Bots Sophie H, Peters Sanne A E, Woodward Mark
The George Institute for Global Health, University of Oxford, Oxford, UK.
The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia.
BMJ Glob Health. 2017 Mar 27;2(2):e000298. doi: 10.1136/bmjgh-2017-000298. eCollection 2017.
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.
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.
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.
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.
众所周知，心血管疾病死亡率女性低于男性，且随年龄增长而上升。近几十年来，这些性别和年龄效应是否发生了变化，以及不同国家之间的差异有多大，尚不清楚。
我们从世界卫生组织死亡率数据库中获取了1980年至2010年期间有数据的世界人口最多国家的特定年龄和性别的冠心病（CHD）及中风死亡率。我们计算了26个国家特定年龄、特定国家和特定时期的男性与女性冠心病及中风死亡率之比，并比较了不同国家之间以及同一国家不同时间的差异。
1980年至2010年期间，大多数国家的冠心病和中风死亡率在两性中均大幅下降。多数情况下，随着时间推移，衰老的影响有所减弱，男性比女性更明显。在整个成年期，男性的冠心病死亡率高于女性，但差异幅度因年龄而异。中年（30 - 64岁）时男性与女性冠心病死亡率之比为4 - 5，此后（65 - 89岁）为2。中风死亡率在两性之间更为接近，直到老年，男性与女性中风死亡率之比约为1.5 - 2。
虽然1980年至2010年期间两性的冠心病和中风死亡率均大幅下降，但有迹象表明男性冠心病特定年龄组的降幅比女性更大。在一系列经济、社会和文化多样的国家中，直到老年，男性的冠心病和中风死亡率仍高于女性。
