By Todd Neale, Staff Writer, MedPage Today 
 
 Published: April 29, 2010 
 
 Although worldwide adult mortality rates have been dropping overall for the past four decades, the gap between men and women, who have lower mortality risk, has widened, researchers found. From 1970 to 2010, the probability that a 15-year-old would die before turning 60 dropped by 19% for men and 34% for women, according to Christopher Murray, MD, director of the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, and colleagues. During that period, the difference between mortality risk in men and women grew from 63 per 1,000 to 80 per 1,000, the researchers reported online in The Lancet. "I think the widening gap between males and females is brought about to a large extent by the bigger impact of the Soviet Union collapse -- social dysfunction, high alcohol use -- on males than females," Murray told MedPage Today. Also contributing is the HIV epidemic's disproportionate effect on males in certain parts of the world, he said. Murray and his colleagues set out to evaluate worldwide trends in premature adult mortality from 1970 to the present, a topic that has not received as much attention as child health. They argued, however, that "the prevention of premature adult death is just as important for global health policy as the improvement of child survival," noting that declining child mortality and aging populations lead to a larger proportion of deaths occurring among adults. The researchers compiled 3,889 measurements of adult mortality for 187 countries using vital registration data, census data, and information on deaths in the household and among siblings. Using the data, the Murray and his colleagues calculated yearly estimates of the probability of a 15-year-old dying before reaching 60. Aside from the widening gap between male and female mortality, Murray said one of the most dramatic findings was the growing disparity between the best-off and worst-off countries since 1970. Mortality probabilities for men ranged from 182 to 413 per 1,000 in 1970 and from 77 to 579 per 1,000 in 2010, an increase in the intercountry spread of 117%. A similar phenomenon was seen among women as well. The drivers, Murray said, were worsening mortality risks in eastern Europe, central Asia, and many parts of Africa, accompanied by dramatic improvements in other parts of the world. In southern Africa in particular, the mortality risks in 2010 for men (578 per 1,000) and women (446 per 1,000) exceed those seen in Sweden in the middle of the 18th century (493 per 1,000 for men and 437 per 1,000 for women). Differing trends in tobacco and alcohol use, the spread of HIV, and the prevalence of key risk factors for noncommunicable disease, such as obesity and physical inactivity, are the main factors contributing to the disparity between nations. Among high-income countries, in the U.S. the rate of decline in mortality risk was less than 1.5% per year from 1970 to 2010, much slower than in many other developed countries. In 1990, the U.S. ranked 34th in female mortality and 41st in male mortality. Those ranks dipped further in 2010, to 49th for women and 45th for men, trailing all of Western Europe and several other countries. "Living in the U.S., that's probably the most disturbing thing," Murray said. He said there are many possible reasons the U.S. gets so little for its healthcare expenditures, including including a lack of insurance to some extent, high rates of elevated blood pressure and cholesterol, obesity, and tobacco consumption. Also, he said, "I think that our primary care system is not effectively managing things like blood pressure, cholesterol, and blood sugar. So even though we spend a lot of money, we don't seem to be spending it in the areas that really generate a lot of health." Among other findings: In 2010, countries with the lowest risk of premature death were Iceland for men (65 per 1,000) and Cyprus for women (38 per 1,000). 
 
 In 2010, countries with the highest risk of premature death were Swaziland for men (765 per 1,000) and Zambia for women (606 per 1,000). 
 
 There was substantial progress in female mortality in India and Bangladesh, but premature mortality stagnated in the Philippines, Indonesia, and Thailand. According to Ai Koyanagi, MD, PhD, and Kenji Shibuya, MD, DrPH, of the University of Tokyo, there were "at least three major breakthroughs" in the study, including an improved method for estimating adult mortality, a better method of accounting for missing data, and the use of a more transparent and replicable approach than previous studies. They said, however, that "the method developed by [the researchers] is promising but is not our final goal. Without empirical measurements, knowledge on the levels and trends of adult mortality will still be haunted by ambiguity and uncertainty." The study was funded by the Bill & Melinda Gates Foundation. The study authors reported no conflicts of interest. Koyanagi reported no conflicts of interest. Shibuya has worked at the WHO and is collaborating with the Institute for Health Metrics and Evaluation in the Global Burden of Disease 2005 study. 
 
 
 
 Primary source: The Lancet 
 
 Source reference: 
 
 Rajaratnam J, et al "Worldwide mortality in men and women aged 15-59 years from 1970 to 2010; a systematic analysis" Lancet 2010; DOI: 10.1016/S0140-6736(10)60517-X. 
 
 
 
 Additional source: The Lancet 
 
 Source reference: 
 
 Koyanagi A, Shibuya K "What do we really know about adult mortality worldwide?" Lancet 2010; DOI: 10.1016/S0140-6736(10)60629-0. The LancetSource reference:The LancetSource reference: 
 
 
 
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 ||||| An Iceland fan shouts during their men's European Handball Championship group B match against Serbia in Linz January 19, 2010. 
 
 WASHINGTON | 
 
 WASHINGTON (Reuters) - AIDS, smoking and obesity are reversing progress made in helping people live longer around the world, with mortality rates worsening over the past 20 years in 37 countries, researchers reported on Thursday. 
 
 They found Icelandic men have the lowest risk of premature death, while Cypriot women do. Some rich countries such as the United States and Britain scored relatively poorly, the survey found. 
 
 In most places, men have twice the relative mortality rate of women, Dr. Christopher Murray of the University of Washington in Seattle and colleagues reported in the Lancet medical journal. 
 
 "Worldwide, the 1990s reversal in the trend in adult mortality is probably a result of the HIV pandemic and the sharp rise in adult mortality in countries of the former Soviet Union," the researchers wrote. 
 
 "One of the most striking patterns is the rapid decline in adult female mortality in south Asia; in 1970 this was the region with the highest risk of female mortality and by 2010, (the risk of dying before age 60) had fallen by 56 percent." 
 
 Murray and colleagues used a complex formula to calculate the probability that someone aged 15 will die before they reach 60. They believe their method paints a more accurate picture than methods used by the United Nations, and can be used to compare countries with populations of different ages. 
 
 In the 40 years since 1970, they found, adult mortality risk fell by 34 percent among women and 19 percent in men globally. 
 
 REVERSING PROGRESS 
 
 But some places had notable reversals in rank, including the former Soviet Union. Russia has fallen from 43rd place for female mortality in 1970 to 121st. 
 
 "Research shows that across countries, inequality in adult mortality has grown to the point where adult men in Swaziland -- the country with the worst mortality rate -- now have a probability of premature death that is nine times the mortality rate of the best country, Cyprus," Murray's team wrote. 
 
 The United States, where 60 percent of adults are overweight or obese, fell in overall rankings, from 34th in the world in female mortality and 41st in male mortality in 1990 to 49th for women and 45th for men in 2010 -- behind Chile, Tunisia, and Albania. 
 
 But mortality rates fell 50 percent over the same time in South Korea. 
 
 Murray said he wanted to study adult mortality globally because so much emphasis goes into helping very young children survive. 
 
 "Every year, more than 7.7 million children die before their fifth birthday; however, over three times that number of adults -- nearly 24 million -- die under the age of 60 years," his team wrote. 
 
 "The prevention of premature adult death is just as important for global health policy as the improvement of child survival." 
 
 According to the United Nations, 8.8 million children under the age of 5 died in 2008.
– America is lagging far behind other countries in preventing premature death among adults and now ranks behind Chile, Tunisia, and Peru, warn the authors of a new study. The researchers analyzed data on deaths before age 60 and found that over the last 20 years, the US has tumbled from 34th in female mortality and 41st in male to 49th for women and 45th for men, Reuters reports. Icelandic men and Cypriot women are the most likely to see their 60th birthdays. "The US is definitely on the wrong trajectory," one of the study's authors says, blaming obesity, smoking, cholesterol, and a flawed health care system. "I think that our primary care system is not effectively managing things like blood pressure, cholesterol, and blood sugar," he told MedPage Today. "So even though we spend a lot of money, we don't seem to be spending it in the areas that really generate a lot of health."