Abstract：
The human sex ratio at birth (SRB) undergoes temporary changes around a mean proportion of 0.51 male births. SRB has been well studied for historical, geographical, and secular trends, but until now not linked to health outcomes in the total population, e.g. for cardiovascular disease (CVD) or mortality during follow-up of birth cohorts. We used linkage analysis based on national registers in Sweden that cover all births from 1900 to 2016. SRB at birth was calculated by every 10-year birth cohort in all survivors living in 1997 for a follow-up analysis of risk of CVD and mortality with data from national registers. When the highest quartile of SRB was used as reference, a slightly increased risk of fatal CVD (HR 1.03 (95% confidence intervals, CI): 1.02-1.04), non-fatal CVD (HR 1.01; 95%CI: 1.01-1.02) and mortality (HR 1.02; 95%CI, 1.01-1.03) was found after full adjustments in men belonging to the lowest SRB quartile. A similar pattern was also found for fatal CHD in women. in the lowest SBR quartile compared to the highest, HR 1.03 (95%CI: 1.02-1.05). In conclusion, in birth cohorts with a relatively lower than expected number of males born, long-term adverse health effects were observed with slightly increased cardiovascular risk and total mortality at the population level. This could indicate that men belonging to so-called \"culled cohorts\" in a developed country during the 20th century are characterized by a slightly increased risk that could reflect negative early life influences and environmental exposures in pregnant women resulting in selective loss of male embryos or fetuses. In a public health perspective SRB could be of some importance to monitor as an aspect of birth statistics linked to relatively minor population health effects.
摘要：
出生时的人类性别比（SRB）发生了暂时的变化，平均男性出生率为0.51。SRB在历史上得到了很好的研究，地理,和长期趋势，但是到目前为止，与总人口的健康结果无关，例如，出生队列随访期间的心血管疾病（CVD）或死亡率。我们使用基于瑞典国家登记册的联系分析，涵盖1900年至2016年的所有出生。出生时的SRB是通过每个10年出生队列在1997年生活的所有幸存者中计算的，用于根据国家登记的数据对CVD风险和死亡率进行随访分析。当SRB的最高四分位数用作参考时，致命CVD的风险略有增加(HR1.03(95%置信区间，CI）：1.02-1.04），在属于最低SRB四分位数的男性中,经过充分校正后发现非致死性CVD(HR1.01;95CI:1.01-1.02)和死亡率(HR1.02;95CI,1.01-1.03).在女性的致命CHD中也发现了类似的模式。在最低的SBR四分位数与最高的四分位数相比，HR1.03（95CI：1.02-1.05）。总之,在出生男性数量相对低于预期的出生队列中，在人群水平观察到长期健康不良效应,心血管风险和总死亡率略有增加.这可能表明，在20世纪的发达国家中，属于所谓的“被淘汰的人群”的男性的特征是风险略有增加，这可能反映出孕妇早期生活的负面影响和环境暴露，导致男性胚胎或胎儿的选择性丧失。从公共卫生的角度来看，作为与相对较小的人口健康影响相关的出生统计数据的一个方面，SRB可能对监测具有一定的重要性。
