Sex differentials in Swiss cancer mortality

Summary Swiss national cancer mortality statistics from 1951 to 1984 and survival rates from the Vaud Cancer Registry datafile over the period 1974–1980 were considered in terms of sex ratios. Overal age-standardized cancer mortality for population aged 35–64 showed only a moderate decline in males (from 230 to 221/100,000), but a substantial one in females (from 191 to 152/100,000). Mortality from most cancer sites (except gallbladder and thyroid) was persistently higher in males, the male/female ratio ranging between 1.2 for intestines, skin, brain and lympho-reticular neoplasms to about 2 for stomach or pancreas, up to 7–10 for lung and cancers related to tobacco and alcohol (mouth or pharynx, oesophagus). The sex ratio for lung cancer increased between the early 1950's and the mid 1960's, but noticeably declined thereafter, probably reflecting trends in smoking prevalence among subsequent generations of Swiss males and females. Less obvious is the substantial increase in the sex ratio for liver cancer (from 1.6 to 5.7), which was evident in younger middle age, too. Population-based cancer survival statistics indicated that for most common sites rates were appreciably higher in females than in males. Thus, better survival explains part of the advantage in cancer mortality for women. This can be related to earlier diagnosis, better compliance or responsiveness to treatment, although there is no obvious single interpretation for this generalized more favourable pattern in females.

---

Geschlechtsunterschiede der Krebssterblichkeit in der Schweiz

Zusammenfassung Die Schweizerische Krebsmortalitätsstatistik von 1959 bis 1984 und Überlebensziffern aus dem Waadtländer Krebsregister von 1977 bis 1980 werden auf Geschlechtsverhältnisse untersucht. Die altersstandardisierte Krebssterblichkeit für die 35- bis 64jährigen zeigte eine geringe Abnahme bei den Männern (von 230 auf 221 pro 100 000), aber einen starken Rückgang bei den Frauen (von 191 auf 152 pro 100 000). Die Mortalität der meisten Krebslokalisationen (mit Ausnahme der Gallenblase) blieb immer höher bei den Männern, das Verhältnis Männer/Frauen variierte zwischen 1,2 für Darm-, Haut-, Hirn- und lympho-reticuläre Neoplasien und etwa 2 für Magen- und Pankreascarzinom bis zu 7 bis 10 für Carzinome mit Beziehung zu Alkohol- und Tabakkonsum (Mund oder Pharynx, Oesophagus). Das Geschlechtsverhältnis für Lungencarzinome vergrösserte sich zwischen den frühen fünfziger Jahren und Mitte der sechziger Jahre, aber verringert sich seither deutlich, was wahrscheinlich die Veränderungen in der Häufigkeit des Rauchens späterer Generationen von Schweizer Männern und Frauen widerspiegelt. Weniger leicht für verstehen ist die starke Zunahme des Geschlechtsverhältnisses für Lebercarzinome (von 1,6 zu 5,7), welches auch im jüngeren Alter deutlich ist. Bevölkerungsbezogene Krebsüberlebensstatistiken zeigen für die meisten häufigen Lokalisationen deutlich höhere Ziffern für Frauen als für Männer. Damit scheint eine bessere Überlebenschance einen Teil der geringeren Krebsmortalität der Frauen zu erklären, Möglicherweise ist dies die Folge früherer Diagnose, besserer «compliance» oder von besserem Behandlungserfolg, obschon kaum eine gemeinsame offensichtliche Erklärung für diese allgemein bessere Überlebensstatistik bei den Frauen gefunden werden kann.

---

Les différences entre sexes de la mortalité cancéreuse en Suisse

Résumé Les statistiques suisses de mortalité par cancer 1951–1984 et les taux de survie estimés par le Registre Vaudois des Tumeurs pour la période 1974–1980 sont considérés sous la forme de rapports entre sexes (H/F). La mortalité cancéreuse globale corrigée pour l'âge n'a diminué de façon substantielle que chez la femme (de 191 à 152/ 100 000 versus de 230 à 221/100 000 pour les hommes). A l'exception de la vésicule biliaire et de la thyroïde, la mortalité liée à la plupart des localisations cancéreuses s'est maintenue constamment plus élevée chez l'homme, les rapports H/F allant de 1.2 pour les intestins, la peau, le cerveau et les néoplasies lympho-réticulaires à environ 2 pour l'estomac ou le pancréas et jusqu'à 7–10 pour le poumon et les cancers liés au tabac et à l'alcool (buccopharynx, oesophage). Le rapport H/F pour le cancer pulmonaire a augmenté entre le début des années 50 et la moitié des années 60, pour décroître nettement par la suite, ce qui reflète probablement les tendances de la prévalence de la consommation de tabac au sein des générations successives d'hommes et de femmes suisses. Moins évidente est l'interprétation de l'accroissement substantiel des rapports H/F pour le cancer hépatique (de 1.6 à 5.7), confirmé aussi dans les classes d'âge moyennes. Pour la plupart des localisations cancéreuses, les estimations de survie dans la population générale sont apparues nettement plus favorables chez les femmes, ce qui peut en partie expliquer la moindre mortalité cancéreuse de ces dernières. Ce tableau généralement plus favorable au sexe féminin ne trouve pas d'explication unique ou évidente, bien qu'il puisse être lié à un diagnostic plus précoce, à une meilleure «compliance» ou réponse au traitement.

     

Sex differentials in health.

Health status and health behavior of males and females in the United States are compared; the data employed in the analysis are from community studies and the surveys of the National Center for Health Statistics. Females generally show a higher incidence of acute conditions, higher prevalence of minor chronic conditions, more short-term restricted activity, and more use of health services (especially outpatient services) and medicines. By contrast, males have higher prevalence rates for life-threatening chronic conditions, higher incidence of injuries, more long-term disability, and after about age 50, higher rates of hospitalization. These sex differences appear at all ages, except for early childhood when boys have a worse health profile than girls. The following interpretations are consistent with the data; they are hypotheses rather than demonstrated facts. Women are more frequently ill than men, but with relatively mild problems. By contrast, men feel ill less often, but their illnesses and injuries are more serious. These morbidity differences help to explain sex differentials in health behavior; frequent symptoms lead to more restricted activity, physician and dentist visits, and drug use for women; severe symptoms lead to more permanent limitations and hospitalization for men. But attitudes about symptoms, medical care, drugs, and self-care are also extremely important. Males may be socialized to ignore physical discomforts; thus, they are unaware of symptoms that females feel keenly. Also, men may be less willing and able to seek medical care for perceived symptoms. When diagnosis and treatment are finally obtained, men''s conditions are probably more advanced and less amenable to control. Finally, men may be less willing and able to restrict their activities when ill or injured. Four important factors than underlie sex differentials in health are discussed: inherited risks of illness, acquired risks of illness and injury, illness and prevention orientations, and health reporting behavior. Statistics show that women ultimately have lower mortality rates than men--despite women''s more frequent morbidity and possibly because of more care for their illnesses and injuries. The apparent contradiction between sex differences in morbidity and mortality (females are sicker but males die sooner) is explored.     

Sex differentials in cardiovascular mortality: an ecological analysis

The objective of this study is to explain spatial variations in cardiovascular mortality by sex. Recognizing the interdependence of the various dimensions of the 'ecological complex', it is maintained that spatial variations in cardiovascular mortality by sex and the sex differentials in cardiovascular mortality are the consequences of environmental, sustenance organization, health technology, and demographic factors. The test of the model is based on U.S. county level cardiovascular mortality data for ages 25-65 for the period 1970-1980. The most distinctive feature of the results is that environment has the greatest impact on sex differentials in cardiovascular mortality followed by sustenance organization. In this regard, socioeconomic status is shown to be the single most important variable in explaining cardiovascular mortality rates for both sexes in most community types. The effect of health technology is not significant, and increased availability of health manpower and facilities are often found in conjunction with higher rates of cardiovascular mortality for both sexes. The results of this study confirm the importance of programs directed toward altering the basic environment and sustenance organization structures of communities rather than other ecological components such as health technology.     

Sex differentials in morbidity and mortality risks examined by age and cause in the same cohort

Many studies indicate that women live longer than men but report more physical illness. This report is the first prospective study of sex ratios for morbidity and mortality due to a variety of causes in a single cohort: a random sample of 5,239 adults, aged 30 years or older in 1965, who have been followed through 1983 (19 years) by cause and age. For both cancer incidence and mortality there was a female excess before age 50 years, followed by a male excess peaking between ages 60 and 69 years. Sex ratios for ischemic heart disease mortality, on the other hand, indicated a male excess at virtually all ages, and that these sex ratios declined with age. However, three measures of heart disease morbidity (self-reported chest pain, heart trouble, and high blood pressure) demonstrated a female excess that did not vary by age. All four measures of functional disability (impaired self-care, impaired mobility, cessation of work, and reduction of work) demonstrated a female excess that did not vary by age (with the exception of a male excess in impaired self-care in adults aged 30 to 39 years). Further analyses of sex differences in health need to acknowledge the heterogeneity of the relation of sex to disease, and the complex age-sex interaction that varies remarkably with both cause and manifestation of outcome (morbidity vs. mortality).     

Selection and mortality differentials.

The Office of Population Censuses and Surveys Longitudinal Study provides reliable mortality data by a much wider range of characteristics than are available for other national sources. Although it is based on only a 1% sample of the population, it broadens the scope of mortality analysis and permits study of changes in relationships using different aspects of the time dimension. Data from this study have made us increasingly aware of the importance of selection to the interpretation and understanding of observed mortality differentials. Here we focus on that aspect of selection called "health-related mobility," which is associated with the relative health of people acquiring or losing individual characteristics. It is suggested that, for characteristics affected by health-related mobility, mortality differentials would narrow or widen with increased duration of follow-up. One of the basis of this argument the contribution of health-related mobility to mortality differentials by economic position and social class, to regional differentials, and to family and household differentials is investigated. Selection can thus be shown to operate when people change economic position, when they migrate, or when they change marital status. While the effects of these selection processes can be shown to contribute to social class gradients they do not explain regional differentials and contribute only to a limited degree to differentials by marital status. Differentials by household circumstances also reflect the product of selection processes.     

Sex differences in health and mortality in Moscow and Denmark

In high income countries females outlive men, although they generally report worse health, the so-called male–female health-survival paradox. Russia has one of the world’s largest sex difference in life expectancy with a male disadvantage of more than 10 years. We compare components of the paradox between Denmark and Moscow by examining sex differences in mortality and several health measures. The Human Mortality Database and the Russian Fertility and Mortality Database were used to examine sex differences in all-cause death rates in Denmark, Russia, and Moscow in 2007–2008. Self-reported health data were obtained from the Study of Middle-Aged Danish Twins (n = 4,314), the Longitudinal Study of Aging Danish Twins (n = 4,731), and the study of Stress, Aging, and Health in Russia (n = 1,800). In both Moscow and Denmark there was a consistent female advantage at ages 55–89 years in survival and a male advantage in self-rated health, physical functioning, and depression symptomatology. Only on cognitive tests males performed similarly to or worse than women. Nevertheless, Muscovite males had more than twice higher mortality at ages 55–69 years compared to Muscovite women, almost double the ratio in Denmark. The present study showed that despite similar directions of sex differences in health and mortality in Moscow and Denmark, the male–female health-survival paradox is very pronounced in Moscow suggesting a stronger sex-specific disconnect between health indicators and mortality among middle-aged and young-old Muscovites.     

Early childhood health,reproduction of economic inequalities and the persistence of health and mortality differentials

The persistence of adult health and mortality socioeconomic inequalities and the equally stubborn reproduction of social class inequalities are salient features in modern societies that puzzle researchers in seemingly unconnected research fields. Neither can be satisfactorily explained with standard theoretical frameworks. In the domain of health and mortality, it is unclear if and to what an extent adult health and mortality disparities across socioeconomic status (SES) are the product of attributes of the positions themselves, the partial result of health conditions established earlier in life that influence both adult health and economic success, or the outcome of the reverse impact of health status on SES. In the domain of social stratification, the transmission of inequalities across generations has been remarkably resistant to satisfactory explanations. Although the literature on social stratification is by and large silent about the role played by early health status in shaping adult socioeconomic opportunities, new research on human capital formation suggests this is a serious error of omission. In this paper we propose to investigate the connections between these two domains. We use data from male respondents of the 1958 British Cohort to estimate (a) the influence of early health conditions on adult SES and (b) the contribution of early health status to observed adult health differentials. The model incorporates early conditions as determinants of traits that enhance (inhibit) social mobility and also conventional and unconventional factors that affect adult health and socioeconomic status. Our findings reveal that early childhood health plays a small, but non-trivial role as a determinant of adult SES and the adult socioeconomic gradient in health. These findings enrich current explanations of SES inequalities and of adult health and mortality disparities.     

Socioeconomic and occupational mortality differentials in Europe

Zusammenfassung In England und Wales, Frankreich und den skandinavischen Ländern wurden die sozio-ökonomischen und beruflichen Unterschiede der Sterblichkeit mit Daten aus den Volkszählungen und den Todesscheinen untersucht. Diese Studien zeigen die Beständigkeit eines sozialen Gradients im Bereich allgemeiner Sterblichkeit und weisen somit daraufhin, dass dieser Aspekt der sozialen Gerechtigkeit noch zu realisieren ist. Diese Studien liefern auch nützliche ergänzende Beiträge zu klinischen Studien über berufsspezifische Risikofaktoren. Es ist zu hoffen, dass noch mehr europäische Länder ihre diesbezüglichen Daten in ähnlicher Weise auswerten werden.

---

Différences socio-économiques et professionnelles de la mortalité en Europe

Résumé Au Royaume-Uni, en France et dans les pays scandinaves, les différences socio-économiques et professionnelles de la mortalité ont été étudiées en utilisant les données des recensements et des certificats de décès. Ces études font constater la persistance d'un gradient social de la mortalité générale, et montrent par conséquent que cet aspect de l'équité sociale doit encore Être réalisé. Ces études offrent également des compléments utiles aux études cliniques pour l'identification des risques spécifiques à certaines professions. Il faut souhaiter que d autres pays européens exploitent les données disponibles dans cette perspective.

     

Infant mortality trends and differentials in Nepal

Infant mortality trends and differentials are estimated from the 1981 Nepal Contraceptive Prevalence Survey (NCPS) and compared with similar estimates from the 1976 Nepal Fertility Survey (NFS) and the 1981 Census of Nepal. The analysis indicates that infant mortality rates derived directly from the NFS maternity histories are the most accurate. Infant mortality rates derived directly from the NCPS maternity histories are severely underestimated and yield a strongly biased trend that is the reverse of the true downward trend. Indirect estimates of infant mortality trends derived from child survivorship data do not result in a consistent pattern. Infant mortality differentials, when expressed in relative rather than absolute terms, are generally consistent with findings from earlier studies. Possible reasons for data quality differences among the three data sources are discussed.     

Inequality in health: socioeconomic differentials in mortality in Rome, 1990-95

STUDY OBJECTIVE: Population groups with a lower socioeconomic status (SES) have a greater risk of disease and mortality. The aim of this study was to investigate the relation between SES and mortality in the metropolitan area of Rome during the six year period 1990-1995, and to examine variations in mortality differentials between 1990-92 and 1993-95. DESIGN: Rome has a population of approximately 2,800,000, with 6100 census tracts (CTs). During the study period, 149,002 deaths occurred among residents. The cause-specific mortality rates were compared among four socioeconomic categories defined by a socioeconomic index, derived from characteristics of the CT of residence. MAIN RESULTS: Among men, total mortality and mortality for the major causes of death showed an inverse association with SES. Among 15-44 year old men, the strong positive association between total mortality and low SES was attributable to AIDS and overdose mortality. Among women, a positive association with lower SES was observed for stomach cancer, uterus cancer and cardiovascular disease, whereas mortality for lung and breast cancers was higher in the groups with higher SES. Comparing the periods 1990-92 and 1993-95, differences in total mortality between socioeconomic groups widened in both sexes. Increasing differences were observed for tuberculosis and lung cancer among men, and for uterus cancer, traffic accidents, and overdose mortality among women. CONCLUSIONS: The use of an area-based indicator of SES limits the interpretations of the findings. However, despite the possible limitations, these results suggest that social class differences in mortality in Rome are increasing. Time changes in lifestyle and in the prevalence of risk behaviours may produce differences in disease incidence. Moreover, inequalities in the access to medical care and in the quality of care may contribute to an increasing differentials in mortality.     

National trends in educational differentials in mortality

The authors examined national changes in socioeconomic differentials in mortality for middle-aged and older white men and women in the United States with the use of 1960 data from the Matched Records Study and 1971-1984 data from the first National Health and Nutrition Examination Survey (NHANES I) Epidemiologic Follow-up Study (NHEFS). In 1960, there was little difference in mortality by educational level among middle-aged and older men. Since 1960, death rates among men declined more rapidly for the more educated than the less educated, which resulted in substantial educational differentials in mortality in 1971-1984. In contrast, among women, death rates declined at about the same rate regardless of educational attainment, so that a strong inverse relation between education and mortality in 1960 remained about the same magnitude during 1971-1984. Trends in educational differentials for heart disease mortality are responsible for much of the change for all causes of death. Relative risk estimates based on the NHEFS indicate that after taking into account selected baseline risk factors the least educated are still at substantially elevated risk of death from heart disease, ranging from a relative risk of 1.38 for men aged 65-74 years at baseline to 2.27 for men aged 45-64 years. Reasons for the observed educational differentials and their changes over time are not easily explained and are likely to be multifactorial.     

Ethnic differentials in under-five mortality in Nigeria

Objective. There are huge regional disparities in under-five mortality in Nigeria. While a region within the country has as high as 222 under-five deaths per 1000 live births, the rate is as low as 89 per 1000 live births in another region. Nigeria is culturally diverse as there are more than 250 identifiable ethnic groups in the country; and various ethnic groups have different sociocultural values and practices which could influence child health outcome. Thus, the main objective of this study was to examine the ethnic differentials in under-five mortality in Nigeria.

Design. The study utilized 2008 Nigeria Demographic and Health Survey (NDHS) data. We analyzed data from a nationally representative sample drawn from 33,385 women aged 15–49 that had a total of 104,808 live births within 1993–2008. In order to examine ethnic differentials in under-five mortality over a sufficiently long period of time, our analysis considered live births within 15 years preceding the 2008 NDHS. The risks of death in children below age five were estimated using Cox proportional regression analysis. Results were presented as hazard ratios (HR) with 95% confidence intervals (CI).

Results. The study found substantial differentials in under-five mortality by ethnic affiliations. For instance, risks of death were significantly lower for children of the Yoruba tribes (HR: 0.39, CI: 0.37–0.42, p < 0.001), children of Igbo tribes (HR: 0.58, CI: 0.55–0.61, p < 0.001) and children of the minority ethnic groups (HR: 0.66, CI: 0.64–0.68, p < 0.001), compared to children of the Hausa/Fulani/Kanuri tribes. Besides, practices such as plural marriage, having higher-order births and too close births showed statistical significance for increased risks of under-five mortality (p < 0.05).

Conclusion. The findings of this study stress the need to address the ethnic norms and practices that negatively impact on child health and survival among some ethnic groups in Nigeria.     

Trends in regional and socio-economic mortality differentials in Finland

Trends in mortality in Finland are reviewed over the past 20 years. The author notes that "Finnish female life expectancy has increased more than five years since 1965-1969 and it is now slightly higher than the average in Western Europe. It is also almost five years higher than the average life expectancy in Eastern Europe. The male life expectancy has also risen by more than five years...." However, the author also states that regional differences in mortality have not diminished over this period, despite prevention programs designed to reduce such differences. Furthermore "socio-economic differences in mortality have increased during the same period among men, but had been relatively stable among the women."     

Socio-demographic mortality differentials: new longitudinal perspectives

Recently collected data deriving from Census and vital registration records for one per cent of the population of England and Wales followed prospectively is being used to shed light on issues which have been of central interest to epidemiologists for more than a century. This paper outlines the strengths and weaknesses of this new longitudinal approach.     

Aboriginal and non-Aboriginal health differentials in Australian prisoners

OBJECTIVE: Compare the self-reported physical and mental health of Aboriginal and non-Aboriginal prisoners in New South Wales (NSW). DESIGN: Cross-sectional random sample. SETTING: Twenty-nine correctional centres (27 male and two female) in NSW. PARTICIPANTS: 747 men (227 Aboriginal) and 167 women (29 Aboriginal) in full-time custody. METHODS: Face to-face interviews were used to record self-reported health status. RESULTS: Aboriginal prisoners differed significantly from non-Aboriginal inmates in several socio-demographic and criminographic factors. However, few differences were observed in health status between Aboriginal and non-Aboriginal men and women. After adjusting for age, Aboriginal men were more likely to report high blood pressure and diabetes. No differences were found in chronic health conditions in the female group. Aboriginal men had higher SF-36 scores than non-Aboriginal men on general health, vitality, and mental health. Aboriginal women had lower scores than non-Aboriginal women on social functioning and role-emotional but scored higher on the role-physical dimension. Aboriginal inmates were more likely to report seeing certain health professionals (doctors, dentists, drug and alcohol counsellors, and optometrists) in prison compared with the community. CONCLUSIONS: The health of Aboriginal and non-Aboriginal prisoners is remarkably similar in this population group. Few differences were observed in self-reported chronic health conditions. Aboriginal prisoners report using prison health services more while in prison compared with the community. This highlights that for many, prison is a rare opportunity to contact health services.     

Rural-urban differentials of premature mortality burden in south-west China

Background  

Yunnan province is located in south western China and is one of the poorest provinces of the country. This study examines the premature mortality burden from common causes of deaths among an urban region, suburban region and rural region of Kunming, the capital of Yunnan.