Survival and life expectancy inequality by gender in Thai provinces: Trends from 2015 to 2023

Background: Gender disparities in survival and life expectancy are indicative of broader health and socio-economic inequalities. This study examines temporal trends and subnational variations in gendered survival outcomes across Thailand’s 77 provinces between 2015 and 2023, emphasizing the impacts of the COVID-19 pandemic and environmental factors. For the first time, comprehensive provincial life tables have been produced for all Thai provinces for this period. Methods: Using civil registration data, life tables were constructed, from which life expectancy at birth (e0), at age 65 (e65), and survival probabilities between ages 20 and 65 were derived. Generalized additive models (GAM) with Poisson likelihood were employed to estimate mortality rates and analyze temporal trends and regional disparities. All analyses were conducted separately by sex. National-level estimates were computed as population-weighted aggregates of provincial estimates, from which life table indicators were derived consistently. Uncertainty intervals were estimated for key indicators. Results: From 2015 to 2023, the national gender gap in life expectancy at birth widened from 7.0 years to a peak of 7.7 years in 2021, primarily driven by increased male mortality during the COVID-19 pandemic. Provincial variations were substantial, with gender gaps ranging from 5.7 to 9.5 years. PM2.5 exposure measured in 2024 showed a moderate to strong negative correlation with life expectancy, highlighting significant environmental impacts. Conclusions: Persistent and geographically uneven gender disparities in life expectancy underscore the necessity for localized, gender-sensitive interventions targeting male mortality and environmental health risks.