differenceblog, posts by tag: mortality gap - LiveJournal

Financial columnist Sandra Block (2008) discusses the pitfalls of filing for early benefits from Social Security, an issue facing many of the Baby Boomers (who are now 44-62). Block examines two different mortality differences: the gap between men and women (see 9/28/06), and the gap between unmarried and married men (see 1/10/07)). Both of these differences, Block argues, make it a better idea for married men to delay filing for benefits: married men will live longer, and may be more concerned about leaving their wives a higher survivor benefit.

Block cites the American Academy of Actuaries (AAA) for the disturbing figure that 42% of elderly women depend on Social Security for 90% of their income, but only 28% of men are this dependent on it. The same source notes that 20% of single women over 65 live in poverty, compared to 5% of married couples. The AAA's June report on Women and Social Security" (2007, pdf) points out that while Social Security is calculated on a gender-neutral basis, it's calculated off lifetime earnings, which culturally do not tend to be gender-neutral.

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You know, I don't think I've ever expected to collect on Social Security. I was sort of raised on the rhetoric that it was going to run out before I was eligible. Until recently, I hadn't even considered the possibility that I'd live to see retirement. I figured I'd work until I died. That's not looking as inevitable as it once did, but the idea that I might outlive my retirement savings terrifies me. *scuttles off to increase 401K contributions*

More women than men are diagnosed with Alzheimer's Disease (AD), according to Larry W. Baum (2005). Baum's review focuses on conflicting data from hormone replacement therapy (HRT) in retrospective and prospective studies: in retrospective studies, HRT seems to lower AD risk for women, but increased it in large prospective studies. One theory that Baum suggests is that HRT use was determined by patient interview in the retrospective studies; AD patients might have forgotten their drug history. Independently tested connections between HRT and stroke risk seem the most likely explanation. Microinfarcts (tiny, undetected strokes) may double AD risk.

Roberta Brinton thinks the issue isn't strokes, but timing. Brinton told Tom Siegfried (writing for Nature, 2007): "You have to treat these cells in the brain at a time when they are healthy". In Brinton's studies (Zhao et al, 2005; Chen et al, 2006) applying estrogen to healthy cells showed a protective effect. Once the cells started to deteriorate, however, the estrogen made that decline faster.

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It's been over a year since we've discussed Alzheimer's ("Senior moments" 2006). Honestly, I probably avoid the topic. I'm terrified of it, and I suffer terrible Med student syndrome when I try to research it. I'm convinced I can actually hear my brain dying. Now, some of the studies suggest (but don't test) a protective effect of testosterone that explains the lower rates in men. As discussed in "Senior Moments", the difference in AD rates is not entirely explained by mortality gap. Although testosterone is clearly not an acceptable option for most women, I find any reassurance that my risk is low comforting, especially when they say that reduced estrogen could increase it.

Eva Emerson, in Medical News Today (2/11/07) reports on John Tower's (2006) model for explaining aging and the mortality gap between the sexes. Tower's work with drosophila (fruit flies) suggested that sexula differentiation might come at great cost in terms of aging. Mitochondria seem to be less functional in older fruit flies and mammals, with sex-specific effects. Yan et al (2004) found mitochondrial aging in monkey cardiac cells was accelerated in males compared to females. Vina et al (2006) suggest that estrogen may have a protective effect, by "up-regulation of longevity-associated genes." Ballard and Whitlock (2004 review) point out that much mitochondrial modeling at this point is speculative. Ballard and Whitlock discuss weaknesses in the current data, and in the generalizability of animal models to humans.

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I'm still baffled by the mortality gap. Women seem to be more prone to disease, yet outlive men on average. Social theories about fewer violent deaths or lower risk jobs make some degree of sense to me, but considering the other biological costs of accomodating pregnancy, the genetic theories just confuse me. On that note, any comments on my possible misinterpretation of today's results is welcomed.

However, I have to say that the phrase "[estrogen] cannot be administered to males because of its powerful feminizing effects" (Yan et al, 2006) caused me a bit of a chuckle. My male-to-female transsexual friends are constantly complaining about how ineffective estrogen is in comparison to testosterone, because estrogen supplements seem to achieve very little feminization without the complementary testosterone blockers, whereas my testosterone shots shut down my estrogen production on their own.

Researchers at Purdue University (2007) report that age and gender may have significant effects on the severity of injuries sustained in a car crash. The research, published in The Journal of Safety Research (Islam & Mannering, 2006) was based on Indiana traffic data from 1999. The authors suggest that vehicles designed to adapt to the specific drivers could lessen the severity of injuries. For example, rollover accidents are especially dangerous for older women (over 65). Middle-aged men (25-64) were more likely to have a fatality falling asleep at the wheel, while middle-aged women were more likely to have a fatality on a curvy road. Ulfarsson and Mannering (2004) compared gender outcomes in SUV-related crashes, and found that striking a guardrail was a major risk for female drivers, while male drivers had an increased risk of fatality in SUV-related collisions on starting.

Lee Evans (2006) points out that males are more likely than females to die in traffic accidents starting in infancy. In terms of non-physical impact of an automobile accident, Stallard et al (2004) found that among children (7-18 years), girls were more likely than boys to develop PTSD following a traffic accident.

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There's a tradition among women in my family of flipping VW vans. This "tradition" gets mentioned at family gatherings every couple of years. At least 3 women in my family have done it. I was in the van for one of them -- in a car seat, because I was all of 4 years old. Other accidents in my family have been almost entirely overshadowed by this "pattern" -- including my biggest accident as driver, a head-on collision.

Williams et al. (2006) describes bereavement as "a women's issue", based on their findings that older women "disproportionately bear the burden of loss." Considering that women in the U.S. live an average of 7 years longer than men, this is not a completely unfounded claim. Stroebe (1998) found that, in people who had lost their spouses, men were more likely than women to develop "excessive detrimental consequences": to put it poetically, to die of a broken heart. William J. Cromie (1998), reporting for the Harvard Gazette suggests that menopause may be the reason that women live longer. Another factor may be that the diseases that women are more prone to tend to be non-fatal; Cromie quotes geriatrician Thomas Perls as saying "while men die from their diseases, women live with them." The mortality gap makes Williams et al's portrayal of bereavement as a women's issue plausible, at least.

But on an individual basis, both men and women must deal with the reality of losing loved ones. Martin and Doka's 1999 book, Men Don't Cry, Women Do: Transcending Gender Stereotypes of Grief examines the ways in which men and women cope with loss differently. Although the writers are careful to point out that personality and culture affect the way an individual copes with grief, there do seem to be patterns that tend to be more male or more female (although they can be found in members of either sex, as well as a third "blended" strategy), and these each have their strengths and weaknesses. The female pattern tends to be affective (emotional) whereas men are more likely to deal with grief cognitively or physically (such as by working on a project). The authors prefer the terms "instrumental" and "intuitive" to "masculine" and "feminine" (respectively), because of concerns that people who do not fit their stereotyped roles finding gendered labels threatening. The important thing, according to the author's, is to find the strategies that works best for the individual.

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My own experiences with grief have been mercifully few. I've noticed two patterns in my experiences with grief: the fear that one is not grieving "correctly" and increased sex drive. In nearly every bereaved person I've ever met is the concern that they are not experiencing grief "correctly." There seems to be a social model of the way one is supposed to grieve, and even during the grieving process, people seem to worry that they are not appropriately expressing their loss. This is also true of the people around the bereaved. It seems like there is nearly always a sympathy card being passed around my office, followed by hushed, ashamed whispers of "I never know what to write." The increased sex drive is less discussed. Although the people I know who admit to it usually seem to feel slightly ashamed, the need for comfort and affirmation in a time of loss seems very common, although I have not had an opportunity to ask anyone who has lost a partner about this. It also makes sense from an evolutionary standpoint to have a drive to breed in the face of death. Unfortunately, so far I have found no literature to either confirm or deny this theory, apart from some speculative evolutionary psychology.