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This chapter addresses the following Geriatric Fellowship Curriculum Milestone: #9

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LEARNING OBJECTIVES

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Learning Objectives

  • Understand the demographic metrics that define the female longevity advantage.

  • Identify disease patterns that differentially affect men and women.

  • Describe the health impacts of hormone transitions and replacement therapies for men and women.

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Key Clinical Points

  1. Women live longer than men in every country and in every historical epoch for which reliable information exists.

  2. Women appear more resistant than men to multiple fatal diseases, acquiring them at lower rates and/or later in life.

  3. Despite their broad survival advantage, women are more likely to suffer from physical ailments than men later in life.

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THE ROBUSTNESS OF SEX DIFFERENCES IN LONGEVITY

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Women live longer than men in every country and in every historical epoch for which reliable information exists. This fact is documented in the Human Mortality Database (www.mortality.org), which compiles historical demographic information from 37 countries over periods for which data are particularly dependable. Accordingly, the length of these records varies. Japan, currently the longest-lived country in the world, has good records beginning only in 1947 as most earlier records were destroyed during World War II. By contrast, Sweden has the longest period of reliable birth and death records of any country. Beginning in 1751 these records are moderately reliable, and they are very reliable from 1860 to the present day. Sweden’s life expectancy over these 250+-year period dipped as low as 18 years during periods of famine or pestilence and risen as high as today’s 82 years. However, in each and every year, regardless of overall life expectancy, women have outlived men (Figure 8-1). The same is true for each of the 37 countries in the Human Mortality Database for every year on record!

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FIGURE 8-1.

Demographic data from Sweden from 1751 to the present. A. Male and female life expectancies at birth show a steady increase after 1800 with occasional brief decreases due to war, famine, or infectious disease. B. Sex difference (Female minus Male) in life expectancy at birth and at age 50 is always positive, indicating greater female survival in all years for both ages. (Source: Human Demographic Database.)

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Understanding Life Expectancy

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To interpret sex differences in longevity—call it the “life expectancy gender gap”—it is useful to understand the meaning of two demographic parameters. The first of these is life expectancy itself. Life expectancy, unlike its name suggests, does not measure the expectation of future life, which is by its nature not really knowable. Life expectancy, as typically used in describing human longevity, measures past life. That is, as most commonly reported, life expectancy is equivalent to the average age of death of all ...

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