Cigarette Use and the Narrowing Sex Differential in Mortality

What explains the recent reversal in many countries of century‐long trends toward a growing female advantage in mortality? And might the reversal indicate that new roles and statuses of women have begun to harm their health relative to men? Using data on 21 high‐income countries that separate smoking deaths from other deaths, this study answers the first question by showing that the reversal in the direction of change in the sex differential results from increased levels of smoking among women relative to men. Using additional cross‐national data on cigarette consumption and indicators of gender equality, this article answers the second question in the negative by showing that the declining female advantage in smoking mortality results from patterns of the diffusion of cigarette use rather than from improvements in women's status. Evidence of continued improvement in the female mortality advantage net of smoking deaths, and the likely decline of smoking among women in the future, imply that the recent narrowing of the differential will reverse.