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dc.contributor.authorRosella, Laura C
dc.contributor.authorCalzavara, Andrew
dc.contributor.authorFrank, John W
dc.contributor.authorFitzpatrick, Tiffany
dc.contributor.authorDonnelly, Peter D
dc.contributor.authorHenry, David
dc.identifier.citationRosella , L C , Calzavara , A , Frank , J W , Fitzpatrick , T , Donnelly , P D & Henry , D 2016 , ' Narrowing mortality gap between men and women over two decades : a registry-based study in Ontario, Canada ' , BMJ Open , vol. 6 , no. 11 , e012564 .
dc.identifier.otherPURE: 273497927
dc.identifier.otherPURE UUID: 3148415e-e1f6-4141-b2e9-1502e99fc33c
dc.identifier.otherPubMed: 28186936
dc.identifier.otherPubMedCentral: PMC5129136
dc.identifier.otherScopus: 84995960280
dc.identifier.otherWOS: 000391303400166
dc.identifier.otherPubMed: 28186936
dc.descriptionFunding: This project was funded as an Applied Health Research Question (AHRQ), a process by which government-funded research organisations are funded to answer questions from relevant knowledge users. The Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC), was funded to carry out this AHRQ research question on behalf of Public Health Ontario, Ontario's expert technical and scientific public health organisation.en
dc.description.abstractBackground: Historically, women have lower all-cause mortality than men. It is less understood that sex differences have been converging, particularly among certain subgroups and causes. This has implications for public health and health system planning. Our objective was to analyse contemporary sex differences over a 20-year period. Methods: We analysed data from a population-based death registry, the Ontario Registrar's General Death file, which includes all deaths recorded in Canada's most populous province, from 1992 to 2012 (N=1 710 080 deaths). We calculated absolute and relative mortality sex differences for all-cause and cause-specific mortality, age-adjusted and age-specific, including the following causes: circulatory, cancers, respiratory and injuries. We used negative-binomial regression of mortality on socioeconomic status with direct age adjustment for the overall population. Results: In the 20-year period, age-adjusted mortality dropped 39.2% and 29.8%, respectively, among men and women. The age-adjusted male-to-female mortality ratio dropped 41.4%, falling from 1.47 to 1.28. From 2000 onwards, all-cause mortality rates of high-income men were lower than those seen among low-income women. Relative mortality declines were greater among men than women for cancer, respiratory and injury-related deaths. The absolute decline in circulatory deaths was greater among men, although relative deciles were similar to women. The largest absolute mortality gains were seen among men over the age of 85 years. Conclusions: The large decline in mortality sex ratios in a Canadian province with universal healthcare over two decades signals an important population shift. These narrowing trends varied according to cause of death and age. In addition, persistent social inequalities in mortality exist and differentially affect men and women. The observed change in sex ratios has implications for healthcare and social systems.
dc.relation.ispartofBMJ Openen
dc.rightsCopyright © Author(s) (or their employer(s)) 2016. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.en
dc.subjectAcute Disease/mortalityen
dc.subjectCause of Death/trendsen
dc.subjectChronic Disease/mortalityen
dc.subjectLife Expectancyen
dc.subjectMiddle Ageden
dc.subjectPublic Healthen
dc.subjectResidence Characteristicsen
dc.subjectSex Distributionen
dc.subjectSocioeconomic Factorsen
dc.subjectHV Social pathology. Social and public welfareen
dc.subjectRA0421 Public health. Hygiene. Preventive Medicineen
dc.subjectSDG 3 - Good Health and Well-beingen
dc.titleNarrowing mortality gap between men and women over two decades : a registry-based study in Ontario, Canadaen
dc.typeJournal articleen
dc.description.versionPublisher PDFen
dc.contributor.institutionUniversity of St Andrews. School of Medicineen
dc.contributor.institutionUniversity of St Andrews. WHO Collaborating Centre for International Child & Adolescent Health Policyen
dc.description.statusPeer revieweden

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