Temporal and Spatial Patterns of Mortality Gender Gap in Developing Countries: evidence from Brazil from 1980 to 2022

Brazil exhibits one of the widest and most persistent gender gaps in life expectancy among developing countries. From 1980 to 2024, the gap widened from 3.2 to nearly 8 years, reflecting complex inequalities in health behavior, access to care, exposure to violence, and socioeconomic conditions. While previous studies have explored gender differences in infant and young adult mortality, fewer have examined prime-aged adult mortality (15–60 years), despite its relevance for understanding labor force health and the impacts of social policy. This study investigates temporal and spatial patterns of adult mortality by sex across Brazil’s meso-regions from 1980 to 2022, emphasizing how regional contexts shape the evolution of the gender gap.

Adult mortality data were drawn from the Ministry of Health’s DATASUS system (1979–2022) and population estimates from IBGE. To address underreporting and quality issues, especially in the North and Northeast, mortality estimates were corrected using death distribution methods. The analysis focused on the probability of dying between ages 15 and 60 (45q15) and the male-to-female mortality ratio as the gender gap indicator. Temporal trends were assessed using relative pace-of-change metrics, while spatial heterogeneity was evaluated through bivariate choropleth mapping and Lee’s (2001) bivariate spatial correlation index at the meso-regional level (n=137).

Between 1980 and 2022, female adult mortality rates declined from 0.14 to 0.09, while male mortality decreased from 0.23 to 0.19, widening the average gender gap from 1.72 to 2.07. Spatially, the gap first intensified in the South and Southeast, particularly in urbanized and economically advanced coastal regions, while smaller gaps persisted in high-mortality areas of the North and Northeast. Bivariate analyses revealed a strong negative correlation between the gender gap and female mortality levels, suggesting that men in lower-mortality regions have not shared equally in health gains.

Brazil’s widening adult mortality gender gap reflects uneven health improvements and structural inequalities. Men remain disproportionately affected by external causes, behavioral risks, and limited preventive care. Targeted interventions addressing male-specific vulnerabilities—particularly in regions with rapid female health gains—are crucial to reducing gender-based mortality disparities and promoting equitable health progress across regions.