期刊
CANADIAN MEDICAL ASSOCIATION JOURNAL
卷 193, 期 11, 页码 E361-E370出版社
CMA-CANADIAN MEDICAL ASSOC
DOI: 10.1503/cmaj.200484
关键词
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资金
- 5-year Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project
- European Union [635316]
- Wellcome Trust [GR066133/GR080002, WT064947, WT081081]
- European Research Council [340755]
- US Alzheimer's Association
- World Health Organization (WHO)
- FONDACIT (Venezuela)
- Puerto Rico State Government
- Medical Research Council [MR/K021907/1]
- South Australian Health Commission
- Australian Rotary Health Research Fund
- US National Institute on Aging [AG 08523-02]
- Office for the Ageing (South Australia [SA])
- National Health and Medical Research Council [NHMRC 22922]
- Premiers Science Research Fund (SA)
- Australian Research Council [DP0879152, DP130100428]
- Hellenic Cardiology Society [HCS2002]
- Hellenic Atherosclerosis Society [HAS2003]
- European Community [223071]
- Instituto de Salud Carlos III-FIS [PS09/00295, PS09/01845, PI12/01490, PI13/00059, PI16/00218, PI16/01073]
- Spanish Ministry of Science and Innovation ACI-Promociona [ACI2009-1010]
- European Regional Development Fund (ERDF) A Way to Build Europe [PI12/01490, PI13/00059]
- Centro de Investigacion Biomedica en Red de Salud Mental, Instituto de Salud Carlos III
- Polish Ministry for Science and Higher Education [1277/7PR/UE/2009/7]
- Jagiellonian University Medical College [K/ZDS/005241]
- Ministry of Health of Spain, FIS grant [12/1166]
- Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica, Instituto de Salud Carlos III
- US National Institute of Aging [1RO1AG23522, U01_ AG09740-13S2, P01_ AG005842, P01_ AG08291, P30_ AG12815, R21_ AG025169, Y1-AG-4553-01, IAG_ BSR06-11, OGHA_ 04-064, HHSN271201300071C]
- National Centre for Social Research
- University College London
- MacArthur Foundation Initiative on Social Upheaval and Health
- National Institute on Aging [NIA U01AG009740]
- Social Security Administration
- Korea Employment Information Service (KEIS)
- Korea Labor Institute's KLOSA Team
- European Commission [QLK6-CT-2001-00360, SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812, 211909, 227822, 261982]
- German Ministry of Education and Research
- Max Planck Society for the Advancement of Science
- Elderly Citizens Homes (SA)
- Sanofi-Aventis
- Institute for Fiscal Studies
- European Research Council (ERC) [340755] Funding Source: European Research Council (ERC)
This study found that men have a 60% higher mortality risk than women at older age, with variations across countries. Smoking and cardiovascular diseases were key factors contributing to the reduction in mortality gap.
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 (I-2 = 71.5%, HR range 1.1-2.4). Only smoking and cardiovascular diseases substantially attenuated the effect size (by about 22%). INTERPRETATION: Lifestyle and health factors may partially account for excess mortality in men compared with women, but residual variation remains unaccounted for. Variation in the effect sizes across countries may indicate contextual factors contributing to gender inequality in specific settings.
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