Sex differences in all-cause and cause-specific mortality and years of life lost in the United States, 2000-2023

BACKGROUND: A persistent mortality gap exists between males and females in the United States. We describe temporal, age-specific, cause-specific trends in mortality with respect to sex differences. METHODS: Data from individuals with national death certificate data from 2000 to 2023 available in CDC WONDER were collected. We estimated sex-specific age-adjusted mortality rates (AAMR) and years of potential life lost (YPLL) by 5-year age groups, year, and cause of death. Excess mortality was defined as the difference between male and female AAMR and YPLL for each subgroup. RESULTS: Males exhibited higher AAMR than females from 2000 to 2023. Despite excess male AAMR decreasing from 291 per 100,000 in 2000 to 216 in 2014, excess YPLL remained stable. After approximately 2014, excess YPLL mirrored excess AAMR trends and increased markedly, reaching 8.1 million years in 2023-a burden concentrated in younger and middle-aged men. External causes of death were the largest contributors to excess YPLL in men aged 25-44, while circulatory diseases dominated among men over 55. CONCLUSIONS: Excess male mortality is persistently elevated in cardiovascular causes and increasingly concentrated in external causes in young and middle-aged males. Prevention and care strategies targeted to these drivers may reduce the gap. Results may be influenced by death certificate misclassification, competing risks of death changing over time, and differences in race/ethnicity subgroups.