, Volume 47, Issue 3, pp 555–578 | Cite as

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

  • Richard G. RogersEmail author
  • Bethany G. Everett
  • Jarron M. Saint Onge
  • Patrick M. Krueger


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.


Chronic Liver Disease Religious Service Adult Mortality Religious Attendance Circulatory Disease 
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  1. Alley, D.E. and V.W. Chang. 2007. “The Changing Relationship of Obesity and Disability, 1988– 2004.” Journal of the American Medical Association 298: 2020–27.CrossRefGoogle Scholar
  2. Allison, P.D. 1984. Event History Analysis: Regression for Longitudinal Event Data. Beverly Hills, CA: Sage Publications.Google Scholar
  3. Anderson, R.N. 1999. U.S. Decennial Life Tables for 1989–91, Volume 1, Number. 4, United States Life Tables Eliminating Certain Causes of Death. National Center for Health Statistics, Hyattsville, MD.Google Scholar
  4. Arias, E. 2007. “United States Life Tables, 2004.” National Vital Statistics Reports 54(14): 1–40.Google Scholar
  5. Berkman, L.F. and T. Glass. 2000. “Social Integration, Social Networks, Social Support, and Health.” Pp 137–73 in Social Epidemiology, edited by L.F. Berkman and I. Kawachi. New York: Oxford University Press.Google Scholar
  6. Bhrolcháin, M.N. and T. Dyson. 2007. “On Causation in Demography: Issues and Illustrations.” Population and Development Review 33(1): 1–36.CrossRefGoogle Scholar
  7. Case, A. and C. Paxson. 2005. “Sex Differences in Morbidity and Mortality.” Demography 42: 189–214.CrossRefGoogle Scholar
  8. Caspersen, C.J., M.A. Pereira, and K.M. Curran. 2000. “Changes in Physical Activity Patterns in the United States, by Sex and Cross-Sectional Age.” Medicine and Science in Sports Exercise 32: 1601–609.CrossRefGoogle Scholar
  9. Centers for Disease Control and Prevention (CDC). 2008. “Cigarette Smoking Among Adults—United States, 2007.” Morbidity and Mortality Weekly Report 57: 1221–26.Google Scholar
  10. Corrao, G., V. Bagnardi, A. Zambon, and C. La Vecchia. 2004. “A Meta-Analysis of Alcohol Consumption and the Risk of 15 Diseases.” Preventive Medicine 38: 613–19.CrossRefGoogle Scholar
  11. Crimmins, E., M. Johnston, M. Hayward, and T. Seeman. 2003. “Age Differences in Allostatic Load: An Index of Physiological Dysregulation.” Experimental Gerontology 38: 731–34.CrossRefGoogle Scholar
  12. Danesh, J., R. Collins, P. Appleby, and R. Peto. 1998. “Association of Fibrinogen, C-Reactive Protein, Albumin, or Leukocyte Count With Coronary Heart Disease.” Journal of the American Medical Association 279: 1477–82.CrossRefGoogle Scholar
  13. DiPrete, T.A. and C. Buchman. 2006. “Gender-Specific Trends in the Value of Education and the Emerging Gender Gap in College Completion.” Demography 41: 1–24.CrossRefGoogle Scholar
  14. Durkheim, E. [1897] 1951. Suicide: A Study in Sociology. New York: Free Press.Google Scholar
  15. Fields, L.E., V.L. Burt, J.A. Cutler, J. Hughes, E.J. Roccella, and P. Sorlie. 2004. “The Burden of Adult Hypertension in the United States 1999 to 2000: A Rising Tide.” Hypertension 44: 398–404.CrossRefGoogle Scholar
  16. Flegal, K.M., B.I. Graubard, D.F. Williamson, and M.H. Gail. 2005. “Excess Deaths Associated With Underweight, Overweight, and Obesity.” Journal of the American Medical Association 293: 1861–67.CrossRefGoogle Scholar
  17. Freedman, V.A., L.G. Martin, and R.F. Schoeni. 2002. “Recent Trends in Disability and Functioning Among Older Adults in the United States: A Systematic Review.” Journal of the American Medical Association 288: 3137–46.CrossRefGoogle Scholar
  18. Fried, L.P., R.A. Kronmal, A.B. Newman, D.E. Bild, M.B. Mittlemark, J.F. Polak, J.A. Robbins, and J.M. Gardin. 1998. “Risk Factors for 5-Year Mortality in Older Adults: The Cardiovascular Health Study.” Journal of the American Medical Association 279: 585–92.CrossRefGoogle Scholar
  19. Gelman, A. and J. Hill. 2007. Data Analysis Using Regression and Multilevel/Hierarchical Models. New York: Cambridge University Press.Google Scholar
  20. Goldwasser, P. and J. Feldman. 1997. “Association of Serum Albumin and Mortality Risk.” Journal of Clinical Epidemiology 50: 693–703.CrossRefGoogle Scholar
  21. Gregg, E.W., Y.J. Cheng, B.L. Cadwell, G. Imperatore, D.E. Williams, K.M. Flegal, K.M.V. Narayan, and D.F. Williamson. 2005. “Secular Trends in Cardiovascular Disease Risk Factors According to Body Mass Index in US Adults.” Journal of the American Medical Association 293: 1868–74.CrossRefGoogle Scholar
  22. Hummer, R.A., C.G. Ellison, R.G. Rogers, B.E. Moulton, and R.R. Romero. 2004. “Religious Involvement and Adult Mortality in the United States: Review and Perspective.” Southern Medical Journal 97: 1223–30.CrossRefGoogle Scholar
  23. Hummer, R.A., R.G. Rogers, R. Masters, and J.M. Saint Onge. 2009. “Mortality Patterns in Late Life.” Pp. 521–42 in International Handbook of Population Aging, edited by P. Uhlenberg. New York: Springer Publishers.CrossRefGoogle Scholar
  24. Hummer, R.A., R.G. Rogers, C.B. Nam, and C.G. Ellison. 1999. “Religious Involvement and U.S. Adult Mortality.” Demography 36: 273–85.CrossRefGoogle Scholar
  25. Jacobs, D., H. Blackburn, M. Higgins, D. Reed, H. Iso, G. McMillan, J. Neaton, J. Nelson, J. Potter, and B. Rifkind. 1992. “Reports of the Conference on Low Blood Cholesterol: Mortality Associations.” Circulation 86: 1046–60.Google Scholar
  26. Jagger, C., R. Matthews, F. Matthews, T. Robinson, J-M. Robine, and C. Brayne. 2007. “The Burden of Diseases on Disability-Free Life Expectancy in Later Life.” Journals of Gerontology: Medical Sciences 62A: 408–14.Google Scholar
  27. Kalben, B.B. 2000. “Why Men Die Younger: Causes of Mortality Differences by Sex.” North American Actuarial Journal 4: 83–111.Google Scholar
  28. Kiecolt-Glaser, J.K., L. McGuire, T.F. Robles, and R. Glaser. 2002. “Emotions, Morbidity, and Mortality: New Perspectives From Psychoneuroimmunology.” Annual Review of Psychology 53: 83–107.CrossRefGoogle Scholar
  29. Klatsky, A.L. and N. Udaltsova. 2007. “Alcohol Drinking and Total Mortality Risk.” Annals of Epidemiology 17(5): S63-S67.CrossRefGoogle Scholar
  30. Kom, E., B.I. Graubard, and D. Midthune. 1997. “Time-to-Event Analysis of Longitudinal Follow-up of a Survey: Choice of the Time-Scale.” American Journal of Epidemiology 145: 72–80.Google Scholar
  31. Kung, H.C., D.L. Hoyert, J. Xu, and S.L. Murphy. 2008. “Deaths: Final Data for 2005.” National Vital Statistics Reports 56(10): 1–124.Google Scholar
  32. Liu, H. and D.J. Umberson. 2008. “Marital Status and Health Differentials From 1972 to 2003.” Journal of Health and Social Behavior 49: 239–53.CrossRefGoogle Scholar
  33. Lyon, J.L., H.P. Wetzler, J.W. Gardner, M.R. Klauber, and R.R. Williams. 1978. “Cardiovascular Mortality in Mormons and Non-Mormons in Utah, 1969–1971.” American Journal of Epidemiology 108: 357–66.Google Scholar
  34. Marang-van de Mheen, P.J., G.D. Smith, C.L. Hart, and D.J. Hole. 2001. “Are Women More Sensitive to Smoking Than Men? Findings From the Renfrew and Paisley Study.” International Journal of Epidemiology 30: 787–92.CrossRefGoogle Scholar
  35. McCullough, M., D. Larson, W. Hoyt, H. Koenig, and C. Thoresen. 2000. “Religious Involvement and Mortality: A Meta-Analytic Review.” Health Psychology 19: 211–22.CrossRefGoogle Scholar
  36. Merrill, R.M. and J.L. Lyon. 2005. “Cancer Incidence Among Mormons and Non-Mormons in Utah (United States) 1995–1999.” Preventive Medicine 40: 535–41.CrossRefGoogle Scholar
  37. Moen, P., D. Dempster-McClain, and R.M. Williams, Jr. 1989. “Social Integration and Longevity: An Event History Analysis of Women’s Roles and Resilience.” American Sociological Review 54: 653–47.CrossRefGoogle Scholar
  38. Moffitt, R. 2005. “Remarks on the Analysis of Causal Relationships in Population Research.” Demography 42: 91–108.CrossRefGoogle Scholar
  39. Nathan, D.M., D.E. Singer, K. Hurxthal, and J.D. Goodson. 1984. “The Clinical Information Value of the Glycosylated Hemoglobin Assay.” New England Journal of Medicine 310: 341–46.CrossRefGoogle Scholar
  40. Nathanson, C.A. 1984. “Sex Differences in Mortality.” Annual Review of Sociology 10: 191–213.CrossRefGoogle Scholar
  41. —. 1995. “Mortality and the Position of Women in Developed Countries.” Pp. 135–57 in Adult Mortality in Developed Countries: From Description to Explanation, edited by A.D. Lopez, G. Caselli, and T. Valkonen. Oxford, UK: Clarendon Press.Google Scholar
  42. National Center for Health Statistics. 1994. “Plan and Operation of the Third National Health and Nutrition Examination Survey, 1998–1994.” Vital and Health Statistics 1(32): 1–416.Google Scholar
  43. -.2005. “Third National Health and Nutrition Examination Survey (NHANES III) Linked Mortality File: Matching Methodology.” Available online at Scholar
  44. -. 2007a. Health, United States, 2007. Hyattsville, MD.Google Scholar
  45. -.2007b. “NHANES III Linked Mortality File.” Available online at Scholar
  46. Osei, K., S. Rhinesmith, T. Gaillard, and D.I. Schuster. 2003. “Is Glycosylated Hemoglobin A1c a Surrogate for Metabolic Syndrome in Nondiabetic, First-Degree Relatives of African-American Patients With Type 2 Diabetes?” Journal of Clinical Endocrinology and Metabolism 88: 4596–601.CrossRefGoogle Scholar
  47. Paffenbarger, R.S., R.T. Hyde, A.L. Winge, and C.C. Hsieh. 1986. “Physical Activity, All-Cause Mortality and Longevity of College Alumni.” New England Journal of Medicine 314: 605–13.CrossRefGoogle Scholar
  48. Pampel, F.C. 2002. “Cigarette Use and the Narrowing Sex Differential in Mortality.” Population and Development Review 28: 77–104.CrossRefGoogle Scholar
  49. —. 2005. “Forecasting Sex Differences in Mortality in High Income Nations: The Contribution of Smoking.” Demographic Research 13: 455–84.CrossRefGoogle Scholar
  50. Passannante, M.R. and C.A. Nathanson. 1985. “Female Labor Force Participation and Female Mortality in Wisconsin 1974–1978.” Social Science and Medicine 21: 655–65.CrossRefGoogle Scholar
  51. Pearson, T.A., G.A. Mensah, R.W. Alexander, R.O. Cannon, M. Criqui, Y.Y. Fadl, S.P. Fortmann, Y. Hong, G.L. Myers, N. Rifai, S.C. Smith, K. Taubert, R.P. Tracy, F. Vinicor. 2003. “Markers of Inflammation and Cardiovascular Disease. Application to Clinical and Public Health Practice. A Statement for Healthcare Professionals From the Centers for Disease Control and Prevention and the American Heart Association.” Circulation 107: 499–511.CrossRefGoogle Scholar
  52. Preston, S.H. and H. Wang. 2006. “Sex Mortality Differences in the United States: The Role of Cohort Smoking Patterns.” Demography 43: 631–46.CrossRefGoogle Scholar
  53. Retherford, R.D. 1972. “Tobacco Smoking and the Sex Mortality Differential.” Demography 9: 203–16.CrossRefGoogle Scholar
  54. Ridker, P.M. 2003. “C-Reactive Protein: A Simple Test to Help Predict Risk of Heart Attack and Stroke.” Circulation 108: 81–85.CrossRefGoogle Scholar
  55. Rieker, P.P. and C.E. Bird. 2000. “Sociological Explanations of Gender Differences in Mental and Physical Health.” Pp. 98–113 in Handbook of Medical Sociology, 5th ed., edited by C.E. Bird, P. Conrad, and A.M. Fremont. Upper Saddle River, NY: Prentice Hall.Google Scholar
  56. Rogers, R.G., R.A. Hummer, P.M. Krueger, and F.C. Pampel. 2005. “Mortality Attributable to Cigarette Smoking in the United States.” Population and Development Review 31: 259–92.CrossRefGoogle Scholar
  57. Rogers, R.G., R.A. Hummer, and C.B. Nam. 2000. Living and Dying in the USA: Behavioral, Health, and Social Differentials of Adult Mortality. New York: Academic Press.Google Scholar
  58. Ross, C.E., J. Mirowsky, and K. Goldsteen. 1990. “The Impact of Family on Health: The Decade in Review.” Journal of Marriage and the Family 52: 1059–78.CrossRefGoogle Scholar
  59. Schnittker, J. 2007. “Working More and Feeling Better: Women’s Health, Employment, and Family Life, 1974–2004.” American Sociological Review 72: 221–38.CrossRefGoogle Scholar
  60. Schoen, R. and R.M. Weinick. 1993. “The Slowing Metabolism of Marriage: Figures From 1988 U.S. Marital Status Life Tables.” Demography 30: 737–46.CrossRefGoogle Scholar
  61. Selvin, E., S. Marinopoulos, G. Berkenblit, T. Rami, F.L. Brancati, N.R. Powe, and S.H. Golden. 2004. “Meta-Analysis: Glycosylated Hemoglobin and Cardiovascular Disease in Diabetes Mellitus.” Annals of Internal Medicine 141: 421–41.Google Scholar
  62. South, S.J. and K.D. Crowder. 2000. “The Declining Significance of Neighborhoods? Marital Transitions in Community Context.” Social Forces 78: 1067–99.CrossRefGoogle Scholar
  63. StataCorp. 2007. Stata Statistical Software: Release 10.0. College Station, TX: Stata Corp.Google Scholar
  64. Trovato, F. and N.M. Lalu. 1996. “Narrowing Sex Differentials in Life Expectancy in the Industrialized World: Early 1970’s to Early 1990’s.” Social Biology 43(1–2): 20–37.Google Scholar
  65. Umberson, D. 1992. “Gender, Marital Status, and the Social Control of Health Behavior.” Social Science and Medicine 34: 907–17.CrossRefGoogle Scholar
  66. Umberson, D., M.D. Chen, J.S. House, K. Hopkins, and E. Slaten. 1996. “The Effect of Social Relationships on Psychological Well-being: Are Men and Women Really So Different?” American Sociological Review 61: 837–57.CrossRefGoogle Scholar
  67. United Nations. 1991. The World’s Women, 1970–1990: Trends and Statistics. Social Statistics and Indicators, Series K, No. 8. New York: United Nations.Google Scholar
  68. U.S. Department of Health and Human Services (DHHS). 1990. The Health Benefits of Smoking Cessation. A Report of the Surgeon General. HHS Pub. No (CDC) 90-8416. Atlanta, GA.: HHS, Public Health Service, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.Google Scholar
  69. —. 2000. Healthy People 2010. 2nd ed. With Understanding and Improving Health and Objectives for Improving Health. 2 vols. Washington, DC: USGPO.Google Scholar
  70. -. 2003. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). NIH Publication No. 03-5233. Available online at Scholar
  71. U.S. Department of Labor. 2008. Women in the Labor Force: A Databook. Report 1011. Available online at Scholar
  72. Valkonen, T. and F. van Poppel. 1997. “The Contribution of Smoking to Sex Differences in Life Expectancy: Four Nordic Countries and The Netherlands 1970–1989.” European Journal of Public Health 7: 302–10.CrossRefGoogle Scholar
  73. Verschuren, W.M.M., D.R. Jacobs, B.P.M. Bloemberg, D. Kromhout, A. Menotti, C. Aravanis, H. Blackburn, R. Buzina, A.S. Dontas, F. Fidanza, M. Karvonen, S. Nedelijović, A. Nissinen, and H. Toshima. 1995. “Serum Total Cholesterol and Long-Term Coronary Heart Disease Mortality in Different Cultures. Twenty Five Year Follow-Up of the Seven Countries Study.” Journal of the American Medical Association 274: 131–36.CrossRefGoogle Scholar
  74. Visser, M., S.B. Kritchevsky, A.B. Newman, B.H. Goodpaster, F.A. Tylavsky, M.C. Nevitt, and T.B. Harris. 2005. “Lower Serum Albumin Concentration and Change in Muscle Mass: The Health, Aging and Body Composition Study.” American Journal of Clinical Nutrition 82: 531–37.Google Scholar
  75. Waite, L.J. and M. Gallagher. 2000. The Case for Marriage: Why Married People Are Happier, Healthier, and Better Off Financially. New York: Doubleday.Google Scholar
  76. Waldron, I. 1985. “What Do We Know About Causes of Sex Differences in Mortality? A Review of the Literature.” Population Bulletin of the United Nations 18: 59–76.Google Scholar
  77. —. 1986. “The Contribution of Smoking to Sex Differences in Mortality.” Public Health Reports 101: 163–73.Google Scholar
  78. —. 1995. “Contributions of Biological and Behavioural Factors to Changing Sex Differences in Ischaemic Heart Disease Mortality.” Pp. 161–78 in Adult Mortality in Developed Countries: From Description to Explanation, edited by A.D. Lopez, G. Caselli, and T. Valkonen. Oxford, UK: Clarendon Press.Google Scholar
  79. Waldron, I., C. McCloskey, and I. Earle. 2005. “Trends in Gender Differences in Accidents Mortality: Relationships to Changing Gender Roles and Other Societal Trends.” Demographic Research 13: 415–54.CrossRefGoogle Scholar
  80. Wingard, D.L. 1982. “The Sex Differential in Mortality Rates: Demographic and Behavioral Factors.” American Journal of Epidemiology 115: 205–16.Google Scholar
  81. Wingard, D.L., L. Suarez, and E. Barrett-Connor. 1983. “The Sex Differential in Mortality From All Causes and Ischemic Heart Disease.” American Journal of Epidemiology 117: 165–72.Google Scholar
  82. World Health Organization (WHO). 2007. International Statistical Classification of Diseases and Related Health Problems, 10th Revision. Geneva: WHO.Google Scholar

Copyright information

© Population Association of America 2010

Authors and Affiliations

  • Richard G. Rogers
    • 1
    Email author
  • Bethany G. Everett
    • 1
  • Jarron M. Saint Onge
    • 2
  • Patrick M. Krueger
    • 3
  1. 1.Population Program, 484 UCBUniversity of ColoradoBoulder
  2. 2.Department of SociologyUniversity of HoustonUSA
  3. 3.University of ColoradoDenver

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