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.

人类出生性别比 （SRB） 发生临时变化，平均比例约为 0.51 名男性出生。SRB 已针对历史、地理和长期趋势进行了充分研究，但到目前为止，它与总人口的健康结果无关，例如心血管疾病 （CVD） 或出生队列随访期间的死亡率。我们使用了基于瑞典国家登记册的连锁分析，这些登记册涵盖了 1900 年至 2016 年的所有出生。根据 1997 年生活的所有幸存者的每 10 年出生队列计算出生时的 SRB，以便使用来自国家登记册的数据对 CVD 风险和死亡率进行后续分析。当使用 SRB 的最高四分位数作为参考时，在完全调整属于最低 SRB 四分位数的男性后，发现致命性 CVD （HR 1.03 （95% 置信区间，CI）： 1.02-1.04）、非致命性 CVD （HR 1.01;95% CI： 1.01-1.02） 和死亡率 （HR 1.02;95% CI， 1.01-1.03） 的风险略有增加。在女性的致命性 CHD 中也发现了类似的模式。与最高 SBR 四分位数相比，最低的 SBR 四分位数为 HR 1.03 （95%CI： 1.02–1.05）。总之，在男性出生人数相对低于预期的出生队列中，观察到长期的不良健康影响，人群水平的心血管风险和总死亡率略有增加。这可能表明，在 20 世纪发达国家属于所谓“被淘汰队列”的男性的特点是风险略有增加，这可能反映了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丢失。从公共卫生的角度来看，SRB 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，可能具有一定的监测意义。