Sex Disparities in Recorded Heart Failure-Attributed Mortality Among Adults Aged 20–49 Years: A 25-Country Comparison with Broader Mortality Categories

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.