Socioeconomic development and sex differences in cardiovascular disease mortality between East Asian and Western populations

The excessive mortality from cardiovascular disease (CVD) among males is an important component of high sex ratio of overall mortality. It has been observed that the sex ratio of CVD mortality in some Western countries increased from the 1950s but that has declined in recent years. However, little research has assessed secular trends in the sex differentials of CVD mortality, particularly by age-period-cohort decomposition, in areas under rapid economic development with swift epidemiologic transition and nutrition transition. We examine the trends in the sex ratio of CVD mortality in East Asia (Japan, Republic of Korea, Hong Kong, and Taiwan) which went through a rapid economic development during the past 5 decades. These trends are compared with those in selected Western populations (Australia, France, England & Wales, and Sweden). Our analyses suggest that the higher sex ratio of CVD mortality occurred among cohorts that had spent a large part of their childhood and early to middle adulthood in a more developed environment. This could be due to the influence of risk factors on males, who appear to be more susceptible to CVD than females. These risk factors are associated with the Nutrition Transition under economic development.