Getting back the missing men of Aotearoa: declining gender inequality in NZ life expectancy.

Introduction: Men's health is of increasing concern to policy makers worldwide. Although women generally live significantly longer than men, the difference in life expectancy in many countries is now narrowing.

Aim: To document the trend in sex differences in New Zealand (NZ) life expectancy at birth (LEB) over the last decades and to determine disease patterns which account for it.

Methods: Decomposition of sex differences in LEB by age and cause for the periods 1980-82, 1985-87, 1990-92,1995-97, 2000-02, and 2005-06, using registered deaths and model life tables.

Results: Sex differences in LEB increased from 1951 to peak in 1976 before narrowing again. In 2006 they reached almost exactly the level they were at 55 years earlier. Changes in relative mortality from ischaemic heart disease (IHD) and to a lesser extent accidents, respiratory disease and other circulatory causes, brought about the recent decline in gender survival disparities. IHD continues to be a significant cause of gender inequality, but cancers have now become a major component of the sex difference in LEB.

Discussion: NZ's experience mirrors closely that of other developed countries in pattern, timingand the age-cause composition of the trend in gender survival disparities. Thus differences in the timing of taking up smoking, found to explain a substantial portion of the trend elsewhere, were probably also important in NZ, but improvements in medical outcomes for smokers also must have played a significant role. Primary care practitioners will continue to reduce gender survival disparities by workingto ensure a high uptake of services such as screening for colorectal cancer, one of many diseases responsible for lower male life expectancy.