Sex differences in coronary heart disease and stroke mortality: a global assessment of the effect of ageing between 1980 and 2010

Abstract

Background: Cardiovascular disease mortality rates are well known to be lower in women than men and to increase with age. Whether these sex and age effects have changed over recent decades, and how much they differ by country, is unclear.

Method: From the WHO Mortality Database, we obtained age-specific and sex-specific coronary heart disease (CHD) and stroke mortality rates for the world's most populous countries with data available between 1980 and 2010. We calculated age-specific, country-specific and period-specific men-to-women CHD and stroke mortality rate ratios for 26 countries and compared the differences between and within countries over time.

Results: CHD and stroke mortality decreased substantially between 1980 and 2010 in most countries, in both sexes. Mostly there was an attenuation of the effect of ageing over calendar time, more so in men than in women. CHD mortality was higher in men than in women throughout adulthood, but the magnitude of the difference varied by age. Men-to-women CHD mortality rate ratios were 4-5 in middle age (30-64 years) and 2 thereafter (65-89 years). Stroke mortality was more similar between sexes, with men-to-women stroke mortality rate ratios of around 1.5-2 until old age.

Conclusions: While CHD and stroke mortality rates declined considerably between 1980 and 2010 in both sexes, there was some indication for stronger age-specific reductions in CHD in men than women. Mortality from CHD and stroke remains higher among men than women until old age across a range of economically, socially and culturally diverse countries.

Figure 1

Mortality from CHD and stroke in women and men, by country and year. For aesthetic reasons, mortality rates for Ukraine in 2000 are not included in the Figure. In 2000, CHD mortality rates in Ukraine were 502 per 100 000 for women and 719 per 100 000 for men. For stroke, this was 221 per 100 000 for women and 412 per 100 000 for men.

Figure 2

Age-specific mortality rates from CHD and stroke in women and men in 2010 in selected countries. Mortality rates are per 100 000 women (in red) or men (in blue) in each age group. Mortality rates for all countries and years are provided in efigures 1 and 2. CHD, coronary heart disease.

Figure 3

Estimated increment, over a 10-year period, in the additional rate of CHD and stroke mortality (per 100 000) for every 5 years higher age. For example, in Canada, it is estimated that, for a man at any age between 20 and 89 years, his increased chance of death from CHD within the next 12 months, compared with a male compatriot 5 years younger, has decreased by about 7 per 100 000 over any 10-year calendar period within the range 1980–2010 (for instance between 2000 and 2010). For the equivalent woman, the decrease was about 5 per 100 000. For stroke, in both sexes the decrease was about 2 per 100 000 in Canada. Estimates and SEs are provided in eTable 3. Country codes: ARgentina, BRazil, CANada, CHina, COlombia, EGypt, FRance, GErmany, JApan, ITaly, MAlaysia, MExico, PEru, PHilippines, POland, RUssia, South Africa, South Korea, SPain, THailand, TUrkey, UK, UKRaine, USA, UZbekistan, VEnezuela. CHD, coronary heart disease.

Figure 4

Men-to-women mortality rate ratios for CHD and stroke across countries in 1980 and 2010, by age. The band inside the box is the median mortality rate ratio, the bottom and top of the box are the first and third quartiles, the ends of the whiskers are placed 1.5 IQR distant from the lower and upper quartile. The dots represent observations outside that range. Countries contributing data to each of the years are listed in eTable 1. CHD, coronary heart disease.

Figure 5

CHD-to-stroke mortality rate ratios for men and women across countries in 1980 and 2010, by age. Conventions as in figure 4. CHD, coronary heart disease.