Smoking cigarettes accounts for between 40% and 60% of the difference in men and women's mortality right across Europe, new research reveals. Alcohol accounts for around 20% of the gender gap. The findings, published in the journal Tobacco Control, highlight the need for public health measures to tackle these harmful behaviors.

Women have outlived men in some European countries since the middle of the 18th century, and since the late 1990s, there has been evidence that women in every country in the world can expect to live longer than their male compatriots. The reasons for this difference have been hotly debated; some attribute the gender gap to biology, while others point to men's (relative) unwillingness to seek out medical care when they need it. One area which has been largely neglected is the influence of health behaviors on the gender gap in death rates.

In this study, scientists in the UK used World Health Organization (WHO) data on death rates in 30 European countries from the year 2005. They studied differences between the genders in deaths from all causes as well as deaths from smoking-related conditions and alcohol-related deaths.

The results revealed that although the death rates from all causes were higher for men than for women in all countries studied, the scale of the gender gap varied widely, from 188 (per 100,000 of the population per year) 'excess' deaths among men in Iceland to 942 in Ukraine. Generally speaking, the gender gap was higher in Eastern Europe; all countries with a gender gap over 400 per 100,000 were in this region. The lowest gender gaps were found in Cyprus, Greece, Iceland, Sweden and the UK, which all recorded gaps of under 230 per 100,000.

Smoking accounted for between 38% and 60% of the gender gap in all countries, with the exception of Malta, where smoking was behind 74% of the excess deaths. According to the researchers, variations in the proportion of excess deaths due to smoking tobacco can be attributed to gender differences in the uptake of smoking in different countries in earlier decades.

Meanwhile alcohol-related deaths accounted for between 20% and 30% of the gender gap in Eastern Europe and between 10% and 20% elsewhere. However, in all 30 countries studied, the contribution of smoking to the gender gap in all-cause mortality was greater than that of alcohol.

The scientists point out that it should not come as a surprise that smoking and drinking are such significant drivers of the gender gap in life expectancy, as these behaviors 'have long been a powerful way of portraying gendered identities'.

Furthermore, the researchers note, 'it has been suggested that cultural portrayals of drinking keep shifting to maintain a gendered distinction in drinking behaviors, so that as men and women both modify their drinking behaviors, considerable effort is devoted to constructing men's drinking in different ways to women's drinking.'

The fact that young smokers continue to take up smoking and engage in harmful patterns of alcohol consumption suggests that public health measures are urgently needed to tackle these behaviors. The fact that these behaviors appear to be linked to gender identities means that dealing with them will not be easy.

'These behaviors are culturally bound and these cultural constructions of behaviors are partially shaped by and exploited by the alcohol and tobacco industries,' the researchers warn.

Looking to the future, the team predicts that the gender gap due to smoking will dwindle in the coming decades. They concluded that it may still be several decades before profound changes in gender differences in smoking in some of these countries are reflected in a smaller contribution of smoking-related deaths to a reduced gender gap in mortality.

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