Differences between male and female mortality in Colombia: a population-based analysis since 1980.

BACKGROUND: Globally, women have consistently exhibited lower mortality and higher life expectancy than men. While this sex gap is well-documented in high-income countries, evidence from Latin America remains scarce. Colombia's history of armed conflict and inequality presents a unique context to examine sex differences in mortality. This study aims to describe long-term trends in sex-specific mortality in Colombia over the past four decades, examining differences by age group, cause of death, geographic region, and health insurance scheme. METHODS: We analysed Colombian mortality data from 1980 to 2023 using national vital statistics (DANE) and health insurance records (BDUA). Age-standardised mortality rates were estimated across six age groups and 20 causes of death, following OECD guidelines. Mortality rate ratios (MRRs), and years of life lost were computed, while life expectancy was calculated using the Lee-Carter model. FINDINGS: A persistent and widening sex gap in mortality was observed. Male age-standardised mortality declined from 591 to 437 deaths per 100,000 between the 1980s and 2020s, while female mortality declined from 445 to 287. The mortality gap peaked in the 1990s (MRR, 1.58; 95% CI, 1.58-1.58) and remained high in the 2020s (MRR, 1.52; 95% CI, 1.52-1.52). The largest disparities occurred in the 15-59 age group and were primarily due to external causes, where male mortality was up to 874% higher (in the 2000s). In older adults, chronic diseases drove the gap. Conflict-affected regions such as Antioquia, Guaviare, and Arauca showed the highest disparities. INTERPRETATION: Colombia's persistent sex-based mortality gap likely reflects the interplay of contextual factors such as violence, social inequality, and structural barriers to care. Reducing excess male mortality-particularly among young men-may require targeted, gender-responsive policies that incorporate violence prevention, health system strengthening, and strategies to address social inequities. FUNDING: None.