Generated Summary
This document comprises two distinct yet related studies. The first, a letter, discusses the need for research into e-cigarette cessation treatments, citing the potential for harm reduction but also the risks associated with e-cigarette use and the absence of effective treatments. The second part of the document presents a research article examining the widening gender gap in life expectancy in the US from 2010 to 2021, with a focus on the contributing factors. The study utilizes mortality data from the National Center for Health Statistics, employing a cross-sectional design to analyze the association between cause-specific mortality changes and alterations in the life expectancy gap between men and women, pre- and post-COVID-19. The decomposition technique was used to identify the causes of death most significantly associated with these changes. Furthermore, the study also examines the association between smoking cessation and mortality, using nationally representative data from the National Health Interview Survey from 1997-2018 with follow-up through December 31, 2019. Analyses compared self-reported current and never smokers with former smokers to examine cardiovascular, cancer, and respiratory deaths. The overarching goal is to understand the shifts in mortality and their specific causes, with an emphasis on the impact of the COVID-19 pandemic and the role of smoking cessation.
Key Findings & Statistics
- The life expectancy gap between men and women widened to 5.8 years in 2021, the largest since 1996, after decreasing from 4.8 years in 2010.
- From 2010 to 2019, the gender life expectancy gap increased by 0.23 years.
- The gender life expectancy gap increased by an additional 0.70 years from 2019 to 2021.
- Prior to COVID-19 (2010-2019), the factors that increased the life expectancy gap were unintentional injuries (-0.23 years), diabetes (-0.05 years), suicide (-0.04 years), homicide (-0.03 years), and heart disease (-0.03 years).
- In the same period (2010-2019), cancer (0.12 years), Alzheimer’s disease (0.06 years), and chronic lower respiratory disease (0.04 years) were among the factors that decreased the gap.
- From 2019 to 2021, COVID-19 was the leading contributor to the widening gap (-0.33 years), followed by unintentional injuries (-0.27 years).
- From 2019 to 2021, increasing maternal deaths and relative reductions in cancer and perinatal conditions among men partially mitigated the increasing gap.
- Unintentional poisonings (mostly drug overdoses) and unintentional transport-related injuries contributed to a 0.44-year (86.3%) and 0.06-year (11.8%) decrease in life expectancy from unintentional injuries from 2010-2021.
- Between 2010 and 2021, the absolute difference in age-adjusted death rates between men and women increased from 252 to 315 per 100,000.
- The current vs never smoker RRs (95% CIs) for cardiovascular, cancer, and respiratory mortality were 2.30 (2.17-2.44), 3.38 (3.19-3.58), and 13.31 (11.46-15.45), respectively.
- Within the first decade after quitting, former smokers avoided an estimated 64%, 53%, and 57% of excess cardiovascular, cancer, and respiratory mortality associated with current smoking, respectively.
- Age-adjusted mortality rates per 100,000 for all causes increased from 887.08 (men) and 634.93 (women) in 2010 to 1047.97 (men) and 733.26 (women) in 2021.
- Age-adjusted mortality rates per 100,000 for COVID-19 were NA (men and women) in 2010 and 2019, but 131.31 (men) and 81.66 (women) in 2021.
- Age-adjusted mortality rates per 100,000 for unintentional injuries increased from 51.53 (men) and 25.61 (women) in 2010 to 89.77 (men) and 40.43 (women) in 2021.
- Age-adjusted mortality rates per 100,000 for diabetes increased from 24.86 (men) and 17.60 (women) in 2010 to 31.83 (men) and 20.02 (women) in 2021.
- Age-adjusted mortality rates per 100,000 for homicide increased from 8.36 (men) and 2.26 (women) in 2010 to 13.17 (men) and 3.09 (women) in 2021.
- Age-adjusted mortality rates per 100,000 for heart disease decreased from 225.07 (men) and 143.25 (women) in 2010 to 219.54 (men) and 135.65 (women) in 2021.
- Age-adjusted mortality rates per 100,000 for suicide increased from 19.80 (men) and 4.98 (women) in 2010 to 22.78 (men) and 5.72 (women) in 2021.
- Age-adjusted mortality rates per 100,000 for cancer decreased from 209.86 (men) and 146.75 (women) in 2010 to 172.02 (men) and 127.65 (women) in 2021.
- Age-adjusted mortality rates per 100,000 for Alzheimer disease increased from 21.01 (men) and 27.32 (women) in 2010 to 24.05 (men) and 35.39 (women) in 2021.
- Age-adjusted mortality rates per 100,000 for chronic lower respiratory disease decreased from 48.73 (men) and 37.96 (women) in 2010 to 37.62 (men) and 32.53 (women) in 2021.
- Age-adjusted mortality rates per 100,000 for HIV decreased from 3.85 (men) and 1.42 (women) in 2010 to 2.08 (men) and 0.64 (women) in 2021.
- Age-adjusted mortality rates per 100,000 for viral hepatitis decreased from 2.93 (men) and 1.36 (women) in 2010 to 1.14 (men) and 0.58 (women) in 2021.
- Age-adjusted mortality rates per 100,000 for perinatal conditions decreased from 4.65 (men) and 3.79 (women) in 2010 to 3.99 (men) and 3.40 (women) in 2021.
- Age-adjusted mortality rates per 100,000 for residual increased from 266.43 (men) and 222.63 (women) in 2010 to 298.67 (men) and 246.50 (women) in 2021.
Other Important Findings
- The study examining the gender gap in life expectancy found that the widening gap from 2010 to 2021 was primarily due to increases in unintentional injuries, the impact of COVID-19, and, to a lesser extent, increases in deaths from suicide and homicide.
- The study on smoking cessation revealed that former smokers experienced significant reductions in excess mortality compared to current smokers, with benefits for cardiovascular, cancer, and respiratory mortality.
- The study suggests that chronic metabolic diseases and mental illnesses may contribute to the widening gender gap in life expectancy.
- The increase in overdose deaths, homicides, and suicides highlights the crises of deaths from despair and firearm violence.
Limitations Noted in the Document
- The limitations include the use of binary gender classification and the lack of exploration of heterogeneity within disease classifications and across different demographic groups.
- The study on smoking cessation analysis was restricted to those without self-reported cardiovascular disease, cancer, or respiratory disease at recruitment to limit reverse causality.
- The studies are limited by the use of deidentified publicly available data.
- Future analyses could explore whether the trends changed after 2021, especially as the pandemic recedes.
Conclusion
The studies highlight significant shifts in mortality patterns and their underlying causes in the US. The widening gender gap in life expectancy, exacerbated by the COVID-19 pandemic and the rise in deaths from unintentional injuries, underscores the need for targeted interventions. The findings indicate that the increasing maternal deaths among women, and relative reductions in cancer and perinatal conditions among men, has partially mitigated the increasing gap. The analysis reveals a critical need to address the twin crises of deaths from despair and firearm violence, as well as to improve the understanding of the impacts of chronic metabolic diseases and mental illnesses. The data on smoking cessation provide evidence for the benefits of quitting, emphasizing the importance of supporting smoking cessation efforts. The findings reinforce the need for public health interventions to address the root causes of the mortality trends and implement effective prevention and treatment strategies. The importance of ongoing monitoring and research into these evolving trends is emphasized, particularly with regard to the impact of the pandemic and its aftermath.