posts: 26840

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                                "text": "From",
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                        "url": "https://ourworldindata.org/life-expectancy",
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                                        "text": "life expectancy",
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                        "url": "https://ourworldindata.org/mental-health",
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                                "text": " ",
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                                        "text": "mental health",
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                        "url": "https://ourworldindata.org/substance-use",
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                                "text": " ",
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                                        "text": "substance use",
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                                "text": " to",
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                        "url": "https://ourworldindata.org/cancer",
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                                "text": " ",
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                                "children": [
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                                        "text": "cancer rates",
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                                "text": "; there are important differences in health outcomes between the sexes. In a related post, my colleague Esteban Ortiz-Ospina looks at the evidence to answer the question \"",
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                        "url": "https://ourworldindata.org/why-do-women-live-longer-than-men",
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                                "children": [
                                    {
                                        "text": "Why do women live longer than men?",
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                                "text": "\"",
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                        "children": [
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                                "text": "Here we focus on the youngest, asking, why do young boys die more often than girls?",
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                "text": [
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                        "text": "Child and infant mortality is higher for boys in nearly all countries",
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                        "text": "Child mortality measures the share of newborns who die before reaching their 5th birthday.\u00a0In the chart below we see the comparison of child mortality by sex.",
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                        "text": "Here, the mortality rate for boys is shown on the y-axis, and the mortality rate for girls on the x-axis. The grey line running diagonally across the chart marks where the mortality rate for both sexes is equal. In countries which lie above the grey line, the rate for boys is higher than for girls.",
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                        "text": "What's striking is that with exception of two countries \u2013 India and Tonga \u2013 child mortality is more common for boys in all countries of the world. This is also ",
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                        "url": "https://ourworldindata.org/grapher/infant-mortality-by-sex",
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                                "text": "true for infant mortality",
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                        "text": ", which is the share of newborns who die within their 1st year of life. We study why India and Tonga are outliers ",
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                        "url": "https://ourworldindata.org/gender-ratio#infanticide-and-excess-female-mortality",
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                                        "text": "here",
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                        "text": "Over the past half-century in particular, child mortality has been falling rapidly across the world. This has been ",
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                        "url": "https://ourworldindata.org/grapher/child-mortality-line-chart-by-sex",
                        "children": [
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                                "text": "true for boys and girls",
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                        "text": " alike.",
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                        "text": "It has been known for a long time that the mortality of boys is higher. As early as 1786 the physician, Dr Joseph Clarke, read a paper to the Royal Society of London on his observations that ",
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                                "text": "\"mortality of males exceeds that of females in almost all stages of life, and particularly the earliest stages\"",
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                        "text": ".{ref}Clarke, J., & Price, R. (1786). XVII. Observations on some causes of the excess of the mortality of males above that of females. By Joseph Clarke, MD Physician to the Lying-in Hospital at Dublin. Communicated by the Rev. Richard Price, DDFRS in a letter to Charles Blagden, MD Sec. R. S. Philosophical Transactions of the Royal Society of London, (76), 349-362.{/ref}",
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                "url": "https://ourworldindata.org/grapher/child-mortality-by-sex",
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                "text": [
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                        "text": "What do infants die from?",
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                        "text": "Why is it the case that boys die more often than girls? First of all, it's important to understand what young children die from.",
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                                "text": "In this chart we see global mortality rates in infants across different causes in 2017. This data comes from the IHME's ",
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                                        "text": "Global Burden of Disease",
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                                "text": " study, which provides estimates by sex \u2013 on the y-axis we have plotted mortality rates in boys, and on the x-axis for girls. Just like the charts above, causes which lie above the grey line are more common in boys.",
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                                "text": "The chart shows that for all major causes of death, mortality is higher in boys. The sex differences in the causes of infant deaths were already documented almost a century ago: in an impressive paper published in 1929, Bawkin explores the mortality sex ratio of specific diseases from countries across the world.",
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                        "text": "{ref}Bakwin, H. (1929).",
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                    {
                        "url": "https://search.proquest.com/docview/1301822705?pq-origsite=gscholar",
                        "children": [
                            {
                                "text": " The sex factor in infant mortality",
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                        "spanType": "span-link"
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                    {
                        "text": ". ",
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                        "children": [
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                                "text": "Human Biology",
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                        "text": ", 1(1), 90.{/ref}",
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                        "children": [
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                                "text": "There are some causes \u2013",
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                    {
                        "url": "https://owid.cloud/hiv-aids",
                        "children": [
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                                "text": " ",
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                            {
                                "children": [
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                                        "text": "HIV/AIDS",
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                                "text": ", nutritional deficiencies, whooping cough, among others \u2013 for which the mortality rates are higher in girls. But overall, infant boys are more likely to die in childhood than girls.",
                                "spanType": "span-simple-text"
                            }
                        ],
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                    },
                    {
                        "text": "{ref}Sawyer, C. C. (2012).",
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                    },
                    {
                        "url": "https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001287",
                        "children": [
                            {
                                "text": " Child mortality estimation: estimating sex differences in childhood mortality since the 1970s",
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                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ". ",
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                        "children": [
                            {
                                "text": "PLoS Medicine",
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                        "text": ", 9(8), e1001287.{/ref}{ref}Naeye, R. L., Burt, L. S., Wright, D. L., Blanc, W. A., & Tatter, D. (1971).",
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                    {
                        "url": "https://pediatrics.aappublications.org/content/48/6/902.short",
                        "children": [
                            {
                                "text": " Neonatal mortality, the male disadvantage",
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                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ". ",
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                    {
                        "children": [
                            {
                                "text": "Pediatrics",
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                        "text": ", 48(6), 902-906.{/ref}{ref}This is also the explanation",
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                        "url": "http://www.searo.who.int/entity/health_situation_trends/data/chi/sex-diff-imr/en/",
                        "children": [
                            {
                                "text": " reported by",
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                        "text": " the World Health Organization: \"",
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                        "children": [
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                                "text": "Newborn girls have a biological advantage in survival over newborn boys. They have lesser vulnerability to perinatal conditions (including birth trauma, intrauterine hypoxia and birth asphyxia, prematurity, respiratory distress syndrome and neonatal tetanus), congenital anomalies, and such infectious diseases as intestinal infections and lower respiratory infections.",
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                        "text": "\"{/ref}",
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                                "text": "Boys are more vulnerable in two key ways: they are at higher risk of birth complications, and infectious disease. We explore the possible reasons for this below.",
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                "url": "https://ourworldindata.org/grapher/infant-death-rates-by-cause-by-sex",
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                "text": [
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                        "text": "Boys are at higher risk of birth complications",
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                                "text": "From comparison of mortality rates in infant boys and girls, it becomes clear that boys are at higher risk of complications in the first few days of life: preterm births, asphyxia, birth defects and heart anomalies. But why?",
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                                "text": " ",
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                            {
                                "text": "First of all, ",
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                        "children": [
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                                "text": "boys are more likely to be born prematurely",
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                        "children": [
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                                "text": ": the share of boys born before full-term pregnancy is higher than for girls.",
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                        "text": "{ref}Peelen, M. J., Kazemier, B. M., Ravelli, A. C., De Groot, C. J., Van Der Post, J. A., Mol, B. W., \u2026 & Kok, M. (2016).",
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                    {
                        "url": "https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1111/aogs.12929",
                        "children": [
                            {
                                "text": " Impact of fetal gender on the risk of preterm birth, a national cohort study",
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                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ". ",
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                    {
                        "children": [
                            {
                                "text": "Acta obstetricia et gynecologica Scandinavica",
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                        "text": ", 95(9), 1034-1041.{/ref}\u00a0This occurs naturally, but is exacerbated by the rate of induced preterm births. Boys tend to have a higher birthweight than girls \u2013 which can increase the risk of waiting to term to deliver \u2013 meaning that more boys are induced before the end of the pregnancy term.{ref}Zeitlin, J., Saurel-Cubizolles, M. J., de Mouzon, J., Rivera, L., Ancel, P. Y., Blondel, B., & Kaminski, M. (2002).",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://academic.oup.com/humrep/article/17/10/2762/607779",
                        "children": [
                            {
                                "text": " Fetal sex and preterm birth: are males at greater risk?",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ". ",
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                    {
                        "children": [
                            {
                                "text": "Human Reproduction",
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                        "text": ", 17(10), 2762-2768.{/ref}\u00a0The chart above shows that more boys die from preterm births. The fact that preterm births are more common for boys contributes to this.",
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                        "children": [
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                                "text": "Although boys are, on average, heavier than girls at birth, ",
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                        "children": [
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                                "text": "they are less physiologically mature at birth",
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                        "children": [
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                                "text": ".",
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                        "children": [
                            {
                                "text": "This means they are at higher risk of having delayed physiological function (such as lung function) and adverse neurological outcomes.",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-fallback"
                    },
                    {
                        "text": "{ref}Peacock, J. L., Marston, L., Marlow, N., Calvert, S. A., & Greenough, A. (2012).",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.nature.com/articles/pr201150",
                        "children": [
                            {
                                "text": " Neonatal and infant outcome in boys and girls born very prematurely",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ". ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "children": [
                            {
                                "text": "Pediatric Research",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-italic"
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                    {
                        "text": ", 71(3), 305.{/ref}{ref}Hintz, S. R., Kendrick, D. E., Vohr, B. R., Poole, W. K., Higgins, R. D., & Nichd Neonatal Research Network. (2006).",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://onlinelibrary.wiley.com/doi/abs/10.1080/08035250600599727",
                        "children": [
                            {
                                "text": " Gender differences in neurodevelopmental outcomes among extremely preterm, extremely\u2010low\u2010birthweight infants",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ". ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "children": [
                            {
                                "text": "Acta Paediatrica",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": ", 95(10), 1239-1248.{/ref}\u00a0For example, poorer lung function in newborn boys has been shown for both term and preterm infants.{ref}Jones, M., Castile, R., Davis, S., Kisling, J., Filbrun, D., Flucke, R., \u2026 & Tepper, R. S. (2000).",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.atsjournals.org/doi/full/10.1164/ajrccm.161.2.9903026",
                        "children": [
                            {
                                "text": " Forced expiratory flows and volumes in infants: normative data and lung growth",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ". ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "children": [
                            {
                                "text": "American Journal of Respiratory and Critical Care Medicine",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": ", 161(2), 353-359.{/ref}{ref}Hoo, A. F., Henschen, M., Dezateux, C., Costeloe, K., & Stocks, J. (1998).",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.atsjournals.org/doi/full/10.1164/ajrccm.158.3.9711057",
                        "children": [
                            {
                                "text": " Respiratory function among preterm infants whose mothers smoked during pregnancy",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ". ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "children": [
                            {
                                "text": "American Journal of Respiratory and Critical Care Medicine",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-italic"
                    },
                    {
                        "text": ", 158(3), 700-705.{/ref}\u00a0Studies have suggested that even in the case of straightforward pregnancies, lung maturation in boys lags that of girls by approximately one week.{ref}Fleisher, B., Kulovich, M. V., Hallman, M. I. K. K. O., & Gluck, L. O. U. I. S. (1985).",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://europepmc.org/abstract/med/4022494",
                        "children": [
                            {
                                "text": " Lung profile: sex differences in normal pregnancy",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
                    },
                    {
                        "text": ". ",
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                        "children": [
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                                "text": "Obstetrics and Gynecology",
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                        "text": ", 66(3), 327-330.{/ref}\u00a0These differences in maturity at birth are not restricted to lung function.{ref}Peacock, J. L., Marston, L., Marlow, N., Calvert, S. A., & Greenough, A. (2012).",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.nature.com/articles/pr201150",
                        "children": [
                            {
                                "text": " Neonatal and infant outcome in boys and girls born very prematurely",
                                "spanType": "span-simple-text"
                            }
                        ],
                        "spanType": "span-link"
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                    {
                        "text": ". ",
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                                "text": "Pediatric Research",
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                    {
                        "text": ", 71(3), 305.{/ref}",
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                                "text": "The reason for this difference has been an important question for decades \u2013 the answer is still not clear. But there are some leading hypotheses: surfactant production for lung function has been observed earlier in female fetuses, leading to improved airway flow in the lungs; estrogen has been shown to affect lung development positively in females; males, on average, have a higher birthweight meaning they may trade-off increased size for functional development; and the uterus may be less hospitable to male fetuses \u2013 the introduction of a Y chromosome in females can create an immunoreactive response to the central nervous system.",
                                "spanType": "span-simple-text"
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                        "spanType": "span-fallback"
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                    {
                        "text": "{ref}DiPietro, J. A., & Voegtline, K. M. (2017).",
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                    {
                        "url": "https://www.sciencedirect.com/science/article/pii/S0306452215006958",
                        "children": [
                            {
                                "text": " The gestational foundation of sex differences in development and vulnerability",
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                        "text": ". ",
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                        "text": ", 342, 4-20.{/ref}{ref}Townsel, C. D., Emmer, S. F., Campbell, W. A., & Hussain, N. (2017).",
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                    {
                        "url": "https://www.frontiersin.org/articles/10.3389/fped.2017.00006/full",
                        "children": [
                            {
                                "text": " Gender differences in respiratory morbidity and mortality of preterm neonates",
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                        "text": ". ",
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                        "children": [
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                                "text": "Frontiers in Pediatrics",
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                        "text": ", 5, 6.{/ref}",
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                                "text": "This, combined with a higher risk of premature birth may explain why boys have higher rates of asphyxia, respiratory infections and birth defects.",
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                "text": [
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                        "text": "Boys are at higher risk of infectious diseases",
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                        "children": [
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                                "text": "Boys are also at higher risk of infectious diseases such as syphilis,",
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                    {
                        "url": "https://owid.cloud/malaria",
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                                "children": [
                                    {
                                        "text": "malaria",
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                        "children": [
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                                "text": ", respiratory infections, tetanus and diarrheal diseases. This is more generally true for a broad range of infections, spanning person-to-person, vector-borne, blood-borne, and food and water borne diseases.",
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                            }
                        ],
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                    },
                    {
                        "text": "{ref}Giefing\u2010Kr\u00f6ll, C., Berger, P., Lepperdinger, G., & Grubeck\u2010Loebenstein, B. (2015).",
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                    },
                    {
                        "url": "https://onlinelibrary.wiley.com/doi/full/10.1111/acel.12326",
                        "children": [
                            {
                                "text": " How sex and age affect immune responses, susceptibility to infections, and response to vaccination",
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                        "spanType": "span-link"
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                    {
                        "text": ". ",
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                        "children": [
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                                "text": "Aging Cell",
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                        "text": ", 14(3), 309-321.{/ref}",
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                                "text": "We see this clearly when we compare mortality rates for boys and girls in the earlier chart. But why are boys more susceptible to infection?",
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                                "text": "Overall, boys have weaker immune systems. There are two key hypotheses for why.",
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                                "children": [
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                                        "text": "The Y-chromosome in boys increases their vulnerability.",
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                            },
                            {
                                "text": " Biologically, males and females are differentiated by chromosomes: females have two X chromosomes (XX) and males one X and one Y chromosome (XY). Having two X chromosomes means that the newborn has a stronger immune system because X chromosomes contain a larger number of immune-related genes.",
                                "spanType": "span-simple-text"
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                    {
                        "text": "{ref}Markle, J. G., & Fish, E. N. (2014).",
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                        "url": "https://www.sciencedirect.com/science/article/pii/S1471490613001592",
                        "children": [
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                                "text": " SeXX matters in immunity",
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                        "text": ". ",
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                        "children": [
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                                "text": "Trends in Immunology",
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                        "text": ", 35(3), 97-104.{/ref}{ref}Libert, C., Dejager, L., & Pinheiro, I. (2010).",
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                    {
                        "url": "https://www.nature.com/articles/nri2815",
                        "children": [
                            {
                                "text": " The X chromosome in immune functions: when a chromosome makes the difference",
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                        "text": ". ",
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                        "children": [
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                                "text": "Nature Reviews Immunology",
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                        "text": ", 10(8), 594.{/ref}\u00a0This means that, since females have two X chromosomes, they have a stronger immune response; boys on the other hand, are more vulnerable to X-linked infections.{ref}Waldron, I. (1983). Sex differences in human mortality: the role of genetic factors.",
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                        "url": "https://www.sciencedirect.com/science/article/pii/0277953683902344",
                        "children": [
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                                "text": " ",
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                                "children": [
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                                        "text": "Social Science & Medicine",
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                        "text": ", 17(6), 321-333.{/ref}",
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                                "text": "This makes males more vulnerable to many infectious diseases. They are also more susceptible to specific genetic diseases where the defective genes are carried on either the X or Y chromosomes; this is because boys have only one X chromosome so a single recessive gene on that X chromosome results in the disease.",
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                                "text": "But the stronger immune response of females comes with a cost. It\u2019s the reason why women are more susceptible to autoimmune disorders such as HIV/AIDS.",
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                        "text": "{ref}Libert, C., Dejager, L., & Pinheiro, I. (2010).",
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                                "text": " The X chromosome in immune functions: when a chromosome makes the difference",
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                                "text": "Sex hormones may be another key reason for weaker immune systems in males. ",
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                        "children": [
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                                "text": "Males have much higher amounts of testosterone which seem to inhibit two major parts of the immune system \u2013 B and T-lymphocytes.",
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                        "text": "{ref}Fischer, J., Jung, N., Robinson, N., & Lehmann, C. (2015).",
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                        "url": "https://link.springer.com/article/10.1007/s15010-015-0791-9",
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                                "text": " Sex differences in immune responses to infectious diseases",
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                        "text": ". ",
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                                "text": "Infection",
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                        "text": ", 43(4), 399-403.{/ref}",
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                                "text": "Estrogen, on the other hand, acts as an effective regulator of this. Overall, male hormones weaken the immune system relative to females.",
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                                "text": "The male disadvantage",
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                                "text": "The fact that boys are more susceptible than girls to a range of health conditions is often summarized as the \u201cmale disadvantage\u201d. This is not restricted to childhood: the female advantage carries into adulthood. It\u2019s part of the reason ",
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                        "url": "https://ourworldindata.org/why-do-women-live-longer-than-men",
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                                "children": [
                                    {
                                        "text": "why women tend to live longer than men",
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                                "text": "The leading explanations for the \"male disadvantage\" lie in the biological differences between the sexes. More specifically, differences in maturity, sex chromosomes, and hormones.",
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                                "text": "In circumstances where both sexes are treated equally, we would therefore expect infant and child mortality rates to be slightly higher for boys.",
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        "title": "Why do boys die more often than girls?",
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