Contribution of smoking-related and alcohol-related deaths to the gender gap in mortality: evidence from 30 European countries

Background Women now outlive men throughout the globe, a mortality advantage that is very established in developed European countries. Debate continues about the causes of the gender gap, although smoking is known to have been a major contributor to the difference in the past. Objectives To compare the magnitude of the gender gap in all-cause mortality in 30 European countries and assess the contribution of smoking-related and alcohol-related deaths. Methods Data on all-cause mortality, smoking-related mortality and alcohol-related mortality for 30 European countries were extracted from the World Health Organization Health for All database for the year closest to 2005. Rates were standardised by the direct method using the European population standard and were for all age groups. The proportion of the gender gap in all-cause mortality attributable to smoking-related and alcohol-related deaths was then calculated. Results There was considerable variation in the magnitude of the male 'excess' of all-cause mortality across Europe, ranging from 188 per 100 000 per year in Iceland to 942 per 100 000 per year in Ukraine. Smoking-related deaths accounted for around 40% to 60% of the gender gap, while alcohol-related mortality typically accounted for 20% to 30% of the gender gap in Eastern Europe and 10% to 20% elsewhere in Europe. Conclusions Smoking continues to be the most important cause of gender differences in mortality across Europe, but its importance as an explanation for this difference is often overshadowed by presumptions about other explanations. Changes in smoking patterns by gender suggest that the gender gap in mortality will diminish in the coming decades.