Department of Public Health Sciences, Karolinska Institutet, Stockholm 171 76, Sweden.
BMC Public Health. 2012 Nov 12;12:969. doi: 10.1186/1471-2458-12-969.
Gender differences in mortality vary widely between countries and over time, but few studies have examined predictors of these variations, apart from smoking. The aim of this study is to investigate the link between gender policy and the gender gap in cause-specific mortality, adjusted for economic factors and health behaviours.
22 OECD countries were followed 1973-2008 and the outcomes were gender gaps in external cause and circulatory disease mortality. A previously found country cluster solution was used, which includes indicators on taxes, parental leave, pensions, social insurances and social services in kind. Male breadwinner countries were made reference group and compared to earner-carer, compensatory breadwinner, and universal citizen countries. Specific policies were also analysed. Mixed effect models were used, where years were the level 1-units, and countries were the level 2-units.
Both the earner-carer cluster (ns after adjustment for GDP) and policies characteristic of that cluster are associated with smaller gender differences in external causes, particularly due to an association with increased female mortality. Cluster differences in the gender gap in circulatory disease mortality are the result of a larger relative decrease of male mortality in the compensatory breadwinner cluster and the earner-carer cluster. Policies characteristic of those clusters were however generally related to increased mortality.
Results for external cause mortality are in concordance with the hypothesis that women become more exposed to risks of accident and violence when they are economically more active. For circulatory disease mortality, results differ depending on approach--cluster or indicator. Whether cluster differences not explained by specific policies reflect other welfare policies or unrelated societal trends is an open question. Recommendations for further studies are made.
各国之间和随着时间的推移，死亡率的性别差异差异很大，但除了吸烟之外，很少有研究探讨这些差异的预测因素。本研究旨在探讨性别政策与特定原因死亡率性别差距之间的联系，同时调整经济因素和健康行为。
对 22 个经合组织国家进行了 1973 年至 2008 年的跟踪调查，结果是外部原因和循环系统疾病死亡率的性别差距。使用了先前发现的国家聚类解决方案，其中包括税收、育儿假、养老金、社会保险和实物社会服务的指标。男性养家糊口的国家被作为参考组，与挣钱养家的国家、补偿型养家糊口的国家和普遍公民的国家进行比较。还分析了具体政策。使用混合效应模型，其中年份是一级单位，国家是二级单位。
挣钱养家的国家（调整 GDP 后无统计学差异）和具有该特征的政策集群与外部原因性别差异较小相关，特别是由于女性死亡率增加所致。循环系统疾病死亡率性别差距的聚类差异是补偿型养家糊口的国家和挣钱养家的国家中男性死亡率相对下降较大的结果。然而，这些集群的政策特征通常与死亡率增加有关。
对于外部原因死亡率的结果与以下假设一致，即当女性在经济上更加活跃时，她们更容易接触到事故和暴力的风险。对于循环系统疾病死亡率，结果因方法（聚类或指标）而异。聚类差异是否不能用具体政策来解释，反映了其他福利政策还是与社会无关的趋势，这是一个悬而未决的问题。提出了进一步研究的建议。
