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Mortality, Life and Health Expectancy of Canadian Women

Marie DesMeules, MSc (Health Canada); Douglas Manuel (University of Toronto); and Robert Cho (Health Canada)

Health Issue

Mortality and life expectancy are well established and commonly used indicators of population health, and important patterns by sex and over time have been observed. Canadians' life expectancy at birth, estimated at approximately 76 years for men and 81 years for women, has consistently ranked among the top 10 of all OECD countries for several decades. The overall decrease in mortality over the last century among men and women, and the narrowing difference between them over the last few decades are well known. As well, women have an advantage, though less pronounced, in health- adjusted life expectancy. This indicator of population health has gained recognition in recent years. Although these indicators have been well described in the Canadian population, there is a paucity of information on the factors contributing to this sex gap and how gender-relevant determinants affect the life expectancy of subgroups of Canadian women. This chapter explores such issues, and examines preventable deaths and biologically based sex differences in mortality and life expectancy as well as in health-adjusted life expectancy (using the Canadian Mortality Database (1959-1999), and the Canadian Community Health Survey (2000-2001)).

• The main causes of death among women and men are similar and include coronary heart disease, cancer, and chronic lung disease. The distribution by cause of potential years of life lost (PYLL) does, however, differ by sex. In women, a larger number of PYLL are attributable to cancer, whereas in men, a larger number of PYLL are frequently attributable to accidents.
• Age-adjusted mortality rates and life expectancies, calculated by including and excluding causes of death considered avoidable through primary prevention ("external deaths," e.g. smoking-related deaths, injuries, HIV/AIDS) or medical intervention (e.g. asthma, hypertensive disease, etc.), revealed that, overall, external causes of death represented approximately 19% of deaths among women, as compared with 35% among men in 1997-1999. Mortality from causes amenable to medical intervention represented 25% and 23% of all deaths among women and men respectively.
• Smoking-related deaths represent a major contribution to the gap between men's and women's life expectancies. If all Canadians were nonsmokers, the estimated life expectancy at birth would be approximately 83.3 and 79.9 years for women and men respectively. When all external causes were deleted, the sex gap in life expectancy was greatly reduced, at an estimated 84.9 and 82.7 years for women and men, indicating that women do not appear to have a large biological survival advantage but, rather, are at lower risk of preventable deaths.
• Health adjusted life expectancy (HALE) was 70.0 for women and 66.7 years for men. A similar reduction in the difference between men and women was observed when the same external causes were excluded from HALE. Given the higher prevalence of many conditions causing disability in women, such as arthritis, these results highlight the unique health vulnerabilities of women.
• The relative importance of sex-specific causes of death (e.g. prostate and testicular cancer, pregnancy and its complications, breast cancer, etc.) was examined. A larger death burden due to these sex-specific causes was observed among women than men (age-adjusted mortality rates were 40.55 per 100,000 for women and 29.15 per 100,000 per annum for men in 1997-1999).
• Analysis of information on province and rural/urban area of residence showed significantly higher mortality rates among rural women as compared with their urban counterparts (at least a 20% excess among rural women aged 20.64 over the last 10 years). Accidental deaths and chronic diseases contributed significantly to this rural/urban gradient.

The authors identified the following data gaps and made the following recommendations:

• Information on mortality and life expectancy by variables such as socio-economic status and women's roles is currently limited in Canada. New studies on these variables will be greatly facilitated by national linkages of census and mortality data, and will provide enhanced opportunities for gender analyses in this area.
• Knowledge of unique mortality patterns by subgroups of women will be enhanced by a number of ongoing national initiatives in the area of immigrant and rural health.
• With the changing patterns of avoidable (e.g. smoking-related) deaths, projections of life expectancy and mortality rates would be very useful in planning gender and sex-specific interventions to reduce disparities in the gender gap.
• More comprehensive analysis of the total burden of preventable causes of death (e.g. breast cancer and heart disease, smoking-related deaths) in women and men and subgroups of women would provide insight for developing policies aimed at more vulnerable populations.

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