Sibling rank and sibling number in relation to cardiovascular disease and mortality risk: A nationwide cohort study

Research output: Contribution to journalArticle


Background The number and rank order of siblings could be of importance for risk of cardiovascular disease and mortality. Previous studies have used only fatal events for risk prediction. We, therefore, aimed to use also non-fatal coronary and cardiovascular events in fully adjusted models. Methods From the Multiple-Generation Register in Sweden, data were used from 1.36 million men and 1.32 million women (born 1932-1960), aged 30-58 years at baseline and with follow-up from 1990 to 2015. Mean age at follow-up was 67 years (range 55-83 years). Fatal and non-fatal events were retrieved from national registers. Results Compared with men with no siblings, those with 1-2 siblings had a lower, and those with four or more siblings had a higher adjusted risk of cardiovascular events. Again, compared with men with no siblings, those with more than one sibling had a lower total mortality risk, and those with three or more siblings had an increased risk of coronary events. Correspondingly, compared with women with no siblings those women with three siblings or more had an increased risk of cardiovascular events, and those with two siblings or more had an increased risk of coronary events. Women with one sibling or more were at lower total mortality risk, following full adjustment. Conclusion Being first born is associated with a favourable effect on non-fatal cardiovascular and coronary events for both men and women. The underlying biological mechanisms for this should be studied in a sociocultural context.


Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Public Health, Global Health, Social Medicine and Epidemiology


  • epidemiology, reproductive medicine, social medicine
Original languageEnglish
Article numbere042881
JournalBMJ Open
Issue number6
Publication statusPublished - 2021 May 25
Publication categoryResearch

Bibliographic note

Funding Information: Funding This work was supported by the grants to Kristina Sundquist from The Swedish Research Council; ALF funding from Region Skåne and the Swedish Heart-Lung foundation.