Sex and gender gaps in medicine and the androcentric history of medical research

Despite advancements in medical research worldwide, there are still gender and geographical inequities in clinical trials, with a disproportionate underrepresentation of women and marginalised groups. In order to overcome these...

To explore the role played by human research ethics committees (HRECs) with regard to the fair inclusion of men and women in Australian clinical research. Semi-structured face-to-face and telephone interviews with 25 chairs (or their nominees) of Australian HRECs between 9 June 2006 and 24 January 2007. Chairs' views about the role of HRECs in identifying sex discrimination, monitoring the inclusion of men and women in clinical research, and interpreting and applying National Health and Medical Research Council (NHMRC) guidelines relating to fair inclusion in research. In general, HRECs do not take an active role in monitoring the sex of research participants. They do not ask for or often receive information about the sex of participants. Most HREC chairs did not believe that sex discrimination in research is currently a significant or widespread problem, and were confident that their committees would be able to identify arbitrary exclusion of either men or women from research. However, many chairs expressed a lack of familiarity with debates about sex equity in research. Most chairs were unaware that anti-sex-discrimination legislation could apply to research. "Fair inclusion" was interpreted in a number of ways by chairs, but most frequently that the sex balance among research participants should reflect the sex distribution in the community of the condition under investigation. Chairs said their committees would be reluctant to reject a research protocol on the grounds that the sex balance among participants was perceived to be unfair. Views about, and expertise on, sex equity in research vary among chairs of HRECs. Many HRECs require further guidance about the appropriate standards for fair inclusion of men and women in Australian clinical research.

Societal level gender inequalities amplify gender gaps in problem solving more than in academic disciplines

This study considers whether societal gender inequality moderates the relationship between gender and perceptions of personal safety. Pooled 1992–2005 rounds of the International Crime Victims Survey, comprising more than 285,000 respondents from 75 countries, are used to estimate multilevel models of safety perceptions, with a cross-level interaction specified between gender and gender inequality. We find that the gender gap in safety perceptions, although statistically significant in all countries, is largest in countries exhibiting high gender equality and smallest in countries with high gender inequality. This is explained entirely by variation in men’s safety perceptions; male respondents perceive themselves as safer in a milieu of gender equality, but less safe in a milieu of gender inequality. In contrast, the safety perceptions of female respondents are uncorrelated with societal gender inequality.

Background Peripheral artery disease (PAD) is a major manifestation of atherosclerosis and a risk factor for morbidity and mortality. Guideline-recommended therapy and specialized outpatient care are essential for optimal treatment. Gender-based inequalities in diagnosis and treatment of cardiovascular diseases are still present, despite clear guideline recommendations. Knowledge of the treatment structures in the outpatient setting are essential to identify and solve gender-based inequalities in this high-risk population. Purpose Aim of the study was to identify gender-based inequalities in an outpatient clinic setting in terms of treatment structures and pharmacotherapy in patients with PAD. Methods We analyzed gender-based differences in pharmacotherapy (statins, antiplatelets) and treatment by specialized outpatient care (angiology, vascular surgery, internal medicine, cardiology) in 17.633.970 patients with PAD and statutorily insurance presenting to outpatient care facilities in Germany between 2009 and 2018. The study is based on the ambulatory claims data of the panel doctors' services according to § 295 SGB V and drug prescription data according to § 300 SGB V. Diagnosis of PAD was defined upon medical diagnoses of PAD ICD I70.2–9. Statistical analysis was performed with chi-squared test for trend and two-way Anova. Results Overall, 17.633.970 patients were included in the study and 53% were female. Only a minority of 37,1% presented to a vascular specialist (8,5% angiology, 10,2% vascular surgery, 24,6% cardiology) with no significant change over the course between 2009 and 2018. Interestingly, female patients were less likely to present to a vascular specialist and less likely to receive guideline recommended medical therapy. The gender gap between male and female patients presenting to a vascular specialist, however, narrowed in the observed time frame (angiology in 2009 1,8% vs 2018 1,0%, p<0,0001; vascular surgery 2009 3,2% vs 2018 1,5%, p<0,0001). Pharmacotherapy also significantly differed between female and male patients over the course of time. While prescription rates of statins and antiplatelet drugs increased in the observed time period (statins 42,8% vs 55,7% (male), 35,1% vs 45% (female); antiplatelets 29,2% vs 34,4% (male), 20,2 vs 24,3% (female)), the gender gap also increased between 2009 and 2018 (7,7% vs 10,7%, p<0,0001 (statins); 8,9% vs 10%, p<0,0001 (antiplatelets)). Conclusion Our results demonstrate that gender-based differences in pharmacotherapy and specialized outpatient care of patients with PAD are still evident in Germany. While overall outpatient treatment by a vascular specialist and guideline recommended medical therapy of PAD with antiplatelets and statins are overall remarkably low, female patients are even less likely to receive both, compared to male patients. While adherence to guideline recommended therapy is increasing, the gender-gap still continues to widen over the course of time. Funding Acknowledgement Type of funding sources: None.

Background: Historically, medical studies have excluded female participants and research data have been collected from males and generalized to females. The gender gap in medical research, alongside overarching misogyny, results in real-life disadvantages for female patients. This systematic scoping review of the literature aims to determine the extent of research into the medical research sex and gender gap and to assess the extent of misogyny, if any, in modern medical research.Methods: Initial literature searches were conducted using PubMed, Science Direct, PsychINFO and Google Scholar. Articles published between January 01, 2009, and December 31, 2019, were included. An article was deemed to display misogyny if it discussed the female aesthetic in terms of health, but did not measure health or could not be utilized to improve clinical practice.Results: Of the 17 included articles, 12 examined the gender gap in medical research and 5 demonstrated misogyny, assessing female attractiveness for alleged medical reasons. Females remain broadly under-represented in the medical literature, sex and gender are poorly reported and inadequately analyzed in research, and misogynistic perceptions continue to permeate the narrative.Conclusion: The gender gap and misogynistic studies remain present in the contemporary medical literature. Reasons and implications for practice are discussed.

Perhaps the most prevailing inequalities in educational achievement in England are those associated with socio-economic status (SES), ethnicity and gender. However, little research has sought to compare the relative size of these gaps or to explore interactions between these factors. This paper analyses the educational achievement at age 11, 14 and 16 of over 15,000 students from the nationally representative longitudinal study of young people in England. At age 16, the achievement gap associated with social class was twice as large as the biggest ethnic gap and six times as large as the gender gap. However, the results indicate that ethnicity, gender and SES do not combine in a simple additive fashion; rather, there are substantial interactions particularly between ethnicity and SES and between ethnicity and gender. At age 16 among low SES students, all ethnic minority groups achieve significantly better than White British students (except Black Caribbean boys who do not differ from White British boys), but at high SES only Indian students outperform White British students. A similar pattern of results was apparent in terms of progress age 11–16, with White British low SES students and Black Caribbean boys (particularly the more able) making the least progress. Parents’ educational aspirations for their child and students’ own educational aspirations, academic self-concept, frequency of completing homework, truancy and exclusion could account for the minority ethnic advantage at low SES, but conditioning on such factors simultaneously indicates substantial ethnic underachievement at average and high SES. Accounts of educational achievement framed exclusively in terms of social class, ethnicity or gender are insufficient, and the results challenge educational researchers to develop more nuanced accounts of educational success or failure.

Gender differences in depression are globally documented across a wide range of studies that analyse self-reports of depressive symptoms or clinical diagnoses. Extensive research fails to identify any single reason for this finding but given systematic variation in depressive symptomatology across social groups, gender differences must derive at least partly from environmental or social factors. Among the social factors that are considered most important are those relating to gender differences in socio-economic status and the underlying gender division of labor. In this study, we add to existing research by interrogating heterogeneity in gender differences in mental health. Studies that investigate environmental factors typically consider these only in relation to the average gender gap in depression. We use a novel sorting and classification method (Chernozhukov et al., 2018) that makes it possible to map the full distribution of gender differences in depressive symptomatology among comparable women and men. Although we cannot attribute causality, the method allows us to isolate those social factors that are distinctive to women who experience the largest gender gap in depressive symptoms compared to those who exhibit the smallest. The study analyses detailed nationally representative micro-data from South Africa, a country with high rates of poverty, which are higher still among women. As is common elsewhere, women report significantly more depressive symptoms than men, and low socio-economic status is correlated with poor mental health. However, women with low socio-economic status are not relatively more concentrated among women who face the largest gender gap in depressive symptomatology. These findings would not be consistent with the hypothesis that women have a greater tendency than men to ruminate over economic hardship and could rather point to resilience and a “steeling effect” among poor women.

Background:The diagnosis of chronic conditions in women is complicated by the historical androcentricity in medical research. Sex and gender gaps in health research may translate to unequal healthcare for women. This cross-sectional survey study aimed to ascertain the median time to diagnosis, proportions of rediagnosis and time to rediagnosis for Australian women with chronic conditions.Methods:An online survey collected anonymous data from voluntary participants. Data were analyzed using Stata14. Cox Proportional Hazards model was used to analyze time to diagnosis and rediagnosis. Logistic regression analysis was used to assess the significance of rediagnosis rates by diagnosis, age at diagnosis, income, employment, state of residence, disability status, and Indigenous status.Results:The median time from first appointment to initial diagnosis was 6 months (range 1 day–50 years) (interquartile range [IQR] 3.74 years). The median time to rediagnosis was 4 years (IQR 9) with a range of 1 day–43 years. Almost half of the women (n = 161/343, 47%) reported their primary condition being rediagnosed. From the complete responses, 40% were rediagnosed from one organic condition to another organic condition, however, 32% of women originally diagnosed with psychological, medically unexplained syndromes, or chronic pain were later rediagnosed with organic conditions.Conclusion:Median wait times for a diagnosis for women in Australia, when factoring in high rates of rediagnosis and time to rediagnosis, was 4 years. It is important that clinicians are aware of the high rediagnosis rates in female patients with chronic conditions and understand the potential impact of systemic biases on the diagnostic process for women under their care.

Background Across Europe, women tend to report worse health than men, probably due to women's lower position in society. Although societal gender inequalities have decreased, differences persist regarding employment, income and use of time. This study aims to assess the evolution of gender-based inequalities in 27 European countries between 2004 and 2016, and to analyze the impact of societal gender equality in this evolution. Methods We used data from the Survey on Income and Living Conditions (EU-SILC), from subjects between 25 and 64 years old (N = 2,931,081) from 27 European countries. Logistic regressions were performed with bad self-reported health as dependent variable, first adjusted for age, country and year, and later also for education and employment. Interactions between gender and year were added to the models to assess changes over time. Countries were clustered according to their societal gender equality, based on their Gender Equality Index of 2005 and 2015 (GEI). Analyzes were stratified by education, employment and cluster of GEI. Results Women were 17% (OR = 1.17, 95%CI=1.15-1.19) more likely than men to report bad health. Considering education and employment, women were 3% less likely to report bad health (OR = 0.97, 95%CI=0.96-0.99). Gender-based inequalities were larger among the cluster with higher GEI (OR = 1.37, 95%CI=1.26-1.48) and those with lower education (OR = 1.21, 95%CI=1.18-1.24). Although the gender gap reduced from 26% (OR = 1.26, 95%CI=1.18-1.34) in 2004 to 16% (OR = 1.16, 95%CI=1.08-1.24) in 2016, the decrease was not significant. Differences between years were not significant when analyses were stratified for education, employment or cluster of GEI. Conclusions Gender-based inequalities persisted between 2014 and 2016 and were strongly related to differences in education and employment. The gender gap was larger among countries with greater societal gender equality. Key messages Women’s disadvantage in self-reported health persisted in 2016 and was connected to socioeconomic differences. The gender gap is not smaller in countries with greater societal gender equality.

Since the previous century, gender mainstreaming has been attempting to gain a foothold in our culture. The goal is to achieve gender equality at all societal levels, enforcing the equal status of all genders. However, the so-called ‘gender gap’ is still evident in many areas, including medicine with the ‘gender health gap’. The evidence shows that men continue to be at the center of (medical) research, with an androcentric worldview and strong binary thinking persisting. This has severe consequences for medicine, often leading to misdiagnoses or delayed diagnoses for other genders: heart diseases in women are frequently not recognized or identified too late. Pain is more often unjustifiably diagnosed as psychosomatic in women, as they are perceived as sensitive and emotional from a young age. Non-binary individuals are almost entirely absent in medical research. Medical insights into gender differences are relevant to all healthcare professions, as symptoms need to be interpreted and treated in a gender-sensitive manner to rule out contraindications and provide fast and correct treatment. Keywords Sex• Gender • Gender health gap • Pain • Heart disease

Esophageal cancer is the sixth most common gastrointestinal cancer in the United States. Treatment for esophageal cancer depends on the extent of the disease but often includes surgery with or without chemoradiation. The aim of this study is to identify possible gender, racial, and socioeconomic disparities in treatment decisions and survival outcomes for patients with locally advanced esophageal cancer. Locally advanced (stage IIA-IVA) esophageal cancer cases in adults (age ≥ 20years) diagnosed between 2012 and 2021 were identified from the Surveillance, Epidemiology, and End Results database. Data regarding patient demographics, treatment strategies, and survival outcomes was collected. Multivariate logistic and Cox regression analyses were performed to evaluate the association between various patient characteristics and management patterns and survival. A total of 10,823 cases were included in this study. Female (OR: 0.71, p < 0.001), Black (OR 0.33, p < 0.001), and Hispanic (OR: 0.75, p < 0.001) patients were less likely to be recommended surgery for their esophageal cancer. Among patients who were recommended surgery, Black race (OR: 0.062, p = 0.006) and Low SES (OR: 0.662, p = 0.007) were associated with a lower likelihood of surgery being performed. Female (OR: 0.74, p = 0.007) and Hispanic (OR 0.64, p = 0.003) patients were less likely to receive neoadjuvant therapy. Female (OR: 0.82, p = 0.040), Black (OR: 0.63, p = 0.018), and Low SES (OR: 0.734, p = 0.008) patients were less likely to receive adjuvant therapy. Female patients had improved OS (HR: 0.88, p < 0.001) and CSS (HR: 0.85, p = 0.003) whereas Black race (OS-HR: 1.32, p < 0.001, CSS-HR: 1.31, p < 0.001) and Low SES (OS-HR: 1.15, p < 0.001, CSS-HR: 1.17, p < 0.001) were associated with worse OS and CSS. Significant differences in surgical management, administration of neoadjuvant and adjuvant therapy, OS, and CSS exist based on gender, race/ethnicity, and SES. Further research is needed to elucidate and ameliorate the possible causes of these disparities.

Gender equality in medicine: change is coming

Student voices in Readers’ Theater: Exploring communication in the hidden curriculum

Objective:Country-level structural stigma toward sexual minority individuals (i.e.,discriminatory laws and policies and prejudicial attitudes) shows robustassociations with sexual minority individuals’ mental health andindividual-level stigma processes, such as identity concealment. Whetherstructural stigma is also associated with interpersonal-level stigmaprocesses, such as victimization, is rarely studied. Whether the associationbetween structural stigma and sexual minority individuals’ interpersonalmistreatment varies across gender, gender nonconformity, and socioeconomicstatus also remains to be determined.Methods:In 2012, sexual minority adults (n = 86,308) living in 28European countries responded to questions assessing past-12-monthvictimization experiences (i.e., physical or sexual attack or threat ofviolence). Country-level structural stigma was objectively indexed as anaggregate of national laws, policies, and population attitudes negativelyaffecting sexual minority individualsResults:Country-level structural stigma was significantly associated withvictimization (adjusted odds ratios [AOR]: 1.13, 95% confidence interval[CI]: 1.04–1.22; p = .004). However, this effect varied bygender, gender nonconformity, and socioeconomic status. For both sexualminority men and women, gender nonconformity and lower socioeconomic statuswere associated with increased risk of victimization. The strongestassociation between country-level stigma and victimization was found amonggender nonconforming men with lower socioeconomic status (AOR: 1.32, 95% CI:1.14–1.52; p < .001).Conclusions:A much larger proportion of sexual minorities living in higher stigmacountries reports victimization than those living in lower stigma countries.At the same time, the association between country-level structural stigmaand victimization is most heavily concentrated among gender nonconformingmen with lower socioeconomic status.