Public Citizen | Publications - A Tale of Three Cities: Racial and Ethnic Disparities in Premature Mortality in the; District of Columbia, 2005; Results – Sex Differentials within Subgroups - Part 1

A Tale of Three Cities: Racial and Ethnic Disparities in Premature Mortality in the; District of Columbia, 2005; Results – Sex Differentials within Subgroups - Part 1



RESULTS

Sex Differentials within Subgroups

Gender-based differences, already noted overall, also vary from one subgroup to another. Men and women tend to lead different lives and therefore often die different deaths. Moreover, they die at different ages due to different causes, being exposed to different illnesses and conditions, including violence. Gender affects all of the determinants of health. Although some of the differences may be rooted in biology, most of the disparities are associated with lifestyles, including exposure to risk factors on the job, prevalence of health-related behaviors such as smoking and drug use, and greater ownership and use of firearms. Even within the same environment, men and women may react differently to their surroundings, adopting different behaviors to cope with potential threats and sources of stress. Thus while men may see their options as “fight or flight,” women may “tend and befriend,”[1] thereby bolstering their social connections and enhancing their health status. Gender also plays a role in access to health care: nationally, women are more likely to have insurance coverage[2] and a regular source of care.[3] Women not only see a physician more frequently, they also receive more preventive services: in 2005, the national female visit rate for preventive care (74.4 visits per 100 persons) was significantly higher than the corresponding rate for males (44.8 visits per 100 persons).[4] But these differences play out differently in different groups, which explains some of the YPLL variation among populations. The following sections therefore will examine the gender divide within each of the three racial/ethnic groups under study.

Sex differences among blacks

Table 6 presents the differences in YPLL rates for blacks, by sex and major cause of death.

Table 6. Rate of Years of Potential Life Lost (YPLL) Before Age 70, District of Columbia and United States: 2005, Blacks, All Deaths, by Cause of Death and Sex 

 

Cause of Death

Rate of Age-Adjusted YPLL per 100,000 Population

Male (M)

Female (F)

Ratio M:F

D.C.

U.S.

D.C.

U.S.

D.C.

U.S.

All Causes

20,018

12,449.0

9,782.8

7,158.0

2.0

1.7

Homicide

4,460.6

1,614.6

395.3

249.6

11.3

6.5

Heart Disease

2,620.2

2,034.6

1,008.7

1,043.3

2.6

2.0

Cancer

2,022.8

1,609.7

1,444.1

1,365.3

1.4

1.2

HIV

1,840.9

724.0

1,249.7

354.5

1.5

2.0

Perinatal Period

1,557.8

906.7

993.4

734.0

1.6

1.2

Accidents

1,435.4

1,515.0

717.7

586.4

2.0

2.6

Stroke

453.8

371.3

255.8

277.9

1.8

1.3

Diabetes

422.9

321.5

199.7

225.8

2.1

1.4

Congenital Anomalies

330.5

247.9

322.0

232.6

1.0

1.1

Liver Disease

303.6

*

*

*

*

*

Septicemia

*

*

124.0

134.8

*

*

Suicide

*

303.9

*

*

*

*

* Data not included because cause of death is not among the top 10 for YPLL for that population.

As Table 6 shows, among the black population in D.C., males are twice as likely as females to suffer premature losses from all major causes of death, higher than the corresponding ratio for blacks nationally. The gender gap in D.C. is particularly marked for premature losses due to homicide, where it is more than 11-fold higher for males. While presumably living in similar neighborhoods, black men are at much greater risk for violent deaths than their female counterparts, which suggests that the causes are more strongly rooted in differences in behavioral and lifestyle differences than in environmental factors. The YPLL rate for men in D.C. is at least twice as high as it is for women for three additional causes: heart disease, accidents and diabetes. Only for congenital anomalies are the two sexes close to parity. The comparison of gender ratios for the District with those for the U.S. as a whole indicates that the gender differences among blacks are not as pronounced nationally. Nevertheless, there are some causes (e.g. HIV, accidents) for which gender disparities in YPLL among blacks are greater nationally than in D.C. 

Sex differences among whites

Table 7 presents comparable data for whites.

Table 7. Rate of Years of Potential Life Lost (YPLL) Before Age 70, District of Columbia and United States: 2005, Whites, all Deaths, by Cause of Death and Sex

 

Cause of Death

Rate of Age-Adjusted YPLL per 100,000 Population

Male (M)

Female (F)

Ratio M:F

D.C.

U.S.

D.C.

U.S.

D.C.

U.S.

All Causes

3,484.3

6,641.4

2,806.7

3,857.6

1.2

1.7

Accidents

470.8

1,502.7

411.9

628.7

1.1

2.4

Cancer

549.6

1,070.5

647.0

982.0

   0.8

1.1

Perinatal Period

385.2

316.2

559.4

259.1

0.7

1.2

HIV

337.3

*

41.2

*

 8.2

*

Heart Disease

284.4

1,023.1

132.1

395.0

 2.2

2.6

Suicide

220.6

573.6

*

153.7

*

3.7

Homicide

78.6

130.8

30.0

*

2.6

*

Congenital Anomalies

*

195.9

279.7

172.8

*

1.1

Liver Disease

45.2

155.8

*

70.8

*

2.2

Diabetes

*

126.9

*

78.4

*

1.6

Septicemia

*

*

59.1

*

*

*

Strokes

67.4

*

41.3

93.0

*

*

Chronic Lower Respiratory Disease

 

107.4

25.7

100.8

*

1.1

* Data not included because cause of death is not among the top 10 for YPLL for that population.

There is less of a difference between the two sexes in YPLL rates among whites in D.C. than there is for other groups in the District, and among whites for the U.S. as a whole. Nevertheless, men are at greater risk overall. The sex-specific distribution of premature losses by cause in D.C. and the U.S. is different for whites than for blacks. This is reflected in the limited overlap of the top 10 causes between genders, particularly in the District, and in the greater variation in cause and gender-specific ratios.

Unlike blacks, for which there are only two causes that appear among the top 10 principal causes of YPLL that are specific to only one sex, the corresponding data for whites in the District reveals seven causes that are among the top 10 for only one sex. This does not mean that the cause does not affect the other sex equally, but rather that its rate does not rank among the 10 principal causes of premature loss for that particular sex because it may be displaced by other causes or may be affecting persons at older ages. Thus, suicide, liver disease and benign neoplasms are among the principal 10 causes of YPLL for men but not for women. Conversely, losses due to congenital anomalies, septicemia, stroke and chronic lower respiratory disease rank among the top causes of YPLL for women but not for men. 

Whereas there is an 11-fold difference in YPLL rates due to homicide between men and women among blacks in D.C., the corresponding ratio for whites is over 2-fold, still marked but considerably lower. And the cause for which there is the greatest gender disparity among whites in the District is HIV (the rate for men being more than 8-fold that for women). 

Moreover, whereas among blacks there is no cause for which the YPLL for males is at parity or below compared to that for females, that is not the case for whites in D.C. The burden of YPLL for white men is lower than that for women for cancer and deaths associated with the perinatal period, for which females appear to be at higher risk.



[1]  Shelley E. Taylor et al. Behavioral Responses to Stress in Females: “Tend-and-Befriend,” Not Fight-or-Flight. Psychological Review 107(3), 2000: 411-429.

[2]  Health Insurance Coverage of Adults Ages 18-64, by Sex, 2006. Kaiser Family Foundation analysis of the March 2007 Current Population Survey, Census Bureau. http://facts.kff.org/chart.aspx?ch=412

[3]  E Hing, DK Cherry, and DA Woodwell. National Ambulatory Medical Care Survey: 2004 Summary. Advanced Data from Vital and Health Statistics, CDC, No. 374. Hyattsville, Md: National Center for Health Statistics. June 23, 2006: 21.

[4]  DK Cherry, DA Woodwell, and EA Rechsteiner. National Ambulatory Care Survey: 2005 Summary. Advanced Data from Vital and Health Statistics, CDC, No. 387. Hyattsville, MD: National Center for Health Statistics. June 23, 2006: 4.