Global Sex Differences in Cancer Mortality with Age and Country Specific Characteristics

  • Liu, Lee (Geography Program, School of Environmental, Physical and Applied Sciences University of Central Missouri)
  • Published : 2016.07.01


Background: The cancer research literature suggests that women, especially premenopausal women, have lower cancer mortality rates than men. However, it is unclear if that is true for populations at all age levels in all countries and what factors affect such sex differences. This paper attempts to fill that gap. Materials and Methods: Sex- and country-specific cancer mortality data were statistically analyzed with particular attention to geographic, social, and economic factors that may affect the sex differences. Results: The sex differences were age and country specific, rather than universal. Premenopausal women actually tend to have a disadvantage compared to men or postmenopausal women. Male cancer mortality appears to be the affecting factor in explaining variations in sex differences. Latitude of residence and literacy rate are the affecting factors in cancer mortality and sex differences. African and Latin American countries tend to have a female disadvantage, while East Asian and Eastern European countries are more likely to have a female advantage. Conclusions: The findings challenge the cancer mortality literature and indicate that the sex differences and their possible causes are more complicated than the current literature suggests. They also highlight the urgency of adapting age- and country- specific health systems and policies to better meet the needs of younger women.


  1. Althuis MD, Dozier JM, Anderson WF, et al (2005). Global trends in breast cancer incidence and mortality 1973-1997. Int J Epidemiol, 34, 405-12.
  2. Baade P, Turrell G, Aitken J (2011). Geographic remoteness, area-level socio-economic disadvantage and advanced breast cancer: a cross-sectional, multilevel study. J Epidemiol Community Health, 65, 1037-43.
  3. Bray F, Znaor A, Cueva P, et al (2015). Chapter 5. quality control at the population-based cancer registry. planning and developing population-based cancer registration in low- and middle-income settings. IARC Technical Publication No. 43.
  4. Borisenkov M (2011). Latitude of residence and position in time zone are predictors of cancer incidence, cancer mortality, and life expectancy at birth. Chronobiol Internat, 28, 155-62.
  5. Cancer Research UK (2015). Worldwide cancer mortality statistics.
  6. Cohen J, Pivodic L, Miccinesi G (2015). International study of the place of death of people with cancer: a population-level comparison of 14 countries across 4 continents using death certificate data. British J Cancer, 113, 1397-404.
  7. Coleman MP, Bch BM, Forman D, et al (2011). Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995-2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. Lancet, 377, 127-38.
  8. Cook MB, Dawsey SM, Freedman ND, et al (2009). Sex disparities in cancer incidence by period and age. Cancer Epidemiol Biomarkers Prev, 18, 1174-82.
  9. Cook MB, McGlynn KA, Devesa SS, Freedman ND, Anderson WF (2011). Sex disparities in cancer mortality and survival. Cancer Epidemiol Biomarkers Prev, 20, 1629-37.
  10. Day P, Pearce J, Dorling D (2008). Twelve worlds: a geodemographic comparison of global inequalities in mortality. J Epidemiol Community Health, 62, 1002-7.
  11. de Blij HJ, Muller PO (2014). Geography: Realms, Regions, and Concepts. John Wiley & Sons, Inc., New York pp DT1-6.
  12. Francisci S, Minicozzi P, Pierannunzio D, et al (2015). Survival patterns in lung and pleural cancer in Europe 1999-2007: Results from the EUROCARE-5 study. Eur J Cancer, 51, 2242-53.
  13. GHODR (Global Health Observatory Data Repository) (2015a). Noncommunicable diseases, mortality: Cancer, deaths per 100000 Data by country 2015.
  14. GHODR (2015b). Demographic and socioeconomic statistics.
  15. GBDSMCDC (Global Burden of Disease Study Mortality and Causes of Death Collaborators) (2013). Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 385, 117-71.
  16. GMT Time Date (2015). Countries Latitudes and Longitudes Centers List.
  17. Harding C, Pompei F, Wilson R (2012). Peak and decline in cancer incidence, mortality, and prevalence at old ages. Cancer, 118, 1371-86.
  18. Hausmann R, Tyson LD, Zahidi S (2012). Global Gender Gap Report 2012. World Economic Forum.
  19. Hirte L, Nolte E, Bain C, McKee M (2007). Breast cancer mortality in Russia and Ukraine 1963-2002: an age-periodcohort analysis. Int J Epidemiol, 36, 900-6.
  20. IARC (International Agency for Research on Cancer) (2015). WHO Cancer Mortality Database.
  21. Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. CA Cancer J Clin, 61, 69-90.
  22. Jemal A, Center MM, DeSantis C, Ward EM (2010). Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev, 19, 1893-907.
  23. Jongsthapongpanth A, Bagchi-Sen S (2010). Spatial and sex differences in AIDS mortality in Chiang Rai, Thailand. Health and Place, 16, 1084-93.
  24. Leung CC, Lam TH, Yew WW, et al (2011). Lower lung cancer mortality in obesity. Int J Epidemiol, 40, 174-82.
  25. Matheu A, Maraver A, Klatt P, et al (2007). Delayed ageing through damage protection by the Arf/p53 pathway. Nature, 448, 375-9.
  26. Moan J, Porojnicu AC, Dahlback A, Setlow RB (2008). Addressing the health benefits and risks, involving vitamin D or skin cancer, of increased sun exposure. Proc Natl Acad Sci USA, 105, 668-73.
  27. Mohr S, Garland C, Gorham E, Grant W, Garland F (2008). Could ultraviolet B irradiance and vitamin D be associated with lower incidence rates of lung cancer? J Epidemiol Community Health, 62, 69-74.
  28. Nur U, Quaresma M, De Stavola B, Peake M, Rachet B (2015). Inequalities in non-small cell lung cancer treatment and mortality. J Epidemiol Community Health, 69, 985-92.
  29. Oksuzyan A, Shkolnikova M, Vaupel JW, Christensen K, Shkolnikov VM (2014). Sex differences in health and mortality in Moscow and Denmark. Eur J Epidemiol, 29, 243-52.
  30. OuYang P-Y, Zhang L-N, Lan X-W, et al (2015). The significant survival advantage of female sex in nasopharyngeal carcinoma: a propensity-matched analysis. British J Cancer, 112, 1554-61.
  31. Pinkston JM, Garigan D, Hansen M, Kenyon C (2006). Mutations that increase the life span of C. elegans inhibit tumor growth. Science, 313, 971-975.
  32. Qu Y, Chen H, Gu W, et al (2015). Age-dependent association between sex and renal cell carcinoma mortality: a populationbased analysis. Sci Rep, 5, 9160.
  33. Quaresma M, Coleman MP, Rachet B (2014). 40-year trends in an index of survival for all cancers combined and survival adjusted for age and sex for each cancer in England and Wales, 1971-2011: a population-based study. Lancet, 385, 1206-18.
  34. Torre LA, Bray F, Siegel RL, et al (2015). Global cancer statistics, 2012. CA Cancer J Clin, 65, 87-108.
  35. Torre LA, Siegel RL, Ward EM, Jemal A (2014). International variation in lung cancer mortality rates and trends among women. Cancer Epidemiology, Biomarkers Prev, 23, 1025-36.
  36. Tsu VD, Jeronimo J, Anderson BO (2013). Why the time is right to tackle breast and cervical cancer in low-resource settings. Bull WHO, 91, 683-90.
  37. Wheeler BW, Kothencz G, Pollard AS (2013). Geography of non-melanoma skin cancer and ecological associations with environmental risk factors in England. British J Cancer, 109, 235-41.
  38. World Bank (2015a). Population density (people per sq. km of land area).
  39. World Bank (2015b). Data: Countries and Economies.
  40. Yang Y, Li T, Nielsen ME (2012). Aging and cancer mortality: dynamics of change and sex differences. Experimental Gerontol, 47, 695-705.