A global analysis published in May in The Lancet Public Health on 20 disabling diseases in men and women corroborates the great paradox of the sexes: they live longer but their quality of life, their health, suffers more than that of men in the later stages.
Nature, biology, has generally endowed females with greater resistance, surely for reproductive reasons. The rule, however, is not universal. Steven Austad and Kathleen Fischer, from the University of Alabama, reported in 2016 in the magazine Cell Metabolism a review of 118 studies with laboratory mice of which in 65 the males survived the females and in 51 the opposite was true; In two there were no differences.
A more exhaustive analysis was carried out by a European team led by the universities of Lyon (France) and Bath (United Kingdom). Published in 2020 in Proceedings of the National Academy of Sciences, estimated that in 60% of the mammal species studied (101 in total), females live 18.6% longer than males. In humans, the advantage is 7.8%.
All historical population cohorts studied in the last century, especially the meticulous ones from the Nordic European countries, confirm this greater longevity of women. 90% of supercentenarians – those who live to 110 years or more – are women. Hormonal, immunological, oxidative stress, cerebral, mitochondrial factors or the fact that men only have one X chromosome have been considered.
But that advantage comes at a price: women’s health is worse than men’s in adult life. This has been confirmed once again by a large study published in May in The Lancet Public Healthwhich includes disparities in the main causes of disease burden between women and men: from diabetes and cardiovascular diseases to covid-19, low back pain, traffic accidents, depressive and anxiety disorders, infections, Alzheimer’s and some tumors.
The research, funded by the Bill and Melinda Gates Foundation, has used the latest data (2021) from the Global Burden of Disease Study, which since 1990 has been estimating morbidity and mortality trends around the world, with the limitations of some statistics. precarious in less developed countries. They compared the total number of years of life lost due to illness and premature death (a measure known as disability-adjusted life years: DALYs) for the 20 leading causes of disease in women and men aged 10 years and older in seven regions of the world. between 1990 and 2021, the year in which the pandemic, with its 10-15 million deaths, emerged as a modern horseman of the Apocalypse.
“Covid-19 has reminded us that sex differences can profoundly impact health outcomes,” says lead author Luisa S. Flor, from the Institute for Health Metrics and Evaluation at the University of Washington, where They centralize the data. Various studies have agreed that the coronavirus has caused more deaths in men than in women – in a proportion of 15 to 10 –, perhaps due to a more robust adaptive immune system in them (with the innate immune system it is the other way around); However, in women the symptoms of persistent or long-term covid are more pronounced.
“A key point that our study highlights – adds Luisa Flor – is how women and men differ in many biological and social factors that fluctuate and sometimes accumulate over time, causing them to experience health and illness. differently at each stage of life. The challenge is to design, implement and evaluate ways to prevent and treat the main causes of morbidity and premature mortality from an early age and in diverse populations.”
The analysis estimates that for 13 of the 20 leading causes of disease burden, such as Covid-19, traffic injuries and cardiovascular, respiratory and liver diseases, health loss was greater in men than in women . For example, men experienced 45% more health loss due to Covid-19 than women (3,978 versus 2,211 DALYs, standardized by age, per 100,000). Ischemic heart disease had the second largest absolute difference.
For women, the biggest contributors to their health loss are low back pain, depressive and anxiety disorders, headaches, other musculoskeletal disorders (osteoporosis), Alzheimer’s and other dementias, and HIV. The largest absolute difference in women’s health loss was seen in low back pain, with DALY rates one-third higher for women than for men.
Pay more attention to the causes
Mental health conditions also disproportionately affect women in all regions of the world. Thus, the loss of health caused by depressive disorders was more than a third greater among them. “It is clear – says Gabriela Gil, another of the authors – that women’s health care must extend far beyond the areas that health systems and research funding have prioritized to date, such as sexual and sexual issues. “reproductive”.
Women participate less in clinical trials and, except in purely gynecological ailments, therapies are often transferred from men to women without specific efficacy or dosage studies.
These global differences in health loss between women and men have been largely consistent over the past 30 years, but for some diseases, such as diabetes, the difference in men’s DALY rates nearly tripled between 1990 and 2021. It is also known that male kidneys are more vulnerable than female kidneys, perhaps due to the hormone testosterone, as a team from the University of Southern California (Los Angeles) showed last year in the journal. Developmental Cell. Trials with antiandrogens seem to alleviate this deterioration.
Luisa Flor concludes that “women have longer lives, but they live more years in poor health; Limited progress has been made in reducing the burden of conditions that lead to disease and disability, underscoring the need to pay greater attention to the non-fatal consequences that limit the physical and mental function of women, especially at older ages. ”.
Paying attention to the different female physiology – which is observed, for example, in that female soccer players have two to six times more injuries to the anterior cruciate ligament than males – has been a pending objective for years. However, women participate less in clinical trials and, except in purely female ailments (gynecological), therapies are often transferred from men to women without specific efficacy or dosage studies.
Thus, when faced with a heart problem – the leading cause of death in the world – women are less likely than men to receive adequate therapy after suffering a heart attack, such as catheterization or implantation of a bypass. And upon discharge, women receive fewer drugs than men and benefit less from cardiac rehabilitation programs. Knowing better the anatomical, genetic and physiological differences, and adapting preventions and treatments, is justice after centuries of marginalization. In men, for example, the heart muscle becomes larger and thicker with age, while in women it retains its size or shrinks slightly. And, given the immunological differences, 80% of patients with autoimmune diseases are women.
Progress towards non-discrimination against women is welcome and should be promoted. But this search for equality or unnatural mimicry should not be transferred to the health field, for the good of women. Like it or not, and no matter how much the sexes are artificially reversed, biology, genetics and neurology continue to divide the world into males and females.