Sex differentials in biological risk factors for chronic disease: Estimates from population-based surveys

Background: In light of substantial sex differences in health outcomes, researchers need to focus on disentangling the underlying biological and social determinants. The objective of this study is to determine whether two populations that differ in many cultural and social dimensions-Taiwan and the United States-also vary with regard to sex differentials in biological markers of chronic disease. Methods: The analysis is based on three population-based surveys that include interviews, urine and blood specimens, and physical examinations: the Social Environment and Biomarkers of Aging Study (SEBAS) in Taiwan, the Wisconsin Longitudinal Survey (WLS), and the MacArthur studies of successful aging. The outcomes comprise six indicators of cardiovascular risk (total/high-density lipoprotein [HDL] cholesterol, HDL cholesterol, systolic and diastolic blood pressure, glycosylated hemoglobin, and waist/hip ratio) and four markers of sympathetic nervous system (SNS) and hypothalamic-pituitary- adrenal (HPA) axis functioning (epinephrine, norepinephrine, cortisol, and dehydroepiandrosterone sulfate [DHEA-S]). Results: U.S. males have significantly higher risk than females for all indicators of cardiovascular risk except glycosylated hemoglobin (p < 0.05). Sex differences are less consistent and smaller in Taiwan. Indicators of SNS and HPA axis functioning reveal a significant female disadvantage in both countries. Conclusions: The analysis identifies important sex differences between Taiwan and the United States in biomarkers of cardiovascular risk that are consistent with cause of death data and may emanate from cultural and social differences between the two societies. The similarity of sex differences in SNS and HPA axis functioning across studies may reflect either stable sex differences in biological aging of these axes or commonalities in the social construction of gender-based responses to life experiences.