Does economic development contribute to sex differences in ischaemic heart disease mortality? Hong Kong as a natural experiment using a case-control study.
BACKGROUND
The male excess risk of premature ischemic heart disease (IHD) mortality may be partially due to an unknown macro-environmental influence associated with economic development. We examined whether excess male risk of IHD mortality was higher with birth in an economically developed environment.


METHODS
We used multivariable logistic regression in a population-based case-control study of all adult deaths in Hong Kong Chinese in 1998 to compare sex differences in IHD mortality (1,189 deaths in men, 1,035 deaths in women and 20,842 controls) between Hong Kong residents born in economically developed Hong Kong or in contemporaneously undeveloped Guangdong province in China.


RESULTS
Younger (35-64 years) native-born Hong Kong men had a higher risk of IHD death than such women (odds ratio 2.91, 95% confidence interval 1.66 to 5.13), adjusted for age, socio-economic status and lifestyle. There was no such sex difference in Hong Kong residents who had migrated from Guangdong. There were no sex differences in pneumonia deaths by birth place.


CONCLUSIONS
Most of these people migrated as young adults; we speculate that environmentally mediated differences in pubertal maturation (when the male disadvantage in lipids and fat patterning emerges) may contribute to excess male premature IHD mortality in developed environments.
Schooling
C Mary
CM
Dept of Community Medicine and School of Public Health, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China. cms1@hkucc.hku.hk
Lam
Tai Hing
TH
Ho
Sai Yin
SY
Mak
Kwok Hang
KH
Leung
Gabriel M
GM
D000328:Adult; D016022:Case-Control Studies; D002423:Cause of Death; D002681:China / Q000208:ethnology; D004641:Emigration and Immigration; D004777:Environment; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000191:economics / Q000209:etiology / Q000401:mortality*; D011627:Puberty / Q000502:physiology; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors