Introduction to Issue on Gender Dynamics and Disparities in Health and Mortality

Trends in American mortality over the past few decades find American women doing worse than men in the United States and worse than women in other countries. For example, since 1980, U.S. women have lost 1–6 years of life expectancy relative to women in comparably wealthy nations, and 2–3 years of life expectancy relative to American males (Crimmins, Preston, and Cohen 2010, 2011). Other health indicators for Americans are also worse than those for many other high income countries, especially for women (Crimmins, Garcia, and Kim 2010). These findings inspired the development of the Network on Lifecourse Health Dynamics and Disparities in 21st Century America, directed by James S. House, Robert A. Hummer, Mark D. Hayward, and Eileen M. Crimmins and supported by the National Institute on Aging (NIA R24AG045061). This group dedicated its first meeting and pilot proposals to the topic of Gender Dynamics and Disparities in Health and Mortality, and this special issue presents some of the papers from that meeting along with other submissions on the topic.

Articles in this issue shed some light on the causes of differential mortality trends. Rivadeneira and Noymer (2017) clarify that as women smoke more, or, that is, as they behave more like men, their lung cancer mortality becomes like that of men; the shapes of their mortality curves from lung cancer have converged since 1983. This change in smoking behavior has been recognized as one of the major reasons for both the poor performance of trends in mortality among American women and their relatively poor mortality compared to that of women in other countries, and this article presents an interesting interaction of the period effect of smoking change across different cohort mortalities.

Masters, Tilstra, and Simon (2017) suggest that recent increases in extrinsic mortality among the middle-aged U.S. white population are overwhelmingly driven by rapid increases in drug-related mortality. Because of stability in the contributions of chronic liver disease and suicide to U.S. mortality levels for the past 30 years, the explanation offered by Case and Deaton (2015) that distress among the middle-aged U.S. white population is a common cause driving trends in U.S. white mortality is called into question.

The article on mortality, by Falconi (2017), assessed evidence that conditions at midlife among women can significantly influence or “program” later life longevity. She interprets the significant inverse association between mortality during the perimenopausal period and life expectancy at age 60 among women in three countries as indicating a plasticity associated with women’s aging in the perimenopause.

Zajacova and Montez (2017) examine recent trends in functional limitations and disability among middle-aged women and men from 2000–2015, further documenting the adverse trends in health for those of lower socioeconomic status. They find that only among those with at least a college degree was there no deterioration in functioning in this period. For this group there was no change in disability and only a mild increase in limitations over time. All other education levels experienced significant increases in functioning problems. These adverse trends are important indicators of worsening health in a population that has not yet reached older age.

Olsen, Hummer, and Harris (2017) deepen our understanding of behavioral contributions to gender disparities in health among younger adults. They find poor health behavior characterizes 40 percent of men but only about half as many women (22 percent). Importantly, they find that women age out of unhealthy behaviors in young adulthood more than men.

This special issue thus increases our understanding of the behavioral and physiological differences between men and women that influence their differential trends in both health and mortality. None of the findings lead to an optimistic outcome for quick changes in trends.