Diferencial de gênero na mortalidade no município de São Paulo, 1920 a 2020: padrões por idade e causas de morte

Abstract

In Brazil, it is well-documented that women live longer and have less variability in age at death than men. However, most studies focus on recent periods due to insufficient available data. In addition, there is a gap in understanding the contribution of causes of death and age groups to explain the gender gap in mortality and its evolution over a more extended period. In this context, this dissertation contributes to understanding the unequal patterns of mortality between men and women by investigating how and why the mortality experience of the male and female population differed in the municipality of São Paulo from 1920 to 2020. The choice of São Paulo municipality is due to its being one of the most developed in the country and providing indications of the expected trajectory for other regions. The study is divided into three articles. In the first one, the gender differential in longevity is analyzed from the perspective of life expectancy at age 10, the median age at death, and the modal age at death. The gender differential in age variability at death is examined through the interquartile range and standard deviation of age at death. The results show that women experienced a higher age at death than men throughout the analysis period. However, the lowest dispersion of age at death among women was observed only since the middle of the 20th century. Regarding the temporal trend, the results indicated that after a period of widening the gender gap in mortality, the differences have narrowed since 1995. To analyze the contribution of causes of death and age groups, it was first necessary to make the series of deaths comparable over time since mortality trends were affected by periodic revisions in the International Classification of Diseases (ICD). This step was carried out in the second article, using death data from 1950 to 2020 (from ICD-6 to ICD-10) due to the difficulty of reconciling previous versions of the ICD. The death series adjusted for the cause of death, age group (from 1 year of age), and sex. The results show consistent behavior without unexpected fluctuations. The estimates allowed for the analysis of the contribution of age patterns and causes of death to the differential life expectancy at age one in the third article. The study of the gender gap decomposition in life expectancy indicate that middle-aged and older adults aged 35-59 and 60-79 years were the main contributors to the differential formation. Only between 1985 and 2000 did the 15-34 age group contribute substantially, reaching similar levels of participation as older adults. Men’s higher mortality due to circulatory system diseases, external causes, and neoplasms explained most of the gender gap in all periods analyzed. The trend of increasing the gender gap in life expectancy until 1995, followed by a decrease in the differential, was mainly explained by the variation in mortality in the 15-34 and 35-59 age groups. The contribution of these age groups was primarily associated with mortality due to external causes. However, the results suggest that in the future, reductions in the gender gap in mortality will depend not only on the continued decrease in the mortality difference from external causes but, above all, on mortality due to circulatory system diseases and neoplasms, especially among older adults. Our findings contribute to a better understanding of unequal mortality patterns between men and women, supporting actions to reduce the gender differential in mortality.