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Sex differences in mortality: Results from a population-based study of 12 longitudinal cohorts

Lookup NU author(s): Dr Yu-Tzu WuORCiD, Dr Martin Prince, Professor Matthew Prina



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2021 Joule Inc. or its licensors.BACKGROUND: Women generally have longer life expectancy than men but have higher levels of disability and morbidity. Few studies have identified factors that explain higher mortality in men. The aim of this study was to identify potential factors contributing to sex differences in mortality at older age and to investigate variation across countries. METHODS: This study included participants age ≥ 50 yr from 28 countries in 12 cohort studies of the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) consortium. Using a 2-step individual participant data meta-analysis framework, we applied Cox proportional hazards modelling to investigate the association between sex and mortality across different countries. We included socioeconomic (education, wealth), lifestyle (smoking, alcohol consumption), social (marital status, living alone) and health factors (cardiovascular disease, diabetes, mental disorders) as covariates or interaction terms with sex to test whether these factors contributed to the mortality gap between men and women. RESULTS: The study included 179 044 individuals. Men had 60% higher mortality risk than women after adjustment for age (pooled hazard ratio [HR] 1.6; 95% confidence interval 1.5-1.7), yet the effect sizes varied across countries (I2 = 71.5%, HR range 1.1-2.4). Only smoking and cardiovascular diseases substantially attenuated the effect size (by about 22%).

Publication metadata

Author(s): Wu Y-T, Niubo AS, Daskalopoulou C, Moreno-Agostino D, Stefler D, Bobak M, Oram S, Prince M, Prina M

Publication type: Article

Publication status: Published

Journal: CMAJ

Year: 2021

Volume: 193

Issue: 11

Pages: E361-E370

Online publication date: 15/03/2021

Acceptance date: 26/08/2020

Date deposited: 15/03/2023

ISSN (print): 0820-3946

ISSN (electronic): 1488-2329

Publisher: Canadian Medical Association


DOI: 10.1503/cmaj.200484

PubMed id: 33722827


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Funder referenceFunder name
US National Institute on Aging
Wellcome Trust
AG 08523–02
ATHLOS project
Australian Rotary Health Research Fund
European Union’s Horizon 2020
South Australian Health Commission