Zhao Jiaying, Booth Heather, Dear Keith, Tu Edward Jow-Ching
The Institute for Asian Demographic Research, School of Sociology and Political Science, Shanghai University, Shanghai, China School of Demography, College of Arts and Social Sciences, The Australian National University, Canberra, Australian Capital Territory, Australia.
School of Demography, College of Arts and Social Sciences, The Australian National University, Canberra, Australian Capital Territory, Australia.
J Epidemiol Community Health. 2016 Oct;70(10):983-9. doi: 10.1136/jech-2015-206577. Epub 2016 Apr 5.
Explaining patterns in the sex ratio (male/female) of cardiovascular disease (CVD) mortality would improve understanding of mortality transitions under modernisation. Little research has examined secular trends in this ratio across populations, taking age and cohort into account. We examine cohort effects in the ratios of CVD mortality (including ischaemic heart disease and cerebrovascular disease) among 4 East Asian populations that vary in the timing of their modernisation, and assess the effect of smoking on these patterns in comparison with Western populations.
The sequential method for log-linear models is applied to analyse age, period and cohort effects for sex ratios. Age and cohort effects are fitted first, with population as offset; period effects are fitted in a second model using the fitted values from the first model as the offset. Lung cancer mortality serves as a proxy for smoking.
Increases in sex ratios of CVD mortality began in earlier cohorts in Western than in East Asian populations. Once begun, increases were more rapid in East Asia. The cohort effect for the sex ratio of CVD mortality differs from that for lung cancer mortality. Trends in sex ratios of CVD mortality by cohort are similar before and after adjustment for lung cancer mortality in East Asia; the increasing trend across 1900-1945 cohorts is maintained in Western populations after adjustment.
The sex ratio of CVD mortality has increased across successive cohorts living in increasingly modernised environments. There is scant evidence that this increase is attributable to changing sex-specific rates of smoking.
解释心血管疾病（CVD）死亡率的性别比（男性/女性）模式，将有助于增进对现代化进程中死亡率转变的理解。很少有研究在考虑年龄和队列因素的情况下，考察不同人群中这一比例的长期趋势。我们研究了4个现代化进程时间不同的东亚人群中心血管疾病（包括缺血性心脏病和脑血管疾病）死亡率的性别比队列效应，并与西方人群相比，评估吸烟对这些模式的影响。
应用对数线性模型的序贯方法分析性别比的年龄、时期和队列效应。首先拟合年龄和队列效应，以人群作为偏移量；在第二个模型中拟合时期效应，使用第一个模型的拟合值作为偏移量。肺癌死亡率作为吸烟的替代指标。
西方人群中，心血管疾病死亡率性别比的上升始于比东亚人群更早的队列。一旦开始，东亚地区的上升速度更快。心血管疾病死亡率性别比的队列效应与肺癌死亡率的队列效应不同。在东亚地区，调整肺癌死亡率前后，心血管疾病死亡率性别比的队列趋势相似；在西方人群中，调整后1900 - 1945年队列的上升趋势得以维持。
在生活环境日益现代化的连续队列中，心血管疾病死亡率的性别比有所上升。几乎没有证据表明这种上升归因于特定性别的吸烟率变化。
