Why men often die earlier than women

Robert Shmerling, MD, 

My wife recently asked me, “Why do you assume you’ll die before me?”
Her question caught me by surprise. But it’s true, I have made that assumption. So, I answered, as matter-of-factly as I could, with one word: statistics.
I knew that, on average, women live longer than men. In fact, 57% of all those ages 65 and older are female. By age 85, 67% are women. The average lifespan is about 5 years longer for women than men in the U.S., and about 7 years longer worldwide.
It’s not hard to see the gender gap among the elderly. A glance around most nursing homes or assisted living facilities in the U.S. often tells the story: women will usually outnumber men, and the magnitude of the difference is often striking. I’m also told that when a man moves into a residential setting dominated by the geriatric set, he tends to be popular; and that’s especially true if he still drives.
Advertisers know this as well. I recently saw an ad for an organization called “A Place for Mom” that helps families find assisted living or other services for senior citizens. And while they help men as well as women, the name of the company reflects how much bigger the elderly female market is.

So why do men, on average, die first?

There are many reasons why the ratio of men to women (which is roughly equal in young adulthood) starts to favor women over time. Among the most powerful factors? Men tend to

• take bigger risks. Some of the reason seems to be “biological destiny.” The frontal lobe of the brain — the part that controls judgment and consideration of an action’s consequences — develops more slowly in boys and young men than in their female counterparts. This likely contributes to the fact that far more boys and men die in accidents or due to violence than girls and women. Examples include biking, driving drunk, and homicide. This tendency toward lack of judgment and consideration of consequences may also contribute to detrimental lifestyle decisions among young men, such as smoking or drinking to excess.
• have more dangerous jobs. Men far outnumber women in some of the riskiest occupations, including military combat, firefighting, and working at construction sites.
• die of heart disease more often and at a younger age. In fact, men are 50% more likely than women to die of heart disease. The fact that men have lower estrogen levels than women may be part of the reason. But medical risks, such as poorly treated high blood pressure or unfavorable cholesterol levels, may contribute as well.
• be larger than women. Across many species, larger animals tend to die younger than smaller ones. Although the magnitude of this effect is uncertain in humans, it tends to work against male longevity.
• commit suicide more often than women. This is true despite the fact that depression is considered more common among women and women make more (non-fatal) suicide attempts. Some attribute this to the tendency for men to avoid seeking care for depression and the cultural norms that discourage men from seeking help for mental illness.
• be less socially connected. For reasons that aren’t entirely clear, people with fewer and weaker social connections (including men) tend to have higher death rates.
• avoid doctors. According to the Agency for Healthcare Research and Quality, men are far more likely to skip routine health screens and far less likely than women to have seen a doctor of any kind during the previous year.

The uneven playing field for boys starts early. The Y chromosome tends to develop mutations more often than X chromosomes and the lack of a second X chromosome in men means that X-linked abnormalities among boys are not “masked” by a second, normal version. Survival in the womb is also less reliable for male fetuses (for uncertain, and probably multiple, reasons). Developmental disorders are also more common among boys; some of these could shorten life expectancy.

What we can do to help men live longer

While there’s not much that can be done about some of these factors, others are modifiable. For example, since men tend to avoid medical care far more often than women, getting men to report symptoms (including depression) and go for regular follow-up for chronic medical problems (such as high blood pressure) could counter some of the tendency for them to die younger.
It’s also worth noting that the survival gap between men and women reflects an average tendency among large numbers of people. In fact, plenty of wives predecease their husbands. Individual risk factors (such as smoking, diabetes, or a strong family history of breast cancer) can outweigh the general tendency for women to live longer.
Perhaps we’ll be more successful in the future in avoiding preventable, premature death among men (and women) — and, because many of these efforts will have a bigger impact on men, the gender gap among the elderly may eventually narrow. Until then, my wife and I will do what we can to stay healthy. But, statistics don’t lie. I’ll probably die first.

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