Smoking is still the main killer of men

We all know women live longer than men. New research suggests that smoking accounts for up to 60% of this difference.

The study of 30 countries across Europe published in Tobacco Control also found that smoking kills more than alcohol. The researchers, from Glasgow, compared World Health Organisation figures on death rates among men and women from all causes to those attributable to smoking and drinking.

Deaths from all causes were higher for men than for women but the excess in male deaths varied considerably across the countries studied, ranging from 188 per 100,000 of the population a year in Iceland to 942 per 100,000 in Ukraine. Most countries with a gender gap of more than 400 per 100,000 were in Eastern Europe, but elsewhere Belgium, Spain, France, Finland and Portugal had the widest gaps.

There was a fivefold difference between countries with the lowest male death rates (Iceland at 97 per 100,000) attributable to smoking and those with the highest (Ukraine at 495 per 100,000). The UK's gap was 132 per 100,000 out of a total gender mortality gap of 225 per 100,000. In other words, in the UK, smoking is responsible for 59% of the difference in mortality rates between men and women.

All told smoking was behind 40% to 60% of the gender gap in all countries except Denmark, Portugal and France, where it was lower, and Malta where it was much higher (74%).

The researchers reckon that as smoking declines so will the gender-divide when it comes to premature death. However, they acknowledged the continuing uptake of smoking among young people and increases in harmful drinking.

Deaths from drinking

There was an eightfold difference between the country with the lowest male death rate attributable to alcohol - Iceland at 29 per 100,000 - and that with the highest - Lithuania at 253 per 100,000. The UK's gap was 42 per 100,000 making alcohol responsible for 19% of the difference between male and female mortality rates.

Deaths related to alcohol were particularly high among men in Eastern European countries, but they were also much higher for women there.

But despite large gender differences in alcohol consumption across Europe and the huge variation in alcohol related deaths, these were significantly lower than deaths caused by smoking.

The maths

The researchers calculated the proportion of the discrepancy in death rates for men and women attributable to smoking and alcohol by dividing the gender gap for each cause by the gender gap for all causes.

This assumes that the assumptions traditionally made about which deaths were caused by alcohol and smoking are accurate. Smoking related deaths included respiratory tract cancers, coronary artery disease, stroke and chronic obstructive pulmonary disease (COPD). Those related to alcohol included cancers of the throat and gullet and chronic liver disease as well as alcoholic psychosis and violence.

For the UK, if smoking was responsible for 59% of the difference in male-female mortailty rates and alcohol for 19%, the implication is that other factors are responsible for 22% of the difference although the researchers don't explicitly claim this.