Healthy Men: Why do girls live longer than boys?

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Dear Healthy Men: Recently, you wrote about why women live longer than women. When does the gender gap start? In other words, do girls live longer than boys?

A: The disparity between male and female death rates exists in every age group, from infants through age 19—and beyond. "Our analysis of the gender difference in mortality among persons under 20 years of age suggests the existence of a 'male syndrome,'" writes Sheri L. Balsara, lead author of a recent study on pediatric mortality. "We observed an overall female survival advantage that starts early in life and exists across many diverse causes of mortality."

Actually, that survival advantage exists even before birth. While more male babies are conceived, male fetuses suffer from a higher death rate at every stage of gestation but one (the 24th week), according to another of the study's researchers, Chris Feudtner, a pediatrician at the Children's Hospital of Philadelphia.

WHAT KINDS OF DISPARITIES ARE THERE IN CHILDREN?

When we talk about male-female health disparities, we're generally referring to the diseases and conditions that kill adult men and women: cancers, heart attacks, diabetes, and so on. If the discussion is about health disparities between male and female children and adolescents, the focus is usually on accidents, homicide, and suicide—all of which end the lives of two to six times more young males than females. But recent research has found that males are more likely than their female peers to die from a variety of other medical conditions as well. In fact, Balsara and other researchers have found that boys had higher death rates from conditions as varied as cancer, heart disease, lung and respiratory disease (such as the flu), infections, chromosomal abnormalities, diseases of the eyes and ears, and many others.

Overall, males under 20 were 44% more likely than females to die from any cause. But the male-female health disparity isn't limited to death. For example, boys are far more likely to be diagnosed with autism, learning disabilities, or ADHD, and they're more likely than girls to develop asthma, have weaker immune systems, and suffer from hearing problems (including hearing loss and tinnitus—ringing in the ears). A study by the Vermont Department of Mental Health found yet another area where boys seem to be at a biological disadvantage when compared with girls: Boys develop emotional and behavioral problems at younger ages than girls. Among children ages 4-7 who experienced "severe emotional disturbances," 91% were boys. Among those 16 and over when those disturbances surfaced, 65% were boys.

HOW BIG ARE THE HEALTH DISPARITIES?

"In each 5-year-span age group, males are at significantly greater risk and the number of males who died... exceeded the number of females by thousands," says Balsara. Actually, it's a lot more than just "thousands." Over the course of her decade-long study, 111,000 more than females died.

WHAT CAUSES THEM?

"Male infants, children, adolescents, and young adults experience an elevated risk of mortality compared with females," the researchers wrote. "This excess mortality is attributable to a wide variety of conditions, and this effect appears to be due to elevated risk both of contracting high-mortality conditions and, once afflicted, dying of these conditions."

That said, no one seems to have a solid explanation for what accounts for this gender gap. According to Children's Hospital of Philadelphia's Chris Feudtner, it's possible that boys are simply more vulnerable to certain diseases. And once they've got it, they're more likely to die from it. Or it could be the opposite: "This could be a story of resilience and ability to overcome," he said. "Maybe there's some robustness factor that are missing."

Bottom line, when it comes to overall health and lifespan, there's a significant disparity between boys and girls—with girls having a distinct disadvantage. Clearly, the mechanisms underlying these disparities warrant investigation.


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