The gap between male and female life expectancy in the United States is the largest it has been since 1996, a full year more than it was in 2010. Insurers have a role to play in shrinking that gap.
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Baby Liam and Baby Olivia came into the world in neighboring birthing suites in the same hospital on the same day in 2021, born to two sets of parents with similar socio-demographic backgrounds. According to data from the US Centers for Disease Control and Prevention (CDC), Olivia’s journey through this life is expected to last nearly six years longer than Liam’s.
What is behind this gap?
CDC data suggests the gap between male and female life expectancy is the largest it has been since 1996, a full year more than it was in 2010.1 This reflects the reversal of a decades-long US trend that saw the gap shrink from 7.4 years in 1980 to 4.8 years in 2010.
Figure 1: Narrowing life expectancy gender gap
Since the start of the millennium’s second decade, the gap, which held relatively steady through 2016, has grown to 5.8 years.
Figure 2: The gap levels off but then begins to widen
There is nothing inevitable about the size of this gap. Biological gender differences mean there likely will always be some discrepancy in favor of female longevity. That females have two X chromosomes while males have one X and one Y gives women a starting-line advantage. Females are better able to deal with a harmful mutation on one X chromosome through the second X, which leaves women less susceptible to X-linked genetic disorders such as hemophilia and muscular dystrophy.2
That said, leading causes of male mortality are due to illnesses and situations that could be prevented or managed through a better lifestyle. Much of the higher male mortality rate can be attributed to controllable conditions and actions that would be in the individual’s as well as the insurance industry’s best interest to help address.
Yet despite this growing gap, US public policy has comparatively deprioritized male health issues. For example, when the federal government released its public health goals for 2030 just as the COVID pandemic was taking hold in 2020, it included 42 goals for children, 29 for women – and just four for men.3
A June 2024 study, “Gender health equity: The case for including men’s health” by Georgetown University’s Center for Men’s Health Equity, illustrated the disparity among the leading causes of death for men and women. It revealed that in 13 of the leading causes of death in the US, men have a higher age-adjusted mortality rate than women.4
The female age-adjusted mortality rate was higher than the male rate in only accidents (unintentional injuries that occur without intent to cause harm) and chronic lower respiratory infections, and in each of those two cases the margin was small. Meanwhile, mortality from heart disease, cancer, COVID, stroke, Alzheimer’s disease, diabetes, nephritis, hypertension, liver disease, septicemia, influenza and pneumonia, Parkinson’s disease, and nutritional deficiencies all caused more deaths in males than females – and often significantly more, as seen in Figure 3.
Figure 3: The 15 leading causes of death in the United States by sex, 2021\
What Figure 3 does not fully illustrate is the true disproportional impact of what has been called “deaths of despair.” Most notably, this includes suicide.
The suicide risk ratio by demographic group for 2023 showed that men were nearly four times as likely to die by suicide compared to women.5 That disparity was roughly twice as much as the demographic difference between old and young, rural and urban, and veteran and non-veteran.
The male suicide rate was roughly 23 deaths per 100,000, compared to approximately six per 100,000 for women. Approximately 40,000 men are lost to suicide each year, nearly the same as the number of women who die from breast cancer annually.5
The CDC’s “Health Disparities in Suicide”6 report focused on veterans, people who live in rural areas, sexual and gender minorities, middle-aged adults, people of color, and tribal populations, and outlined the public policies and programs in place to address each — all which deserve attention.
But the difference between men and women is much less directly addressed.
Figure 4: Demographic differences in suicide rates
This notable difference comes despite that four-fold disparity and some glaring differences between the genders in mental health treatment. For example, 24.7% of women had received mental health treatment in the past 12 months, according to a 2019 CDC analysis. This compares to just 13.4% for men.7
In addition, women were nearly twice as likely to have taken medication for mental health than men (20.6% and 10.7%, respectively).7 Either women are more susceptible to mental health issues or men are not receiving needed treatment.
Government policy plays a role in men’s mortality disparity. Women are actively encouraged through financial incentives to enter the healthcare system earlier and more frequently than men are.
For example, the Affordable Care Act fully covers 44 preventive healthcare measures outside of vaccinations. Of these, 20 apply to both men and women, 23 apply only to women, and just one exists only for men – a one-time screening for an abdominal aortic aneurysm in men aged 65 to 75 who smoke.8
Women’s use of the healthcare system also exceeds that of men. According to the CDC:
Greater use of the healthcare system positively correlates with greater longevity. Prescription history can be used as a proxy for medical treatment and supports the case of medical treatment improving mortality outcomes. Those with fewer prescriptions in their histories experience higher mortality than peers with more prescriptions, according to groundbreaking research by RGA and Milliman IntelliScript.9
These differences reveal a potential role insurers could play for the mutual benefit of their business and their policyholders.
The most common model in the insurance industry dictates that, as health and life (re)insurers, our relationship and engagement with those we insure ends at underwriting and only resurfaces should we need to adjust or increase rates, process a claim for a living benefit, or respond to a beneficiary after a policyholder’s death. There is reason to explore a change in this relationship to find practical and financially beneficial ways to become more of a policyholder’s lifelong health partner.
Strengthen wellness offerings: Insurers can consider exploring the addition of health and wellness benefits to morbidity and mortality products where possible. There are scenarios in which it might be beneficial to extend the insurer/insured relationship with product features that encourage and incentivize health improvement through health management that encourages healthier lifestyles for their insured members.
Engage with insureds on disease management: Life products with medical screenings could feature a hybrid model for disease management, should those screenings uncover any substantive issues. This hybrid model would include digital initiatives to incentivize disease management such as apps featuring reminders for follow-ups and wearable technology for monitoring disease progression or remission. They also could include personal interactions with linked health providers for regular monitoring.
Pursue early intervention opportunities: Men tend to under-report medical issues, resulting in a delay in seeking needed care that leads to better health outcomes. For this reason, critical illness products that target men by incentivizing earlier interventions could be helpful. In addition, insurers could consider new product innovations in life insurance with premiums tied to regular screenings.
Intervene to stop deaths of despair: Insurers play a role in destigmatizing men’s pursuit of mental health treatment. Robust access to counseling, therapy, support groups, and other mental health resources should be specifically aimed at addressing risk factors that contribute to deaths of despair, such as depression, substance abuse disorders, and suicidal ideation. This could involve partnering with mental health professionals, developing digital tools and apps, or offering financial incentives for use these services.
As a trusted partner, insurers can incentivize lifestyle changes and healthcare access to improve overall life expectancy. By the very nature of the current disparity, this approach could benefit the population facing reduced healthcare participation and increased lifestyle ailments – men. Without reducing the focus on women’s health issues, the gap between male and female mortality could be decreased.
That said, insurers cannot shrink the gap without a significant shift in mindset among men to take their health more seriously. A strong partnership among insurers, health providers, and the very men whose health is at proportionally greater risk than women is needed to help lessen the mortality disparity.
Investigate how partnering with RGA to combine technology, data, and expertise delivers exceptional value to your customers. Learn more now.
