Abstract
ObjectiveLittle insight exists into sex differences in diagnostic trajectories for common somatic symptoms. This study aims to quantify sex differences in the provided primary care diagnostic interventions for common somatic symptoms, as well as the consequences hereof for final diagnoses. MethodsIn this observational cohort study, we used real-world clinical data from the Dutch Family Medicine Network (N = 34,268 episodes of care related to common somatic symptoms; 61,4% female). The association between patients' sex on the one hand, and diagnostic interventions and disease diagnoses on the other hand, were assessed using multilevel multiple logistic regression analyses. Structural equation modelling was used to estimate a mediation model with multiple parallel mediators to assess whether the fewer disease diagnoses given to female patients were mediated by the fewer diagnostic interventions female patients receive, compared to male patients. ResultsWomen received fewer physical examinations (OR = 0.84, 95%CI = 0.79–0.89), diagnostic imaging (OR = 0.92, 95%CI = 0.84–0.99) and specialist referrals (OR = 0.85, 95%CI = 0.79–0.91) than men, but more laboratory diagnostics (OR = 1.27, 95%CI = 1.19–1.35). Women received disease diagnoses less often than men for their common somatic symptoms (OR = 0.94, 95%CI = 0.89–0.98). Mediation analysis showed that the fewer disease diagnosis in female patients were mediated by the fewer diagnostic interventions conducted in women compared to men. ConclusionThis study shows that sex inequalities are present in primary care diagnostic trajectories of patients with common somatic symptoms and that these lead to unequal health outcomes in terms of diagnoses between women and men. FPs have to be aware of these inequalities to ensure equal high-quality care for all patients.
Highlights
Health outcomes are closely related to patients’ trajectories to diagnosis [1]
We identified 34,268 unique episode of care (EoC) that started with 46,898 reason for encounter (RFE)
In models in which we included sex-by-RFE interaction terms we found that the associations between the type of RFE and diagnostic imaging or a specialist referral did not differ between women and men
Summary
Health outcomes are closely related to patients’ trajectories to diagnosis [1]. A diagnostic trajectory comprises everything a family physician (FP) does, including diagnostic interventions, to obtain a diagnosis for a patient’s complaint. Patients’ characteristics, including their sex, may influence the FPs perception of symptoms and patients’ diagnostic trajectories [1]. Diagnostic trajectories for multiple diseases differ between women and men. A recent study shows that women receive fewer physical examinations, diagnostic imaging and specialist referrals when they present with cough and/or dyspnoea in primary care than men [2]. Studies show that a patient’s sex is associated with different diagnostic trajectories in coronary heart disease (CHD). Women presenting with symptoms suggestive of CHD in primary care are less likely to receive physical examinations [3,4]. How ever, a recent study shows that men are less likely to receive an early diagnosis of dementia than women [6]
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