Sex Differences In Mortality Research Articles

Differences in in-hospital mortality after STEMI versus NSTEMI by sex. Eleven-year trend in the Spanish National Health Service

Introduction and objectivesConflicting results have been reported on the possible existence of sex differences in mortality after myocardial infarction (MI). There is also a scarcity of data on the impact of sex on outcomes after ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). The aim of this study was to analyze sex difference trends in sex-related differences in mortality for STEMI and NSTEMI. MethodsA retrospective analysis of 445 145 episodes of MI (2005-2015) was carried out using information from the Spanish National Health System. The incidence rates were expressed as events per 10 000 person-years. The denominators (age-specific groups) were obtained from the nationwide census. We calculated crude and adjusted (multilevel logistic regression) mortality. Poisson regression analysis was used to study temporal trends for in-hospital mortality. ResultsA total of 69.8% episodes occurred in men. The mean age in men was 66.1±13.3 years, which was significantly younger than in women, 74.9±12.1 (P<.001). A total of 272 407 (61.2%) episodes were STEMI, and 172 738 (38.8%) were NSTEMI. Women accounted for 28.8% of STEMI and 33.9% of NSTEMI episodes (P <.001). The effect of female sex on risk-adjusted models for in-hospital mortality was the opposite in STEMI (OR for women, 1.18; 95%CI, 1.14-1.22; P <.001) and NSTEMI (OR for women, 0.85; 95%CI, 0.81-0.89; P <.001). MI hospitalization rates were higher in men than in women for all age groups [20 vs 7.7 per 10 000 individuals aged 35-94 years (P <.001)], with a trend to diminish in both sexes. ConclusionsWomen had a slight but significantly increased risk of in-hospital mortality after MI, but the effect of sex depended on MI type, with women exhibiting higher mortality for STEMI and lower mortality for NSTEMI

SO061SEX DIFFERENCES IN MORTALITY AMONG PEOPLE WITH END-STAGE KIDNEY DISEASE: DO WOMEN ALWAYS LIVE LONGER?

Abstract Background and Aims Female life expectancies consistently exceed males in the general population. Yet, this survival advantage may not persist in the presence of a chronic disease due to sex-based differences or healthcare inequities. We aimed to explore sex differences in survival among people with end-stage kidney disease (ESKD) compared to the general population. Method We included the entire ESKD population in Australia, 1980-2013 and New Zealand, 1988-2012 from the Australian and New Zealand Dialysis and Transplant Registry. These were linked to national death registers to ascertain deaths and their causes. We estimated relative measures of survival, including standardized mortality ratios (SMR), cumulative relative survival and expected life years lost, using general population data (adjusting for country, age, sex and calendar year) to account for background mortality. Results Of the 60,823 ESKD patients, there were 25,042 females (41%) and 35,781 males (59%). Overall 34,417 deaths occurred over the 368,719 person-years of follow-up where a similar proportion of females (57%) and males (56%) died. While mortality sex differences within the ESKD population were minor, once compared to the general population female ESKD patients had greater excess deaths, worse relative survival and greater life years lost compared to male ESKD patients. Female ESKD patients had 12 times (SMR:11.5; 95%CI:11.3-11.7) and males had 7 times (SMR:6.7; 95%CI:6.7-6.8) the expected deaths, with the greatest sex disparity among younger ages and from cardiovascular disease. Relative survival was consistently lower in females (0.57, 95%CI:0.57-0.58 in males vs 0.54, 95%CI:0.54-0.55 in females at 5 years), where the excess mortality was 9% higher (95%CI:7-12%) in female ESKD patients (Fig 1A), adjusting for year and age. The average life years lost for female ESKD patients was 4-5 years greater than male ESKD patients (Average life years lost 25.9 years, 95%CI:25.1-26.7 in males and 31.4 years, 95%CI:30.5-32.1 in females aged 15 years at ESKD) (Fig 1B). Kidney transplantation reduced the sex differences in excess mortality, with similar relative survival (p=0.42; Fig 1C) and average life years lost reduced to 3-4 years for females (Fig 1D). Conclusion The impact of ESKD is more profound for women than men with greater excess mortality, however kidney transplantation attenuates these differences. Our findings show that chronic diseases and sex can compound to produce worse outcomes where women lose their survival advantage in the presence of ESKD.

The gendered impact of coronavirus disease (COVID-19): do estrogens play a role?

Objective: Although sex-disaggregated data for COVID-19 show equal numbers of cases between men and women, there seem to be sex differences in mortality rate and vulnerability to the disease: more men than women are dying. Methods: We have explored the potential role of estrogens in this COVID-19 gendered impact. Results: Estrogens stimulate the humoral response to viral infections, while testosterone and progesterone give an immune suppression of both innate and cell-mediated immune responses. We hypothesise that estrogens, in particular estradiol but also synthetic estrogen such as ethinylestradiol, could protect women from the most serious complications of COVID-19. The use of medications that keep hormonal levels high and stable, such as combined hormonal contraceptive, could therefore play a protective role. These potential benefits overtake the thrombotic risk in healthy women. As stated by the World Health Organization, all modern methods of contraception were safe to use during the COVID-19 pandemic.

Sexually Divergent Mortality and Partial Phenotypic Rescue After Gene Therapy in a Mouse Model of Dravet Syndrome.

Dravet syndrome (DS) is a neurodevelopmental genetic disorder caused by mutations in the SCN1A gene encoding the α subunit of the NaV1.1 voltage-gated sodium channel that controls neuronal action potential firing. The high density of this mutated channel in GABAergic interneurons results in impaired inhibitory neurotransmission and subsequent excessive activation of excitatory neurons. The syndrome is associated with severe childhood epilepsy, autistic behaviors, and sudden unexpected death in epilepsy. Here, we compared the rescue effects of an adeno-associated viral (AAV) vector coding for the multifunctional β1 sodium channel auxiliary subunit (AAV-NaVβ1) with a control vector lacking a transgene. We hypothesized that overexpression of NaVβ1 would facilitate the function of residual voltage-gated channels and improve the DS phenotype in the Scn1a+/− mouse model of DS. AAV-NaVβ1 was injected into the cerebral spinal fluid of neonatal Scn1a+/− mice. In untreated control Scn1a+/− mice, females showed a higher degree of mortality than males. Compared with Scn1a+/− control mice, AAV-NaVβ1-treated Scn1a+/− mice displayed increased survival, an outcome that was more pronounced in females than males. In contrast, behavioral analysis revealed that male, but not female, Scn1a+/− mice displayed motor hyperactivity, and abnormal performance on tests of fear and anxiety and learning and memory. Male Scn1a+/− mice treated with AAV-NaVβ1 showed reduced spontaneous seizures and normalization of motor activity and performance on the elevated plus maze test. These findings demonstrate sex differences in mortality in untreated Scn1a+/− mice, an effect that may be related to a lower level of intrinsic inhibitory tone in female mice, and a normalization of aberrant behaviors in males after central nervous system administration of AAV-NaVβ1. The therapeutic efficacy of AAV-NaVβ1 in a mouse model of DS suggests a potential new long-lasting biological therapeutic avenue for the treatment of this catastrophic epilepsy.

Mortality and risk assessment for anorexia nervosa in acute-care hospitals: a nationwide administrative database analysis

BackgroundAnorexia nervosa (AN) is a common eating disorder with the highest mortality rate of all psychiatric diseases. However, few studies have examined inpatient characteristics and treatment for AN. This study aimed to characterise the association between mortality and risk factors in patients with AN in acute-care hospitals.MethodsWe conducted a nationwide, retrospective analysis of the Japanese Diagnosis and Procedure Combination inpatient database. Data extraction occurred from April 2010 to March 2016. We estimated in–hospital mortality and identified independent risk factors, using multivariate logistic regression analysis to examine patient characteristics and physical and psychological comorbidities.ResultsWe identified 6937 patients with AN aged ≥12 years in 885 acute-care hospitals. Of these, 361 (5.2%) were male. Male and female participants’ median ages at first admission were 34 (17–65) and 28 (17–41) years, respectively. In total, 195 in-hospital patient deaths, including 22 (6.1%) men and 173 (2.6%) women, it was observed that the unadjusted odds ratio of mortality for male patients was more than twice that for female patients (OR: 2.40, 95% CI: 1.45–3.81). Multivariate logistic regression analysis demonstrated an adjusted odds ratio of 2.19 (95% CI: 1.29–3.73). Age at first hospital admission, percentage of ideal body weight, comorbidities, and hypotension were significantly associated with increased mortality risk, but the frequency of hospitalization, bradycardia, and other psychiatric disorders were not. Treatment in a university hospital was associated with lower mortality risk (odds ratio: 0.45, 95% CI: 0.30–0.67).ConclusionThe results highlighted sex differences in mortality rates. Potential risk factors could contribute to improved treatment and outcomes. These retrospective findings indicate a need for further longitudinal examination of these patients.

Contemplating on the Etiology of COVID-19 Severity and Mortality Sex Differences

COVID-19 displays a sex-biased behavior with a higher rate of intensity and mortality in men. In that sense, COVID-19 deflects-off the typical trend of many viral infections which are characterized by a higher rate of intensity and prevalence in males, yet a higher female mortality rate. Severity and mortality rates of COVID-19 are associated with several underlying diseases, which exhibit significant self-sufficient male-biased dimorphism, thus are at times hypothesized to be the ones responsible to tilt mortality balance toward higher men death in COVID-19. Yet, similar comorbidities prevail in other viral infections, raising curiosity to what makes COVID-19 unique? The answer may lay in the involvement of renin-angiotensin system and ACE2 receptor in COVID-19 progression, 2 players which are significant contributors to the fatality of COVID-19. A structured difference is evident in the expression and function of RAS and ACE2 between the sexes, presumably tipping over mortality rate tendency toward male-risk factor.

Sex differences in health and mortality by income and income changes

BackgroundThe adverse association between income, health and survival is well documented, but little is known about how income trajectories influence health and survival for men and women. We aim to...

Sex Differences in Mortality After Endovascular Treatment for PAD

Sex Differences in Mortality After Endovascular Treatment for PAD

Standard mortality rates and years of life lost for serologically defined adult-onset type 1 and type 2 diabetes – A fifteen year follow-up

AimsThe Diabetes Incidence in Kronoberg (DIK) study of adult-onset diabetes used serological classification. Standard Mortality Rates (SMR) and Years of Life Lost (YLL) 15 years after adult-onset (18–100 years) of diabetes were compared to the population of Kronoberg. MethodsOf 1609/1660 (97%) patients, 112 (7%) had type 1 (T1D) (GADA+ and/or ICA+, and/or C-peptide < 0.25 nmol/l), and 1497 (93%) had type 2 diabetes (T2D) (antibody- and C-peptide ≥ 0.25 nmol/l). The National Swedish Mortality Register provided time of death. ResultsFor T1D SMR did not differ from the Kronoberg population in any age group. In T2D SMR was 1.20 (1.12–1.29). After 15 years 26% (29/112) T1D and 52% (785/1497) T2D patients had died, p < 0.0001. In T2D SMR was 5.6 (30–39 years), 2 (40–59 years), 1.4 (60–69 years), and thereafter no difference. There were no significant sex differences in mortality, and no YLL to adult-onset T1D, but five YLL to T2D for onset at ages 20–60 years. ConclusionsFor adult-onset T1D SMR did not differ from the general population, in contrast to previous findings in childhood-onset (< 30 years of age) T1D. The difference in mortality between persons with diabetes and the general population was due to higher mortality in T2D.

Sex Disparity in Outcomes of Ruptured Abdominal Aortic Aneurysm Repair Driven by In-hospital Treatment Delays.

We sought to assess whether sex-related differences in timely repair of ruptured abdominal aortic aneurysm (rAAA) were associated with excess risk of early mortality in women. rAAA is a surgical emergency and timeliness of intervention affects outcomes. A door-to-intervention time of <90 minutes is recommended. All rAAA repairs in the Vascular Quality Initiative from 2003 to 2017 were reviewed. Patients were stratified by sex and time-delay cohorts. Univariate and multivariate analyses were performed. There were 3719 rAAA repairs, of which 797 (21%) were performed in women. Sex did not affect repair type: open versus endovascular (21% females, each). Despite similar presentation delays [median 6 hours (inter quartile range, IQR: 3-16)], admission-to-intervention time was longer for women than men [median 1.5 hours (IQR 1-4] vs 1.2 hours (IQR 1-3), P=0.047]. Overall, 45% of patients had a >90-minute delay from admission to repair, with more women than men experiencing this delay (49% vs 44%, P=0.01). Neither were more likely to undergo transfer for treatment. After risk adjustment, female sex was associated with a 48% increase in 30-day mortality. Sex differences in mortality were no longer observed in patients with intervention delays of ≤90 minutes. In patients with >90-minute delays, a 77% increase in 30-day mortality of women over men was noted. Nearly half of rAAA patients have a door-to-intervention time longer than recommended societal guidelines. Sex differences in mortality after rAAA repair seem to be driven by in-hospital treatment delays.

P3512Sex differences in rats with heart failure with preserved ejection fraction and the effect of autonomic modulation

Abstract Background Heart failure (HF) with preserved ejection fraction (HFpEF) accounts for 50% of HF and sudden death is the leading cause of mortality. There are considerable sex differences in cardiac structure and function, which may be related to outcomes in HFpEF. Transcutaneous vagus nerve stimulation (tVNS) is antiarrhythmic. Purpose To describe sex differences in mortality, autonomic tone and ECG parameters in rats with HFpEF and examine the effect of tVNS on these outcomes. Methods Dahl salt sensitive (DS) rats of either sex were randomized into high salt (HS, 8% NaCl) or low salt (LS) diet (0.3% NaCl) at 7 weeks of age. After 6 weeks of LS or HS diets, HS rats were randomized to receive active or sham tVNS, 30min daily (20Hz, 3mA) for 4 weeks. The rats were monitored daily for 4 weeks for the development of HFpEF. ECG and echocardiogram were performed at 13 weeks (baseline) and 17 weeks (endpoint). Heart rate variability (HRV) was calculated at the respective time points. ECG and HRV parameters were analyzed in a blinded fashion. Logistic regression analysis was performed to identify independent predictors of mortality. Results A total of 58 rats were included (5 male LS, 6 female LS, 22 male HS and 25 female HS). HS rats developed significant hypertension and signs of HFpEF, while 24% of females and 53% of males died (P=0.004). There were 4 sudden cardiac deaths in males (with ventricular tachycardia documented in 1 rat), whereas all the females died of HF or stroke. Corrected QT (QTc) at baseline significantly prolonged in HS compared to LS rats (250.5±14.4ms vs. 226.8±13.9ms, respectively, p=0.0007), while all other ECG parameters did not differ significantly between groups. In HS rats, QTc prolongation was significantly more pronounced in males compared to females (259.4±20.6ms vs. 243.8±14.5ms, respectively, P=0.002). In univariate analysis, prolonged baseline QTc (OR=1.04; 95% CI 1.01–1.06, p=0.003) and male sex (OR=3.21, 95% CI 1.19–8.66, p=0.016) predicted mortality. However, in multivariate analysis, QTc was the only significant predictor of mortality (OR=1.04; 95% CI 1.01–1.06, p=0.003). After 4 weeks of treatment, active tVNS significantly decreased QTc compared to sham (244.6±13.8ms vs. 255.8±14.0ms, respectively, p=0.017) in both male and female rats in a similar manner. The low frequency to high frequency ratio (LF/HF) of HRV, which reflects sympathovagal balance, was significantly decreased in active tVNS rats compared to sham (0.21±0.13 vs. 0.54±0.14, respectively; p=0.001) in both male and female rats in a similar manner. Conclusions Male rats with HFpEF exhibit worse survival compared to females and are at higher risk for sudden death. QTc prolongation accounts for the increased risk of sudden death in males compared to females. Autonomic modulation with tVNS attenuates the unfavorable changes in QTc and HRV induced by HS diet and may be used to prevent ventricular arrhythmias in patients with HFpEF.

The Effect of Child’s Body Size at Birth on Infant and Child Mortality in India

Low birth weight is one of the strongest predictors of infant mortality, especially in the neonatal period. In this paper, we use data from the 2015–2016 India’s National Family Health Survey to examine the effect of mother’s assessment of child’s body size at birth on four measures of mortality: infant mortality, neonatal mortality, post-neonatal mortality, and child mortality. Using the Cox proportional hazards model, we found that small babies were slightly more than one and a half times and very small babies nearly four times more likely than average or larger size babies to die in the neonatal period. This was true even when potential confounders were held constant. However, the effect of child size on mortality risk became progressively weaker, though highly significant, in the post-neonatal and early childhood periods. We also found that, in spite of significant sex differences in mortality during infancy and early childhood, boys and girls were equally sensitive to the harmful effects of smaller body size at birth on mortality risks.

IMPACT OF SEX ON THE MANAGEMENT AND OUTCOME OF AORTIC STENOSIS PATIENTS

Sex-differences in management and outcome in aortic valve stenosis (AS) are controversial and poorly understood. The objective of this study was to examine the impact of sex and flow-gradient pattern of AS on aortic valve intervention and mortality in a large cohort of patients with AS. We analyzed the Doppler-echocardiography prospectively collected between 2005 and 2015 from patients with at least mild AS (aortic valve area: AVA≤1.5cm2 or peak aortic jet velocity: Vpeak≥2m/s). We excluded patients with ejection fraction < 50%, mitral or aortic insufficiency > mild or incomplete echocardiography. Outcomes were retrospectively retrieved from the Québec Institute of Statistics. Among 3379 patients, 58% were men and mean age was 70.7±12.6 years, indexed AVA (AVAi) 0.47±0.16, mean gradient (MG) 34.7±19.4 and Vpeak 3.8±0.9m/s. Women were older, had more hypertension and symptoms while less coronary artery disease compared to men (Table). Stenosis severity was equivalent between men and women, ejection fraction was higher in women than in men, but indexed stroke volume was comparable between sexes (Table). During a mean follow-up of 4.00±3.26 years, there were 872 (25.93%) deaths. After adjustment for age, diabetes, hypertension, renal disease, coronary artery disease, chronic pulmonary disease, symptoms, AVAi, MG and indexed stroke volume, female sex was associated with a 17% over-mortality (1.17 [1.01-1.36]; p=0.04). Interestingly, after comprehensive adjustment, men underwent 13% more aortic valve intervention (1.13 [1.05-1.22]; p=0.0011) than women, which may explain the sex-difference in mortality after diagnosis. In this series of AS patients, men represent the majority of patients (58%). Despite similar AS severity at diagnosis, women were less referred to aortic valve intervention (13%) and incurred more mortality (17%).View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Global differences in geography, religion and other societal factors are associated with sex differences in mortality from suicide: An ecological study of 182 countries

BackgroundOver 800,000 individuals die as a consequence of suicide annually, and almost two thirds of these deaths are in males. This analysis aimed to explore sex differences in global suicide rates with regards to geographic location, religion and other societal factors. MethodsData on sex-specific suicide rates were collated for 182 countries in 2015. The exposures of interest were geographical location, majority religion, life expectancy, total fertility rate (TFR), literacy percentage, gender development index and gross domestic product. ResultsBoth continent and predominant religion were strongly associated with the male:female ratio for deaths from suicide (p < 0.001 for both variables). The highest male:female suicide ratio was observed in the Americas with a median value of 4.0 (interquartile range IQR: 3.0–5.0) and the lowest gender suicide ratios were observed in Africa (2.7, IQR: 2.4–3.3) and Asia (2.7, IQR: 1.8–3.9). The predominantly Christian countries revealed the highest male:female suicide ratio (3.3, IQR: 2.7–4.4) whereas the predominantly Hindu countries revealed the lowest (1.3, IQR 1.3–3.8).The following variables were all positively associated with male:female ratio of suicide mortality: Life expectancy (Spearman's correlation coefficient r = +0.21, p = 0.004), GDP per capita (r = +0.26, p = 0.003), literacy percentage (r = +0.46, p < 0.0001), and Gender Development Index (r = +0.56, p < 0.0001). TFR was negatively associated with sex suicide ratio (–0.30, p < 0.0001). ConclusionThere are significant differences between male and female suicide rates across continents and cultures. Markers of societal development are associated with a higher proportion of male suicides compared to females.

Older women are frailer, but less often die than men: a prospective study of older hospitalized people

ObjectivesThe association between frailty, mortality and sex is complex, but a limited literature is available on this topic, particularly for older hospitalized patients. Therefore, the objective of our study was to prospectively evaluate sex differences in frailty, assessed by the Multidimensional Prognostic Index (MPI) and mortality, institutionalization, and re-hospitalization in an international cohort of older people admitted to hospital. Study designWe used data from nine public hospitals in Europe and Australia, to evaluate sex differences in mortality, frailty and the risk of institutionalization and re-hospitalization, during one year of follow-up. Main outcome measuresPeople aged 65 years or more admitted to hospital for an acute medical condition or for a relapse of a chronic disease were included. A standardized comprehensive geriatric assessment, which evaluated functional, nutritional, and cognitive status, risk of pressure sores, comorbidities, medications and co-habitation status, was used to calculate the MPI to measure frailty in all hospitalized older people. Data regarding mortality, institutionalization and re-hospitalization were also recorded for one year. ResultsAltogether, 1140 hospitalized patients (mean age = 84.2 years; 694 women = 60.9%) were included. The one-year mortality rate was 33.2%. In multivariate analysis, adjusted for age, MPI score, centre and diagnosis at baseline, although women had higher MPI scores than men, the latter had higher in-hospital (odds ratio, OR = 2.26; 95% confidence intervals, CI = 1.27–4.01) and one-year post-discharge mortality (OR = 2.04; 95%CI = 1.50–2.79). Furthermore, men were less frequently institutionalized in a care home than female patients (OR = 0.55; 95%CI: 0.34–0.91), but they were also more frequently re-hospitalized (OR = 1.42; 95%CI: 1.06–1.91) during the year after hospital discharge. ConclusionOlder hospitalized men were less frail, but experienced higher in-hospital and one-year mortality than women. Women were admitted more frequently to nursing homes and experienced a lower risk of re-hospitalization. These findings suggest important differences between the sexes and extends the ‘male-female health-survival paradox’ to acutely ill patient groups.

The geometry of mortality change: Convex hulls for demographic analysis

We introduce convex hulls as a data visualization and analytic tool for demography. Convex hulls are widely used in computer science, and have been applied in fields such as ecology, but are heretofore underutilized in population studies. We briefly discuss convex hulls, then we show how they may profitably be applied to demography. We do this through three examples, drawn from the relationship between child and adult mortality (5q0 and 45q15 in life table notation). The three examples are: (i) sex differences in mortality; (ii) period and cohort differences and (iii) outlier identification. Convex hulls can be useful in robust compilation of demographic databases. Moreover, the gap/lag framework for sex differences or period/cohort differences is more complex when mortality data are arrayed by two components as opposed to a unidimensional measure such as life expectancy. Our examples show how, in certain cases, convex hulls can identify patterns in demographic data more readily than other techniques. The potential applicability of convex hulls in population studies goes beyond mortality.

Proximate Sources of Change in Trajectories of First Marriage in the United States, 1960-2010.

This study examines proximate sources of change in first-marriage trajectories in the United States between 1960 and 2010. This was a period of tremendous social change: divorce became more common, people started marrying later or not marrying at all, innovations in medicine and changes in social and behavioral factors led to reduced mortality, inequality grew stronger and was reflected by more intense assortative mating, and the country underwent a massive educational expansion. Each of these factors influenced the formation and dissolution of first marriages over this period. This article extends the multiple-decrement life table to incorporate heterogeneity and assortative mating, which allows the quantification of how changes in the incidence of marriage, divorce, and mortality, along with changes in educational attainment and assortative mating, have shaped trends in first-marriage trajectories. The model is used to prove that stronger educational assortative mating leads to longer average durations of first marriage. Using data from multiple sources and this model, this study shows that although the incidence of divorce was the primary determinant of changes in first-marriage trajectories between 1960 and 1980, it has played a relatively smaller role in driving change in marital trajectories between 1980 and 2010. Instead, factors such as later age at first marriage, educational expansion, declining mortality, narrowing sex differences in mortality, and more intense educational assortative mating have been the major drivers of changes in first-marriage trajectories since 1980.

Trophy hunting mediates sex‐specific associations between early‐life environmental conditions and adult mortality in bighorn sheep

Environmental conditions during early development, from conception to sexual maturity, can have lasting consequences on fitness components. Although adult life span often accounts for much of the variation in fitness in long-lived animals, we know little about how early environment affects adult life span in the wild, and even less about whether these effects differ between the sexes. Using data collected over 45years from wild bighorn sheep (Ovis canadensis), we investigated the effects of early environment on adult mortality in both sexes, distinguishing between natural and anthropogenic sources of mortality. We used the average body mass of yearlings (at about 15months of age) as a yearly index of environmental quality. We first examined sex differences in natural mortality responses to early environment by censoring harvested males in the year they were shot. We then investigated sex differences in the effects of early environment on overall mortality (natural and hunting mortality combined). Finally, we used path analysis to separate the direct influence of early environment from indirect influences, mediated by age at first reproduction, adult mass and horn length. As early environmental conditions improved, natural adult mortality decreased in both sexes, although for males the effect was not statistically supported. Sex differences in the effects of early environment on adult mortality were detected only when natural and hunting mortality were pooled. Males that experienced favourable early environment had longer horns as adults and died earlier because of trophy hunting, which does not mimic natural mortality. Females that experienced favourable early environment started to reproduce earlier and early primiparity was associated with reduced mortality, suggesting a silver-spoon effect. Our results show that early conditions affect males and females differently because of trophy hunting. These findings highlight the importance of considering natural and anthropogenic environmental factors across different life stages to understand sex differences in mortality.

Temporal Trends in Incident Mortality in Dialysis Patients: Focus on Sex and Racial Disparities

Background: Racial minorities and women constitute substantial portions of the incident and prevalent end-stage renal disease (ESRD) population in the United States. Although ESRD is characterized by high mortality, temporal trends, and race and sex differences in mortality have not been studied. Methods: We evaluated 944,650 adult patients who initiated dialysis between January 1, 2005 and December 31, 2014, using the United States Renal Data System, for sex-related and race-related trends in mortality. Logistic regression models adjusted for pre-dialysis health status were used to examine associations among the predictors’ sex, race, and year of incident dialysis, and the outcome all-cause mortality at 1-year post ESRD. Results: The mean age was 65 ± 14 years. The 1-year crude mortality rates in incident ESRD patients decreased by 28% from 2004 to 2015. Risk-adjusted 1-year mortality decreased by 3% for each later year of incident ESRD (p < 0.001). In general, from 2005 to 2014, mortality rates decreased across both sexes, and all races. White patients experienced the lowest reduction in adjusted 1-year mortality rates (16%). While women experienced a survival advantage over men in 2005, by 2014 it was reversed to survival advantage for men. Combining all years, the adjusted risk of dying at 1-year after initiating dialysis was lower in women than men (OR 0.98; 95% CI 0.97–0.99), and as compared to whites, was lower in blacks (OR 0.73; 95% CI ­0.72–0.74), Hispanics (OR 0.64; 95% CI 0.63–0.65), Asians (OR 0.55; 95% CI 0.53–0.56), and Native Americans (OR 0.67; 95% CI 0.63–0.71). Conclusion: The 1-year mortality rates among patients with ESRD have decreased steadily during a recent 10-year period across both men and women, and in all 5 races. Women have only a 2% lower risk of dying at 1-year after dialysis initiation than men. White patients had higher mortality as compared to other races. Our results suggest the need for sex, and race-specific treatment strategies in ESRD care.

Sex differences in mortality in migrants and the Swedish-born population: Is there a double survival advantage for immigrant women?

ObjectivesIn the present study, we examine whether the relationships between country of origin or reason for migration and mortality differ between men and women.MethodsWe apply hazard regression models on high-quality Swedish register data with nationwide coverage.ResultsRelative to their Swedish counterparts, migrants from Nordic and East European (EU) countries and former Yugoslavia have higher mortality. This excess mortality among migrants relative to Swedes is more pronounced in men than in women. Migrants from Western and Southern European countries; Iran, Iraq, and Turkey; Central and South America; and Asia, have lower mortality than Swedes, and the size of the mortality reduction is similar in both sexes. The predictive effects of the reason for migration for mortality are also similar in migrant men and women.ConclusionsThis study provides little support for the hypothesis of a double survival advantage among immigrant women in Sweden. However, it does show that the excess mortality in migrants from Nordic and EU countries and former Yugoslavia relative to the Swedish-born population is more pronounced in men than in women.