Illustrating Global Health 3: No. Seriously. What About The Men?

So the annual furore over White Ribbon Day got me thinking about gendered differences in causes of death, and I decided to have a play around with the cause graphs from the GBD to see which causes predominate in which gender. I already knew that violence and suicide were more common causes of death among men, but I assumed that there would be other categories in which women significantly outnumbered men, and that it might be an even split over all. In fact, as I was surprised to discover, this apparently isn’t so. Female deaths exceed male deaths in only one category; maternal mortality. In all other broad categories, the sexes appear to be evenly matched, or there are a greater number of deaths in males.

The most dramatic over-representation, unsurprisingly, is in deaths due to violence and suicide (the GBD Study counts these together as “intentional injury”), traffic, and other accidents.

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In chronic diseases other than heart disease, including cancer, men lead to a less dramatic degree, and this is largely attributable to a greater burden from cancer, chronic respiratory disease (eg emphysema), and to a lesser extent liver cirrhosis. Men outnumber women only slightly in cardiovascular mortality. I had thought that more men than women died of cardiovascular disease in the West, but apparently this isn’t the case – here, female deaths actually do exceed male deaths. This could be due to deaths among young women in the west being rare enough that we usually live long enough to die of cardiovascular disease in old age, while deaths among young males are about twice as  common.

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Likewise with the “big three” (HIV, Tuberculosis and Malaria), men contribute approximately 60% of all deaths. I was quite surprised by this, as I assumed that women being at higher risk of HIV in high burden regions would result in them contributing a greater number of deaths than men.

Gender HIV Tb Malaria

The gap closes further with diseases of childhood (other than malaria), although boys apparently still suffer slightly higher mortality than girls due to neonatal disorders (such as preterm birth and neonatal infections).

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I wondered if the under-representation of women was due to deaths in childbirth occurring at younger ages than other things might (with the consequence that some women aren’t surviving long enough to die of chronic disease in old age) but this doesn’t seem especially likely. Around 29 million men died in 2010, compared to around 24 million women, and only around 250 thousand of these died due to maternal complications, which isn’t sufficient to explain their under representation among deaths from other causes. Male deaths due to violence, injury and traffic accidents are easy to explain. More deaths to chronic diseases among males may be due to late presentation and reduced engagement with medical care by males, which is well recognised in the West and may be prevalent in other regions as well. Neither I nor the paediatric nurse sitting next to me can explain the difference childhood deaths. All these things in combination, though, contribute to the reduced life expectancy of men relative to women in many regions.

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