, Volume 47, Issue 3, pp 555-578

Social, behavioral, and biological factors, and sex differences in mortality

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Few studies have examined whether sex differences in mortality are associated with different distributions of risk factors or result from the unique relationships between risk factors and mortality for men and women. We extend previous research by systematically testing a variety of factors, including health behaviors, social ties, socioeconomic status, and biological indicators of health. We employ the National Health and Nutritional Examination Survey III Linked Mortality File and use Cox proportional hazards models to examine sex differences in adult mortality in the United States. Our findings document that social and behavioral characteristics are key factors related to the sex gap in mortality. Once we control for women’s lower levels of marriage, poverty, and exercise, the sex gap in mortality widens; and once we control for women’s greater propensity to visit with friends and relatives, attend religious services, and abstain from smoking, the sex gap in mortality narrows. Biological factors—including indicators of inflammation and cardiovascular risk—also inform sex differences in mortality. Nevertheless, persistent sex differences in mortality remain: compared with women, men have 30% to 83% higher risks of death over the follow-up period, depending on the covariates included in the model. Although the prevalence ofriskfactors differs by sex, the impact of those riskfactors on mortality is similar for men and women.

This article also benefited from presentation to the Cells to Society Colloquium Series, Northwestern University; the Department of Demography and Organizational Studies, and the Institute for Demographic and Socioeconomic Research, University of Texas at San Antonio; the Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, Texas; the Division of Social Statistics, University of Southampton; and the Center for Population Dynamics, Arizona State University.