Why do men die younger than women?

Is it biology or man-made factors that lead to men dying younger in every age group until old age? And why does male risk-taking involve much more than fast cars and extreme sport?

The man believed to be the oldest in Australia, 109-year-old Kenneth Weeks, laughs when trying to answer whether there is a trick to living a long life. “It’s not luck, but it’s very hard to explain,” he says.

Rarely drinking alcohol and never smoking likely played a part, Weeks’ family says, as did being physically and mentally active. As a younger man, avoiding risky behaviour might also have lengthened his life. Having low blood pressure, for example, scuttled his chance of being an airman in World War II.

Today, he walks unassisted around his Grafton nursing home in north-east NSW, where he is the only resident who owns a computer, which he writes letters on. “I didn’t anticipate it,” Weeks says of reaching his age. “I outlived all my friends.”

Kenneth Weeks as a child, far left, with brother Gordon; and today, at 109.Credit:Ian Weeks/Whiddon

Australians are on average living longer than ever before. But men, who get to be an average 81.3 years old, typically die about four years younger than women. Men also die at a higher rate in every age group until old age.

The trend occurs all around the world. In fact, relatively speaking, Australian men live longer than males in most other countries. Yet experts say many male deaths are preventable, and men’s behaviour, biology and attitudes to the health system contribute to what is termed a life expectancy “sex gap”.

So why do men die younger? And what can be done to lengthen their lives?

What are men most likely to die from today, and when?

The risk of dying over a lifespan can be imagined in the shape of a tick symbol, demographers say.

In our first year after birth, death rates for both sexes are relatively low compared with later life stages yet higher than during childhood. Birth trauma, disorders in newborns and malformations cause some of these early deaths. Mortality rates then drop between the ages of five and nine, bottoming out at the base of the tick. In adolescence and young adulthood, death rates rise – and then as we age they continue to gradually increase, tracing the longer arm of the tick upwards.

“The older you get, the higher your risk of dying,” says Vladimir Canudas-Romo, head of the Australian National University’s school of demography. “Every day that we wake up, we are very lucky to do that. Because compared to yesterday, we are a little bit more fragile.”

Young men and women have the same leading causes of death in Australia – suicide, car accidents and accidental poisoning (a catch-all for drug or alcohol overdose) – but males aged between 15 and 24 are about three times more likely than females to die from these causes, Australian Institute of Health Data and Welfare data shows.

Canudas-Romo says for younger people in developed countries, the leading causes of death often involve risk-taking behaviour. “We call those the accident hump,” he says. “Young male risk-taking involves not thinking carefully and then ending up in a situation where they have higher mortality.”

Still, the reason for the sex gap in mortality rates is not only because of this relatively small cohort who die young. Unsurprisingly, it’s the 60-pluses who reduce the average life expectancy. In fact, men 60 or older constitute 65 per cent of the life-expectancy sex gap in Australia, says Canudas-Romo. In the past decade, for example, for every 10,000 men aged 65 to 69, 119 died compared with 71 women for every 10,000.

From age 45, chronic diseases become the leading cause of death for both sexes. Heart disease affects men 10 years earlier and more severely than women. It remains the thing that kills most men through the rest of their lifespans. Lung cancer and stroke are also among leading causes of death for middle-aged and older men.

“These are [partly] man-made diseases from exposure to risk factors such as smoking, processed food, obesity and a sedentary life, exposure to pollutants, alcohol, stress and others,” says Canudas-Romo.

In a curious trend, men of very old age tend to be generally healthier than women.

Among Australians aged 65-plus, there were 88 males alive for every 100 females in 2020. By this stage, dementia starts to become a leading cause of death for both sexes, affecting older females in greater numbers.

“The gender differences [in death rates] above age 80 are much smaller,” says University of Melbourne demographer Timothy Adair. “But men who have been smokers and heavy drinkers of alcohol are less likely to survive to those older ages.”

At the 2021 census there were 1165 males aged 100 years or older in Australia compared with 4384 females. In a curious trend, men of very old age tend to be generally healthier than women, according to University of New South Wales neuropsychiatry professor Perminder Sachdev, who studies centenarians. “The ones who survive really are very robust,” Sachdev says.

Credit:

How can men’s behaviour contribute to them dying younger?

Men die more often than women of preventable causes – at least partly, experts suggest, because of their tendencies for risk-taking, substance abuse and interacting less with healthcare.

Geography and wealth also impact life expectancy. Men and women in low socioeconomic areas are more likely to die of a potentially avoidable cause, and life expectancy decreases depending on remoteness from major cities. In the workplace, deaths from injuries, although impacting a small proportion of workers, claimed the lives of 163 men compared with six women in 2021.

Risk-taking is the biggest factor when it comes to preventable male deaths, says University of Melbourne research fellow Zac Seidler​, who is also mental health director at the Movember Foundation charity.

Three in four transport accident deaths in 2019-20 were males – but risk-taking takes many forms. “It’s not about extreme sports,” Seidler says. “It’s much more around the idea of ‘I am going to push this until the brink; until that growth on my testes is too uncomfortable to handle, until my relationship is at a point where I’m so depressed that I can’t get out of bed’. That’s a form of risk-taking.”

As well as avoidance, poor lifestyle choices are a factor. Men are more likely to have high uncontrolled blood pressure and diabetes, which can lead to heart disease. More men than women consumed alcohol at levels that put them at lifetime risk of disease or injury in 2017-18. Men were also 50 per cent more likely to smoke daily.

‘I am going to push this … until my relationship is at a point where I’m so depressed I can’t get out of bed. That’s a form of risk-taking.’

Seidler says tendencies for taking risks are part of how men are socialised, and so could change. “Underpinning risk-taking is that notion of self-reliance and stoicism; the idea of power and dominance,” he says. “Risk-taking encompasses many of these masculine norms.”

Men are also three to four times more likely to die by suicide than women. However, rates of hospitalisations for intentional self-harm are higher for females. Seidler says this is partly because men are more likely to use a lethal method. “We are very poor at diagnosing and understanding what men’s distress looks like,” Seidler says. “Risk-taking is not men behaving badly, in my experience and research. It is a cry for help, in many instances.”

Men tend to exercise slightly more than women, but they look after themselves less well when it comes to seeking healthcare. Of the Australian population in 2020-21, about 79 per cent of men were likely to see a GP, compared to 88 per cent of women. And for mental health, only 12 per cent of men were likely to see a professional, compared to 20 per cent of women.

“Preventative help-seeking is not a masculine trait, whereas crisis-based help is very much,” Seidler says. “Men only want to go to a doctor when they have a good reason to and … [this is] when it’s hardest to treat.”

Some men “bank up” a range of issues before going to the doctor, says Dr Sean Martin, program lead of the Australian Institute of Family Studies’ longitudinal study of 16,000 men nationally. “That’s not a condition in which you can get optimal care,” Martin says.

The study, called Ten to Men and under way for the past 10 years, shows that only about four in 10 men visit their GP at least once a year for preventative reasons. Males also receive fewer Medicare services, averaging 14 in 2019 compared with females, who made an average 19.5 claims. Martin says there are structural and cultural reasons men go to the doctor less often than women.

Some men ‘bank up’ a range of issues before going to the doctor.

“Once men are engaged with the workforce full time they will tend to not attend services as much,” he says. “There are also cultural reasons. A young girl’s first exposure to health services is often with their mother around their own reproductive health, and it’s a critical time in which it’s normalised. Men don’t have that equivalent experience.”

What role does biology play?

Male life expectancy is not only lower in humans. From lions and killer whales to mountain goats, an international study of 101 species of mammals in the wild found a longer lifespan among females in 60 per cent of the populations. Environmental factors, from weather to marauding humans, make a difference, the study says, but so does biology.

There is “some clear biological underpinning” to sex differences in mortality, says the study’s lead author, Dr Jean-Francois Lemaitre, from the University of Lyon. “[In males] this can be explained by the fact they carry only one copy of the X chromosome or by the toxicity of the Y chromosome,” Lemaitre says.

Researchers of a US study say as fruit flies get older, “repeat-rich Y chromosomes are a genomic liability for males”. Associate professor Paul Waters, an expert in sex chromosome biology at UNSW, says: “In any species with a Y chromosome, like humans, we could have the same toxic effects. It’s not the only reason males die earlier than females, but it’s a potential contributor.”

Another theory that receives more attention says females have an advantage due to having two X chromosomes – if one fails the other steps in and compensates. “We know of many genes on the X chromosome that if they are mutated they cause early death, or pre-birth death,” says La Trobe University geneticist professor Jenny Graves. “[It’s] often thought to get rid of a lot of males before they’re even born.”

Testosterone plays a role in male tendencies to engage in risk-taking behaviour. But women’s oestrogen also has protective qualities.

The University of Melbourne’s director for healthy ageing, Cassandra Szoeke, believes human male behaviour plays a greater role. Having just one X chromosome is only a disadvantage “with very rare diseases linked on the X chromosome”, she says.

In humans, testosterone plays a role in male tendencies to engage in risk-taking behaviour, says Sachdev. But women’s oestrogen also has protective qualities against heart disease, stroke and dementia until women reach 50. “For example, we know that women after menopause, their fatal heart disease score goes up,” Sachdev says. “Secondly, testosterone probably does increase the risk of heart disease and hypertension.”

Men are more likely to have disease affecting their large coronary arteries – which is more likely to cause a lethal heart attack – according to cardiologist and Heart Foundation chief medical officer Garry Jennings. “Women get different kinds of heart problems than men and some of the treatments work more effectively in one sex or the other,” he says. “In that men tend to get their heart disease younger, and younger people are more likely to have a precipitous event, then it’s true that men are less likely to survive their event than women.”

While men have been over-represented in medical research, many studies haven’t separated out men and women. Jennings says researchers are still learning how male biology contributes to earlier and more lethal heart disease.

“It’s a sort of Pandora’s box that we haven’t opened yet,” he says. “[But] we’ve certainly found in some experimental studies that there are things on the Y chromosome, which men have and women don’t, that are related to your likelihood of heart disease.”

Prostate cancer, the most commonly diagnosed cancer in Australia (excluding non-melanoma skin cancer), causes the deaths of more males than breast cancer does for females. It is the fifth most common cause of death for males behind heart disease, dementia, lung cancer and stroke. Risk factors include age, race and a genetic history of prostate cancer.

Evolutionary theory has also tried to explain the sex gap. Sachdev says one school of thought, based on disposable soma theory, says men are more disposable than women because of the female’s maternal role. “[The theory says] it’s in nature’s interest to have a more robust female body as opposed to a male body,” he says, adding there is only limited evidence for this. “It [could be] in the interest of the genes to be passed onto the next generation.”

What can be done to improve men’s mortality rates?

When diseases such as smallpox and cholera ravaged populations in the 18th and 19th centuries, men and women had similar life expectancies (in 1891-1900 a newborn Australian girl could expect to live to 54.8, a boy to 51.1). That’s as far back as the records go. But in the 20th century, noncommunicable maladies such as cancers and heart disease became more prominent, with increases in smoking and cars.

In the two decades after World War II, male life expectancy in Australia barely moved as smoking rates peaked, says demographer Timothy Adair. “By about 1970, we had a gap of about seven to eight years in life expectancy between males and females. And today, it’s only four years,” he says, adding this was mostly thanks to smoking rates declining. Along with improved diet and lifestyles, this has reduced deaths from killers such as heart disease, he says.

“With better treatment and control of blood pressure and cholesterol, for example, that’s had a more beneficial impact on males than females simply because males had higher death rates from cardiovascular diseases.”

The sticking points remain lifestyle, diet and access to healthcare.

Australia launched its first national men’s health policy in 2010 – at the time one of only four in the world – which funded male health organisations and supported the Men’s Shed movement. A National Men’s Health Strategy has now replaced it, but it is too early to claim any wins, a federal Department of Health spokesman says. Its focus on preventative health aligns with a goal for Australian males to live long lives, he says. “There are many independent factors that play a part in increasing male life expectancy, such as reduction in injuries [and] tobacco use, [and] increased screening rates.”

The department says these include screening for bowel cancer every two years for males over 50 (thus the home screening kit that arrives in the mail near your 50th birthday), health heart checks at least once every two years for those over 45, regular skin checks, as well as checks for depression and anxiety.

Sean Martin, from the Ten to Men study, says the mortality gap between sexes is starting to close but “still at that stubborn four, five-year gap”. The sticking points remain lifestyle, diet and access to healthcare. “They’re the big ones and have been that way for quite some time,” he says.

Men behaving badly and not taking care of their health has received much of the blame for them living shorter lives. Martin says this is “partly true”, but believes the perception is unhelpful. He says men being able to behave in ways that are “traditionally masculine” – which brings strengths such as resilience and a sense of independence – while also learning to “be vulnerable in that moment, so you can get the help that you need” lie at the heart of changing men’s minds about healthcare.

More after-hours clinics are needed for improved access, he says, as well as pre-screening opportunities for sensitive but serious conditions such as erectile and urinary dysfunction, which can flag heart disease or diabetes.

“Pushes towards the next step, I think, are around the health system,” he says. “The mortality gap is such a big target that involves so many different things but if you create the preconditions where men can personally engage in their own health care, but also structurally can, I think you’re going to see that gap narrow further.”

Kenneth and Jean Weeks with sons Noel (left) and Ian. Credit:Ian Weeks

Kenneth Weeks, at 109, believes he “outgrew” health problems as a younger man, including a bout of pneumonia as a child. But he says he has not always asked for help when he needed it, recalling an accident that caused a back injury.

“Hiding the pain was a mistake that I later regretted because the doctor concluded that [I] had not been injured,” Weeks wrote in an email to this reporter. “I got over it in time while living alone. Only in recent years, when I was given a CAT scan, the doctor told me that I have a crushed vertebra.

“It left me in a lot of pain.”

If you or anyone you know needs support call Lifeline 131 114, or beyondblue 1800 512 348.

Sign up for our Explainer newsletter enlightening explanations for complex questions, delivered to your inbox every Sunday night.

If you'd like some expert background on an issue or a news event, drop us a line at [email protected] or [email protected] Read more explainers here.

Most Viewed in National

Source: Read Full Article