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The life expectancy of men in the U.S. is nearly six years shorter than that of women, according to new research published on Monday in JAMA Internal Medicine.

As life expectancy at birth in the US decreased for the second consecutive year, from 78.8 years (2019) to 77.0 years (2020) and 76.1 years (2021), the gap between women and men widened to 5.8 years, its largest since 1996 and an increase from a low of 4.8 years in 2010.

For more than a century, US women have outlived US men, attributable to lower cardiovascular and lung cancer death rates related largely to differences in smoking behavior.This study systematically examines the contributions of COVID-19 and other underlying causes of death to the widened gender life expectancy gap from 2010 to 2021.

“Across the world, women tend to live longer than men,” said Brandon Yan, a resident physician at the UCSF School of Medicine and a research collaborator at the Harvard T.H. Chan School of Public Health, who is the lead author of the study according to a review published by Stat News. (Both institutions collaborated in the research.)

But the widening gap should concern the U.S., Yan said, because it shows that baseline factors accounting for men’s lower longevity – genetics, men’s higher vulnerability to chronic disease – aren’t the sole reason for the difference in life expectancies.

The opioid epidemic, mental health, and chronic metabolic disease are certainly front and center in the data that we see here, explaining why there’s this widening life expectancy gap by gender, as well as the overall drop in life expectancy,” said Yan. Men have higher mortality rates from all three conditions compared to women.

In addition, Yan notes, “a lot of these drivers of worsening life expectancy in particular for men are preventable causes of death.” Even Covid-19 could be considered a preventable cause of death in the time since vaccines have become available, he said.

The decline in life expectancy in the U.S. suggests that advancements in medical treatment are no longer sufficient to counter ongoing public health crises, Yan said. “We have a health care system that is very advanced in treating illnesses and advanced disease. But for the most part – it is not very good when it comes to preventative care.”

In the years leading to 2010, it was public health improvements – such as aggressive anti-smoking campaigns and the consequent reduction of deaths from respiratory illnesses and cancer – that led to the increased longevity and a reduced male-female gap in life expectancy.

The reasons that issues such as suicide or opioid overdose affect men more than women are complex. “There’s a substantial socio-cultural norms component to this data as well in terms of the ways that society views masculinity and the way that men ought to behave,” said Yan. “That has profound effects on care-seeking behaviors,” he said. Whether a man seeks care for mental health issues, for instance, or even goes to routine primary care visits and takes medications, may be impacted by ideas about masculinity.