Far more men in Tamil Nadu are dying as compared to women. The disparity is widest among people aged 15 to 64, years when many are working, raising children and supporting ageing parents.In 2025, Tamil Nadu registered 401,860 male deaths and 291,347 female deaths — a difference of 110,513. The gap has remained above one lakh in the past three years: 1.10 lakh in 2023, 1.07 lakh in 2024 and 1.11 lakh in 2025.Nearly 86% of that gap, or 94,792 deaths, pertained to those in their prime.The pattern has persisted, experts say. A public health department analysis of civil registration system (CRS) data from 2018 to 2022, published in the medical journal by the directorate of public health, found male mortality higher than female mortality from age 15 onward in every district. The CRS is India’s legally mandated system for continuously recording births, deaths and stillbirths.Public health expert Dr T Sundararaman, former executive director of the National Health Systems Resource Centre, says these figures are more than just about demography. “Families are losing fathers too early. Women are getting widowed. We should be investing in saving these young lives,” he said.The age pattern is consistent with several overlapping risks, experts said: road crashes and suicide among younger men; and cardiovascular disease, stroke, diabetes, kidney failure, chronic respiratory illness and tobacco and alcohol-related disease in the middle aged. At least 50 people, mostly men, die every day of road crashes in Tamil Nadu. An equal number die of suicides. “We see an epidemic of strokes, heart attacks and renal failure in much younger people — much more in men than in women,” said Dr T S Selvavinayagam, a former director of public health who has published research on mortality in Tamil Nadu. While most women are screened at least during their pregnancy and after delivery, many men go without screening till 40. “If these illnesses are detected in time and people are put on chronic care treatment, their life expectancy normalises,” he said.The imbalance is not unique to Tamil Nadu. Across India, men accounted for 60.6% of deaths registered in 2023, against 39.4% for women. But raw death totals cannot be directly compared across states, officials say, because population age structures, sex ratios and death-registration completeness vary.State officials also compared deaths in Tamil Nadu with Sweden. Sweden registered 46,000 male deaths and 46,200 female deaths in 2025. That near parity reflects, in part, the fact that women make up a larger share of the oldest population. Swedish men still had an age-standardised death rate of 1,009 per 100,000 in 2024, compared with 750 among women. “The point is not that Sweden has eliminated men’s mortality disadvantage,” said state health secretary Darez Ahamed. “It is about when the deaths occur. Only about 10% of deaths in Sweden occur before age 65, compared with 42% in Tamil Nadu.”Tamil Nadu, however, can count the gap more clearly than it can explain it. In 2025, only 280,856 of Tamil Nadu’s 693,207 registered deaths — 41% — were medically certified. The certification rate was 42% among male deaths and 38% among female deaths, limiting cause-specific conclusions.Medically certified deaths are concentrated in health institutions and may not reflect deaths outside hospitals, where certification is weaker. The state needs stronger certification, systematic review of uncertified deaths and district-level publication of age, sex and cause-specific mortality data. “At least six out of 10 deaths in the state happen outside hospitals,” said state nosologist Dr Abishek Stanislaus, who works in scientific classification and grouping of diseases. “A cause-wise review of deaths is essential to understand the reasons for this gap and design targeted interventions,” he said, explaining how the state has been developing stronger guidelines on medical certification, including verbal autopsy for deaths outside institutions. “When certifications improve, we see how patterns of death differ even among districts,” he said. That will help the state develop localised health strategies.Tamil Nadu is not starting from zero. Its health programmes include doorstep screening for chronic diseases, early diagnosis and treatment for cardiac conditions, emergency care for road-crash victims and health checks for construction workers. But these schemes are not yet framed as a unified strategy to reduce premature male deaths or evaluated against a target for keeping men alive through their working years. Evening clinics have been introduced to improve access for working people who may avoid daytime visits because of lost wages. “Men don’t visit PHCs fearing loss of daily wages,” said director of public health Dr A Somasundaram. “The evening clinics help us diagnose, treat and manage blood sugar and pressure in men.”Prevention must move beyond hospitals and into the places where risk accumulates — roads, workplaces and neighbourhoods. “Road safety measures are extremely weak,” Dr Sundararaman said. “Men have to travel more; even an ordinary worker needs a motorcycle to get to work.”The question is not whether Tamil Nadu should choose men’s health over women’s health. It is whether it can recognise that preventing early male deaths is also a measure of economic security for women and protection for children.Gone too soonIn 2025, Tamil Nadu registered 9,167 deaths among men aged 15 to 24, compared with 4,461 among women. At ages 25 to 34, the figures were 17,135 and 6,177; at ages 35 to 44, they were 31,585 and 11,406. The numerical gap grew larger in middle age. Men accounted for 28,474 more deaths than women at ages 45 to 54, and 30,475 more at ages 55 to 64. After 70, however, the difference was narrow: 155,093 male deaths and 150,545 female deaths.In 2025, only 280,856 of Tamil Nadu’s 693,207 registered deaths — 41% — were medically certifiedIn 2025, Tamil Nadu registered 401,860 male deaths and 291,347 female deaths — a difference of 110,513.Email your feedback with name and address to southpole.toi@timesofindia.com
