Key result
Male sex did not show a consistently greater excess in HF-attributed mortality than in other circulatory (median ratio of MRRs 0.895) or non-HF all-cause mortality (1.128) in adults aged 20-49.
Why the study?
Whether the relative male excess in recorded HF-attributed mortality among adults aged 20–49 years is greater than that for broader mortality categories was unclear.
Observational (n=200,707)
Yes
Across 25 countries, the relative male excess in recorded heart failure-attributed mortality among young adults aged 20–49 years was not consistently greater than that observed for broader circulatory or all-cause mortality categories.
Answers are grounded in this paper and cite their sources.
HF mortality shows no amplified male disadvantage versus other circulatory causes in adults 20–49; observational data leave open diagnostic versus biologic drivers.
Whether the relative male excess in recorded heart failure (HF)-attributed mortality among adults aged 20–49 years is greater than that for broader mortality categories is unclear. We analysed World Health Organization underlying cause death data for adults aged 20–49 years in 25 countries with complete data for 2001–2019. Stacked count models compared male-to-female mortality rate ratios (MRRs) for HF-attributed, other circulatory, and non-HF all-cause mortality; secondary models estimated temporal changes. Among 200,707 HF-attributed deaths, the median ratio of MRRs was 0.895 for HF-attributed versus other circulatory mortality and 1.128 versus non-HF all-cause mortality. Confidence intervals were entirely above 1 in 4 and 6 of 25 countries, respectively, and entirely below 1 in 5 and 1. Results were similar when the contrast was allowed to vary over time and when the United States, Canada, and Mexico were added, but the comparison with non-HF all-cause mortality depended on the age range. As secondary findings, mortality declined in both sexes in 10 countries, and a male disadvantage was present in 18 countries in both 2001 and 2019. Across these 25 countries, the relative male excess in recorded HF-attributed mortality was not consistently greater than that for broader mortality categories.
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Li et al. (2026) conducted an observational in Heart failure-attributed mortality (n=200,707). Male sex vs. Female sex was evaluated on Ratio of male-to-female mortality rate ratios (MRRs) for HF-attributed mortality versus other circulatory and non-HF all-cause mortality (Median ratio of MRRs 0.895 (vs other circulatory) and 1.128 (vs non-HF all-cause)). Male sex did not show a consistently greater excess in HF-attributed mortality than in other circulatory (median ratio of MRRs 0.895) or non-HF all-cause mortality (1.128) in adults aged 20-49.
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