Introduction An epidemic of premature ischaemic heart disease (IHD) in men usually emerges with economic development. The Hong Kong Chinese population experienced abrupt macro-environmental change generated by mass migration in the late 1940s from pre-industrial China to economically developing Hong Kong. We took advantage of this natural experiment to test whether a “step-change” in living conditions in early life had sex-specific cohort effects on IHD mortality.
Methods We used sex-specific age-period-cohort models to identify cohort effects in adult IHD mortality from 1976 to 2005 overall and by migrant status. To check for specificity, we examined mortality from lung cancer and renal diseases.
Results Birth cohort effects varied with sex, with a marked upturn in IHD mortality for the first generation of men born into the comparatively developed environment of Hong Kong. The upturn occurred first in non-migrants and later in migrants. There were no such upturns in women or such sex-specific changes for lung cancer or renal diseases.
Conclusion Men's vulnerability to premature IHD may be actuated in early life, perhaps mediated by inter-generationally and nutritionally driven levels of pubertal sex-steroids. This has considerable public health implications for the large population of young males in countries undergoing rapid economic transition.
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