The relative effects of sex and deprivation on the risk of early death

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Abstract
Socio-economic factors and sex are both known to have a pronounced bearing on the risk of early death. To determine the relative effects of these factors in our Health Board, an analysis was carried out of all deaths under the age of 70 registered in Tayside during 1989 and 1990, by age, years of life lost, diagnosis and postcode sector/deprivation category. A yearly average of 14 520 years of life up to the age of 70 were lost by males compared with 8248 by females. When cancers of the breast and sex organs were excluded, just over a quarter (28 per cent) of the difference was due to the higher death rate in males resulting from injuries and poisoning and another quarter to ischaemic heart disease (23 per cent), with infant deaths in third place (17 percent). Deprivation category analysis showed that deaths and years of lost life from ischaemic heart disease and injuries and poisoning in males in the most deprived areas were approximately one-third higher than in the most affluent. At the same time, the death rate in males from these causes in each area, from the most affluent to the most deprived, was approximately two and a half to three times as high as in females, as were lost years of life. The combined disadvantages of being male and living in the most deprived areas (deprivation categories 6 and 7) resulted in a nearly five-fold greater chance of death under the age of 70 from ischaemic heart disease, and the loss of five times as many potential years of life, compared with being female and living in an affluent area (deprivation categories 1 and 2). For injuries and poisoning the corresponding figures were both 3⋅6 times. Although it cannot be denied that socio-economic factors have a pronounced effect on death rates, it is important that the influence of sex is fully acknowledged. The relative contributions of genetics and behaviour to the sex difference in mortality cannot be determined with accuracy. However, the fact that 44⋅3 per cent of the sex difference in potential years of life lost between the ages of 1 and 69 is due to injuries and poisoning, lung cancer, drug dependence, chronic liver disease and cirrhosis points to a sizeable behavioural component. The striking polarization of mortality rates between men in deprived areas and women in affluent areas makes these two groups obvious subjects for comparative studies in the future, aimed at further elucidating the reasons for the socio-economic and sex differences in mortality.

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