Evolution Of Sex Gap In Life Expectancy Across High-Income Countries: Universal Patterns And Country-Specific Attributes

The sex gap in life expectancy (LE) at birth is currently narrowing in all high-income countries. Previous research on Western European and English-speaking (WE&ES) countries suggested that smoking-related mortality at ages 50+ was largely responsible for both widening and subsequent narrowing of the gap. However, countries of Central and Eastern Europe (CEE) have had particularly high excess male mortality at young and middle ages that couldn`t be fully attributed to the smoking-related causes. We use the Human Mortality Database to examine the patterns and time trends in male/female differences in LE across 41 high-income countries and 7 country groups from 1959 until the latest available year. Contour decomposition is applied to estimate the contribution of different ages to the maximum sex gap and its change ever since. While the UK was the first country to reach the peak in the sex gap in 1969, Greece did it half a century later, in 2009. The largest male disadvantage in LE was observed in Russia in 2005 (13.7 years), Israel had a peak in 1999 with just 4.4 years. There is a persistent difference between countries and particularly country groups in the age-specific contribution to the maximum sex gap. In WE&ES countries ages older than 50 play the major role in determining the sex gap while CEE countries have high excess male mortality in young and middle ages (20-50). The narrowing of the sex gap in CEE countries hasn`t substantially changed the age contribution. Mortality at ages younger than 50 still plays an important role in determining the sex gap in LE in these countries. Differences in the sex gap between countries add a new dimension to a previously established East-West mortality divide. Country specifics must be taken into account to develop public health policies aimed at reducing sex mortality inequalities