Men in the U.S. Are Dying Nearly Six Years Before Women
Key Points
- The United States has seen a notable decline in life expectancy since the 1980s, now falling behind 50 other nations.
- Women generally outlive men, but the longevity gap between men and women has hit the largest it's been since 1996.
- Several factors are to blame, from COVID-19 and the opioid epidemic to a lack of access to health care, including mental health treatment.
Women in the United States have outlived men for over a century, but the longevity gap has increased since 2010. In 2021, the gap reached nearly six years.
COVID-19 undoubtedly contributed to the longevity gap, but other leading causes of death—including heart disease and unintentional injuries and poisonings—have taken an increasing number of men's lives since before the pandemic began.
Why do women live longer than men?
This gap is the highest in decades, according to the 2024 report published in JAMA Internal Medicine authored by health experts at the Centers for Disease Control and Prevention (CDC) and multiple top universities.
Women in the United States outlived men by 5.8 years in 2021. The disparity hasn't been so pronounced since 1996 and is nearly a year greater than the last low of 4.8 years recorded in 2010.
The Census Bureau predicts the longevity gulf between men and women will persist for the rest of the century, according to population estimates in a 2020 report.
"Biology accounts for some of the discrepancy," said Meleen Chuang, M.D., an OB-GYN and clinical associate professor at Family Health Centers at NYU Langone Health in New York City.
For example, women may have more robust immune systems and estrogen—a hormone more abundant in those assigned females at birth—may have protective effects on the heart. Just look at the numbers.
In the years between 2015 and 2018, heart disease affected about 44.4 percent of women in the U.S. as compared to 54.1 percent of men, indicated an American Heart Association 2022 report.
No distinctions were made for transgender or non-binary people in the research. However, the study authors noted there are many other factors at play.
Between 2010 and 2019, the researchers noted that the longevity gap widened by roughly two-and-a-half months primarily due to higher rates of accidental injuries (including overdoses), diabetes, heart disease, suicide and homicide among men.
Similar mortality rates between men and women for cancer and Alzheimer's disease and a high maternal mortality rate prevented the gulf from expanding further until 2020.
Between 2019 and 2021, the difference in the mortality rate for men increased more than threefold, due mainly to the disproportionate impact of COVID-19, accidental injuries, homicide, heart disease and suicide.
The COVID-19 virus
The coronavirus pandemic disproportionately affected men around the world, according to the World Health Organization (WHO). In 2020 and 2021, the virus claimed the lives of 57 percent of men and 43 percent of women who contracted it.
The virus killed 131 per 100,000 men and 82 per 100,000 women in the U.S.
Study authors pinpointed a few potential reasons, beginning with a higher disease burden, indicated in a 2021 report.
"From a biological standpoint, research indicates that estrogen exhibits anti-inflammatory effects, potentially offering protection against the inflammatory response linked to COVID-19," said Yoshua Quinones, M.D., an internist with Medical Offices of Manhattan in New York City.
"Diseases more prevalent in men, such as heart disease and hypertension, are known to increase the risk of severe COVID-19 illness," Chuang said.
Behavioral and socioeconomic factors may have contributed to the gap, according to the researchers.
Recommended
- It's 2024 and We're Still Living With COVID-19: New vaccines battle with new variants and, yes, you still need to be vaxed for COVID-19.
- Gray Matters: The Basics of Multiple Sclerosis: In the first of this four-part series, learn how to recognize the signs and symptoms of MS.
- Inherited Risk: What to Know About the BRCA Gene: If you have a mutation passed down by a parent, you may have a higher chance of getting cancer.
The deaths of despair
The study authors noted that besides COVID-19, the main driver of the life expectancy gap's increase was the ongoing drug overdose epidemic.
- More than 106,000 people in the U.S. died of drug overdose in 2021, indicated the National Institute on Drug Abuse 2024 report.
- From 2020 to 2021, men were two to three times more likely to die of drug overdoses than women, according to a 2023 study published in Neuropsychopharmacology.
- In 2020 and 2021, roughly 70 percent of accidental drug overdoses and 80 percent of suicides were among men, according to a 2023 report in the International Journal for Health Equity and the National Center for Health Statistics.
"While rates of death from drug overdose and homicide have climbed for both men and women, it is clear that men constitute an increasingly disproportionate share of these deaths," said first study author Brandon Yan, M.D., M.P.H., a resident physician at the University of California San Francisco, in a news release.
Men make up an increasingly disproportionate share of deaths by homicide, overdoses and suicide, also known as "deaths of despair."
Deaths of despair also encompass those related to alcohol, including alcoholic liver disease, which encompasses multiple disorders such as cirrhosis and hepatitis. The disease claimed 33,098 lives in the U.S., shared a 2021 report.
In the press release about the new research, Yan noted that the findings raise questions about the need to develop specialized care, including mental health treatment, for men.
Behavioral factors
"Much of the longevity gap is and always has been attributable to behavioral differences between the sexes," said Chuang.
For example, research suggests men are generally less likely to take preventative measures, such as eating a healthy diet, wearing a mask or seeking medical care, putting them at higher risk of disease and advanced-stage diagnoses.
Additionally, studies suggest men are more likely to engage in more risky behavior, from smoking and drug abuse to reckless driving and firearm use.
"Many of these behavioral discrepancies are tied to cultural pressures around masculinity," said Roshini Singh, M.S.N., A.R.N.P., a Lake Worth, Florida-based family nurse practitioner at 365 Wellness.
"In most cultures, men are expected to be strong and stoic. This can deter them from seeking help or discussing health concerns for fear of seeming weak," Singh said.
"Traditional masculine gender norms often discourage men from seeking help, leading to delayed medical care and poorer health outcomes," Chuang said. "Men are also more likely to engage in risk-taking behaviors, which can increase their susceptibility to accidents and injuries."
Men also tend to have less robust social support networks, Quinones noted. This may adversely affect their mental health, contributing to conditions such as chronic stress, depression and substance abuse, all of which can impact a person's overall health and longevity.
Socioeconomics
Disparities in access to healthcare and socioeconomic factors, including occupation, housing insecurity and incarceration, also tend to affect men's health disproportionately, Chang said.
"Men often find themselves in hazardous or physically demanding professions like construction or mining, increasing the likelihood of workplace injuries and long-term health issues," Quinones said.
Additionally, men made up about 70 percent of unhoused people in the U.S. in a 2018 report, according to the National Alliance to End Homelessness report and 93 percent of incarcerated people in the U.S. are men, per the 2024 report from the Federal Bureau of Prisons.
These circumstances may significantly increase men's vulnerability to numerous risks, from lack of access to healthcare to disease and violence.
Why is there a decrease in overall life expectancy in the U.S.?
From 2020 to 2021, the overall U.S. life expectancy dropped by nearly a year to 76.1 years. That's the lowest since 1996, according to a 2021 provisional report from the CDC. The drop followed a decline of 1.8 years in 2020, the most significant two-year decline since 1921-1923.
More than 50 countries now have a higher life expectancy than the U.S., according to a 2023 study published in the American Journal of Public Health.
Americans' average age at death increased dramatically in the early 1900s and fell around 1950, rebounding again in 1974 and dropping once more in 1983, indicated the report. Since then, the nation has seen a steady decline in life expectancy, primarily in a handful of South Central and Midwestern states.
U.S. healthcare policies and circumstances in the South and Midwest are likely the main reasons for this, the study authors noted.
Since 1999, COVID-19, the opioid crisis and the rise in chronic diseases such as heart disease and diabetes have played a major role in life expectancy, but research suggests several additional factors are at play.
"Socioeconomic factors such as income inequality, limited access to healthcare and inadequate social support systems have played a role," Chuang said.
"High stress levels, poor diet and inadequate exercise have harmed Americans' health as well," Singh said.
For example, research suggests a diet too low in fiber may contribute to conditions including the following:
- Irritable bowel syndrome (IBS)
- Heart disease
- Some cancers, such as colorectal cancer
High stress levels or chronic stress are associated with an increased risk of various conditions, including:
- Insomnia
- Depression
- Anxiety
- Heart disease
- Heart attack
- High blood pressure
- Muscle tension
- Pain
Chronic stress can exacerbate existing problems. Meanwhile, a lack of physical activity can raise the risk of mental health conditions, including depression and anxiety, and physical ailments, such as heart disease, obesity, type 2 diabetes, osteoporosis and certain cancers.
"The information shows big differences in how long people are expected to live, and these differences are influenced by things like COVID-19, differences in race and ethnicity, and how much money people have," Quinones said.
"Knowing about these differences reminds us that we need plans to make sure everyone has good access to healthcare and that specific help is given to different groups facing challenges. It also shows that we should take a full approach to healthcare and work on improving fairness in health," Quinones added.
The bottom line
Some contributors to the declining life expectancy in the United States—such as a worldwide pandemic—are uncontrollable. Other factors, including structural socioeconomic and policy issues, will take time to resolve.
"Leading a healthy lifestyle, seeking preventative care and promptly addressing health concerns can help to improve your life expectancy and quality of life," Chuang said.
Talk to your primary care provider for individualized advice based on your health and goals.
