionary Psychology, 2, 66-85. http://dx.doi.org/10.1177/147470490400200112

Melby, K., Ravn, A, B., Wetterberg, C. C. (2009). Gender Equality and Welfare Politics in Scandinavia: The Limits of Political ambition? Bristol: The Policy Press. Retrieved from: https://books.google.co.uk/

Oksuzyan, A., Juel, K., Vaupel, J. W., & Christensen, K. (2008). Men: good health and high mortality. Sex differences in health and aging. Aging Clinical and Experimental Research, 20(2), 91–102.

Oksuzyan, A., Petersen, I., Stovring, H., Bingley, P., Vaupel, J. W., & Christensen, K. (2009). The male–female health–survival paradox: A survey and register study of the impact of sex-specific selection and information bias. Annals of Epidemiology, 19(7), 504–511. http://doi.org/10.1016/j.annepidem.2009.03.014

United Nations Statistics Division. (2012). Statistics and indicators on women and men. Retrieved from: https://unstats.un.org

Waldron, I. (1967). Why do women live longer than men? Social Science & Medicine, 10,(6-7),349-362. https://doi.org/10.1016/0037-7856(76)90090-1

Wardle, J., Haase, A. M., Steptoe, A., Nillapun, M., Jonwutiwes, K., & Bellisle, F. (2004) Gender differences in food choice: the contribution of health beliefs and dieting. Ann Behav Med, 27(2), 107-16. DOI: 10.1207/s15324796abm2702_5

Weiner, I. B., & Freedheim, D. K. (2003). Handbook of Psychology: Health Psychology. New Jersey: John Wiley & Son. Retrieved from: https://books.google.co.uk

White, P. (2005). Biopsychosocial Medicine: An Integrated Approach to Understanding Illness. Oxford: Oxford University press. Retrieved from: https://books.google.co.uk/

WHO. (2015). Global Health Observatory (GHO) data – Life expectancy. Retrieved from: http://www.who.int