Differences in all-cause, cardiovascular and cancer mortality between Hong Kong and Singapore: role of nutrition

Eur J Epidemiol. 2001;17(5):469-77. doi: 10.1023/a:1013773517052.


Background: The majority of inhabitants in Hong Kong and Singapore are ethnic Chinese, but all-cause and cardiovascular mortality rates in these two regions are markedly different. This study describes differences in the magnitude and trends in mortality and attempts to explain these differences.

Methods: Data of mortality rates in 1963-1965 and 1993-1995 in the age class of 45-74 years, dietary habits and other factors were compared between Hong Kong and Singapore using Japan, Spain and the USA as reference countries. Mortality and food consumption data were obtained from WHO and FAO, respectively.

Results: Large differences in all-cause and cardiovascular mortality exist between Hong Kong and Singapore. The difference in total cancer mortality was less consistent and smaller. The most pronounced finding was that ischemic heart disease mortality in 1993-1995 was 2.98 and 3.14 times higher in Singapore than in Hong Kong in men and women, respectively. Of the five countries considered, Singapore has the highest all-cause mortality in both sexes in the period of 1960-1995. The ratio of animal to vegetal fat was higher in Singapore (2.24) than in Hong Kong (1.08). Singapore had higher serum concentrations of total cholesterol and low-density lipoprotein cholesterol than Hong Kong, but the opposite result was observed for high-density lipoprotein cholesterol.

Conclusions: There are striking differences in all-cause and cardiovascular mortality between Hong Kong and Singapore. These differences can be most reasonably and plausibly explained by their differences in dietary habits, for example, a higher consumption of coconut and palm oil, mainly containing saturated fat, in Singapore.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Analysis of Variance
  • Cardiovascular Diseases / mortality*
  • Cause of Death
  • Female
  • Hong Kong / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Mortality / trends
  • Neoplasms / mortality*
  • Nutritional Physiological Phenomena*
  • Risk Factors
  • Singapore / epidemiology
  • Time Factors