Gender differences in the cross-sectional and cohort age dependence of cause-specific mortality: the United States, 1962 to 1995.
OBJECTIVE: Gender- and age-specific mortality rates were calculated to determine the role of behavioral and biologically based differences in health. DESIGN: Changes in age-specific mortality rates were calculated for males and females across select time periods, in addition to gender- and cause-specific mortality age trajectories for birth cohorts for heart disease, stroke, and lung and breast cancer. Differences between cohort mortality age trajectories and the age pattern of mortality rates were related to socioeconomic differences between genders and to biological risk factors. SUBJECTS: U.S. males and females aged 30 to 95+ over the 34-year period 1962 to 1995. METHODS: Gender- and age-specific mortality rates were computed and displayed using the logarithmic transform of the rates for five-year age categories. RESULTS: Major gender cross-sectional mortality differences were found for heart disease, stroke, and lung cancer, with males being disadvantaged except for stroke. Less variation was found for lung cancer in recent male cohorts compared to large rates of change for recent female cohorts. Female breast cancer mortality showed modest variation, with most of the cohort differential in risk in postmenopausal breast cancer risk. Relative risk of lung cancer with age was greater for females. CONCLUSION: Differences in male and female cohort mortality rates underlie many of the period changes for heart disease, stroke, and lung cancer. Cohort differences were largest for lung cancer, although the cohort-specific smoking patterns these rates imply could also be responsible for some of the heart disease and mortality differences. The breast cancer mortality rates showed consistency with the concept of two distinct etiologies for breast cancer: premenopausal and postmenopausal. Large cohort increases in female lung cancer mortality may be alterable by behavioral measures and education.
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