Sex-based Disparities Research Articles

Sex-biased avian host use by arbovirus vectors.

Prevalence of arthropod-borne parasites often differs drastically between host sexes. This sex-related disparity may be related to physiological (primarily hormonal) differences that facilitate or suppress replication of the pathogen in host tissues. Alternately, differences in pathogen prevalence between host sexes may be owing to differential exposure to infected vectors. Here, we report on the use of PCR-based assays recognizing bird sex chromosomes to investigate sex-related patterns of avian host use from field-collected female mosquitoes from Florida, USA. Mosquitoes took more bloodmeals from male birds (64.0% of 308 sexed samples) than female birds (36.0%), deviating significantly from a hypothetical 1:1 sex ratio. In addition, male-biased host use was consistent across mosquito species (Culex erraticus (64.4%); Culex nigripalpus (61.0%) and Culiseta melanura (64.9%)). Our findings support the hypothesis that sex-biased exposure to vector-borne pathogens contributes to disparities in parasite/pathogen prevalence between the sexes. While few studies have yet to investigate sex-biased host use by mosquitoes, the methods used here could be applied to a variety of mosquito-borne disease systems, including those that affect health of humans, domestic animals and wildlife. Understanding the mechanisms that drive sex-based disparities in host use may lead to novel strategies for interrupting pathogen/parasite transmission.

Trends in and disparities for acute myocardial infarction: an analysis of Medicare claims data from 1992 to 2010.

BackgroundIt is unknown whether previously reported disparities for acute myocardial infarction (AMI) by race and sex have declined over time.MethodsWe used Medicare Part A administrative data files for 1992 to 2010 to evaluate changes in per-capita hospitalization rates for AMI, rates of revascularization (percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG)), and 30-day mortality for four distinct patient subcohorts: black women; black men; white women; and white men, adjusted for age, comorbidities and year using logistic regression.ResultsThe study sample consisted of 4,045,267 AMI admissions between the years 1992 and 2010 (166,660 black women; 116,201 black men; 1,870,816 white women; 1,891,590 white men). AMI hospitalization rates differed significantly in 1992 to 1993 among black women (61.6 hospitalizations per 10,000 Medicare enrollees), black men (73.2 hospitalizations), white women (72.0 hospitalizations) and white men (113.2 hospitalizations) (P <0.0001). By 2009 to 2010 AMI hospitalization rates had declined substantially in all cohorts but disparities remained with significantly lower hospitalization rates among women and blacks compared to men and whites, respectively (P <0.0001). In multivariable-adjusted analyses, despite narrowing of the differences between cohorts over time, disparities in AMI hospitalization rates by race and sex remained statistically significant in 2009 to 2010 (P <0.001). In 1992 to 1993 and 2009 to 2010, rates of PCI within 30-days of AMI differed significantly among black women (8.6% in 1992 to 1993; 24.2% in 2009 to 2010), black men (10.4% and 32.6%), white women (12.8% and 30.5%), and white men (16.1% and 40.7%) (P <0.0001). In multivariable-adjusted analyses, racial disparities in procedure utilization appeared somewhat larger and sex-based disparities remained significant. Unadjusted 30-day mortality after AMI in 1992 to 1993 for black women, black men, white women and white men was 20.4%, 17.9%, 23.1% and 19.5%, respectively (P <0.0001); in 2009 to 2010 mortality was 17.1%, 15.3%, 18.2% and 16.2%, respectively (P <0.0001). In adjusted analyses, racial differences in mortality declined over time but differences by sex (higher mortality for women) persisted.ConclusionsDisparities in AMI have declined modestly, but remain a problem, particularly with respect to patient sex.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-014-0190-6) contains supplementary material, which is available to authorized users.

Global Women's Health: Progress toward Reducing Sex-Based Health Disparities

Though sex-based health disparities are a global reality, nowhere are they greater than in resource-poor nations. Women and girls in developing nations lack basic health care and they face debilitating and life-threatening health issues that have long since been controlled or eradicated elsewhere. The list includes maternal mortality, obstetric fistulas, female genital cutting, HIV/AIDS, malaria in pregnancy, and cervical cancer. Because these girls and women have less access to education and employment and are societally encouraged to marry early and bear many children, they suffer from higher rates of illiteracy, fertility, morbidity, and mortality. These social and economic conditions directly affect the health and well-being of these women, their children, their families, and their communities. In 2000, the United Nations established 8 Millennium Development Goals (MDGs)2: eradicating extreme poverty and hunger; achieving universal primary education; promoting sexual equality and empowering women; reducing child mortality rates; improving maternal health; combating HIV/AIDS, malaria, and other diseases; ensuring environmental sustainability; and developing a global partnership for development (1). (Table 1) By 2005 it was clear that some nations were on track, while others were struggling. Relief was given to countries that were heavily indebted, and funds were given to the World Bank, the International Monetary Fund, and the African Development Bank to help refocus efforts to reach the MDGs. In 2010, the United Nations set a deadline for all nations to achieve all 8 goals by 2015. View this table: Table 1. The MDGs.a Three MDGs are highly relevant to women's health. MDG3, promoting sexual equality and empowering women, specifically stipulates eliminating sex-based disparities in primary and secondary education, preferably by 2005, and at all levels by 2015. MDG5, improving maternal health, targets a 75% reduction in maternal mortality. MDG6, combating HIV/AIDS, malaria, and other diseases, aims to halt and reverse the spread of HIV/AIDs, malaria, and other …

Trends in and disparities for acute myocardial infarction: an analysis of Medicare claims data from 1992 to 2010

It is unknown whether previously reported disparities for acute myocardial infarction (AMI) by race and sex have declined over time. We used Medicare Part A administrative data files for 1992 to 2010 to evaluate changes in per-capita hospitalization rates for AMI, rates of revascularization (percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG)), and 30-day mortality for four distinct patient subcohorts: black women; black men; white women; and white men, adjusted for age, comorbidities and year using logistic regression. The study sample consisted of 4,045,267 AMI admissions between the years 1992 and 2010 (166,660 black women; 116,201 black men; 1,870,816 white women; 1,891,590 white men). AMI hospitalization rates differed significantly in 1992 to 1993 among black women (61.6 hospitalizations per 10,000 Medicare enrollees), black men (73.2 hospitalizations), white women (72.0 hospitalizations) and white men (113.2 hospitalizations) (P <0.0001). By 2009 to 2010 AMI hospitalization rates had declined substantially in all cohorts but disparities remained with significantly lower hospitalization rates among women and blacks compared to men and whites, respectively (P <0.0001). In multivariable-adjusted analyses, despite narrowing of the differences between cohorts over time, disparities in AMI hospitalization rates by race and sex remained statistically significant in 2009 to 2010 (P <0.001). In 1992 to 1993 and 2009 to 2010, rates of PCI within 30-days of AMI differed significantly among black women (8.6% in 1992 to 1993; 24.2% in 2009 to 2010), black men (10.4% and 32.6%), white women (12.8% and 30.5%), and white men (16.1% and 40.7%) (P <0.0001). In multivariable-adjusted analyses, racial disparities in procedure utilization appeared somewhat larger and sex-based disparities remained significant. Unadjusted 30-day mortality after AMI in 1992 to 1993 for black women, black men, white women and white men was 20.4%, 17.9%, 23.1% and 19.5%, respectively (P <0.0001); in 2009 to 2010 mortality was 17.1%, 15.3%, 18.2% and 16.2%, respectively (P <0.0001). In adjusted analyses, racial differences in mortality declined over time but differences by sex (higher mortality for women) persisted. Disparities in AMI have declined modestly, but remain a problem, particularly with respect to patient sex.

Sex-Based Salary Disparity and the Uses of Multiple Regression for Definition and Remediation

Although sex differences in salaries are widely condemned, some organizations tolerate these disparities. When organizations are found to discriminate against women in salaries for the same jobs as men, a number of remedies can be pursued. This study illustrates how a state university responded to demonstrated sex-based salary disparities identified in a class-action lawsuit. In particular, a regression analysis was conducted for male and female faculty members that also included seven other predictors. Statistical differences between male and female faculty members were found. As part of the remediation, the salaries of 39 women faculty members were increased. Subsequent regression analysis indicated that the effect for faculty member sex no longer reached traditional levels of statistical significance. The court-order remediation was deemed to have removed the sex-based salary disparity. Yet, it is not clear that the post-remediation salaries of the women faculty were perceived as fair. This case demonstrates how concepts from regression can be (mis)used in legal cases of salary fairness and disparity.

Age-based and Sex-based Disparities in Screening Colonoscopy Use Among Medicare Beneficiaries

The use of screening colonoscopy among older persons is controversial due to variability in life expectancy and sex-based differences in colorectal cancer incidence. We assessed the relation between sex, age, and receipt of screening colonoscopy overall and within strata of life expectancy. We used Medicare data to identify beneficiaries during the years 2001 to 2005 who had not undergone a colonoscopy in the prior 3 years. Medicare claims were used to identify screening colonoscopy use; life expectancy was estimated using a life table approach. We used Poisson regression to examine sex and age differences in screening colonoscopy, adjusted for patient demographic characteristics. Our sample consisted of 161,229 patients (61.9% female; mean age 76.9 y). The screening colonoscopy rates for females and males were 16.9 and 24.4 screening colonoscopies per 1000 person-years, respectively (P<0.001). The screening colonoscopy rate was highest for patients with the longest life expectancy (10 to 15 y: 27.2 screening colonoscopies per 1000 person-years) compared with 3.4 per 1000 person-years in the life expectancy <5-year group. Within specific life expectancy categories, older patients had significantly lower screening rates; in the 10- to 15-year life expectancy category, patients 75 to 79 years old had a lower rate (21.9 screening colonoscopies per 1000 person-years) than patients 68 to 69 years old (34.1 screening colonoscopies per 1000 person-years; P<0.001). In a large cohort of Medicare beneficiaries, there was evidence of screening colonoscopy use even among patients with a short life expectancy. After accounting for life expectancy, females and older persons were less likely to undergo screening colonoscopy.

Sex-Based Disparities in Pretrial Release Decisions and Outcomes

This study involved an examination of sex-based differences in judicial decision making during pretrial, an understudied stage of the criminal court process. We also examined whether defendants’ sex interacted with other legal and extralegal case characteristics, or the context of the county in which defendants were processed. Analyses of data collected from 62 large urban counties for the years 1994 through 2006 revealed that overall, women were treated more leniently than men throughout the pretrial process. Results also indicated that defendants’ sex interacted with other case characteristics to influence pretrial decisions and outcomes, and that judicial decisions were shaped by the sociopolitical context of the county in which these defendants were processed.

Sex-Based Disparities in Liver Transplant Rates in the United States

We sought to characterize sex-based differences in access to deceased donor liver transplantation. Scientific Registry of Transplant Recipients data were used to analyze n = 78 998 adult candidates listed before (8/1997-2/2002) or after (2/2002-2/2007) implementation of Model for End-Stage Liver Disease (MELD)-based liver allocation. The primary outcome was deceased donor liver transplantation. Cox regression was used to estimate covariate-adjusted differences in transplant rates by sex. Females represented 38% of listed patients in the pre-MELD era and 35% in the MELD era. Females had significantly lower covariate-adjusted transplant rates in the pre-MELD era (by 9%; p < 0.0001) and in the MELD era (by 14%; p < 0.0001). In the MELD era, the disparity in transplant rate for females increased as waiting list mortality risk increased, particularly for MELD scores ≥15. Substantial geographic variation in sex-based differences in transplant rates was observed. Some areas of the United States had more than a 30% lower covariate-adjusted transplant rate for females compared to males in the MELD era. In conclusion, the disparity in liver transplant rates between females and males has increased in the MELD era. It is especially troubling that the disparity is magnified among patients with high MELD scores and in certain regions of the United States.

Toward More Optimal Use of Primary Prevention Implantable Cardioverter-Defibrillators

The implantable cardioverter-defibrillator (ICD) has been shown in several randomized clinical trials to improve the survival of patients with systolic heart failure (HF).1–4 As a result, practice guidelines designate ICD therapy as a class I indication in many patients with HF.5–7 Notwithstanding the evidence from randomized clinical trials and practice guidelines, several studies have demonstrated significant underutilization of primary prevention ICDs in many HF patients who are potentially eligible for this therapy.8,9 Some of these studies also described racial and sex-based disparities in the use of this device.8–10 In one investigation of a national HF registry, the majority of patients with a history of myocardial infarction and a left ventricular ejection fraction (LVEF) ≤35% did not receive an ICD, and black patients were significantly less likely than their white counterparts to receive one.8 In another study that used Medicare Claims data, women were 3 times less likely than men to receive an ICD for a primary prevention indication.10 In a third study of ICD use among patients with HF and an LVEF ≤30% in the American Heart Association's (AHA) Get With the Guidelines-Heart Failure (GWTG-HF) program, only a third of these patients had an ICD in place or an ICD planned after discharge.9 Importantly, this analysis showed major race- and sex-based disparities.9 Articles see p 146 and 152 To appreciate the gravity of these findings, two facts must be emphasized. First, sudden cardiac death is the leading cause of death in the United States.11,12 Second, the ICD is the most effective therapy currently available to prevent sudden cardiac death.13 Thus, underutilization of ICD therapy and racial and sex-based disparities in its use constitute major public health problems that must be …

Aspirin For Primary Prevention Of Cardiovascular Disease In Women

Cardiovascular disease (CVD) accounts for 34% of overall mortality in the United States or an average of 1 death every 38 seconds. While the majority of these events are related to coronary heart disease (CHD), stroke accounts for a sizeable burden of CVD among postmenopausal women. Before 75 years of age, a higher proportion of CVD events due to CHD occur in men than in women, as opposed to a higher proportion of events due to stroke occurring in women. Sex-based disparities in medical care are well documented, and under-treatment of women with aspirin for secondary prevention of CVD is a blatant example of the quality chasm described in the Institute of Medicine report "between the care we have and the care we could have". However, while aspirin appears to be of substantial net benefit in secondary prevention, the balance of its beneficial effects and bleeding hazards in primary prevention remains less certain, especially in women. The current review examines the evidence and provides recommendations for the use of aspirin for primary prevention of CVD in women.

Equitable Improvement for Women and Men in the Use of Guideline-Recommended Therapies for Heart Failure: Findings From IMPROVE HF

Background Although sex-based disparities in use of guideline-recommended heart failure (HF) therapies have been described, little is known about whether performance improvement (PI) initiatives produce equitable improvements in guideline-recommended therapies. Methods and Results IMPROVE HF is a prospective study of a practice-based PI intervention in patients with systolic HF or post–myocardial infarction left ventricular dysfunction. Mean changes from baseline to 24 months after intervention were compared between women and men for treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, aldosterone antagonists, anticoagulation for atrial fibrillation, cardiac resynchronization therapy (CRT), implantable cardioverter-defibrillator (ICD), and HF education. This analysis included 15,170 patients at 167 cardiology practices (4,383 [28.9%] women, 10,787 [71.1%] men). At baseline, women were less likely than men to be treated with anticoagulation and ICD. Significant improvements in 6 of 7 quality measures were evident at 24 months for both sexes. The absolute magnitude of improvement was similar for 5 measures and significantly better in women for CRT, ICD, and composite care. Conclusions This PI intervention was associated with similar or greater increases in use of guideline-recommended HF therapies for eligible women compared with men. Clinical decision support and performance feedback may help to ensure improved, equitable care for men and women with HF. Clinical Trial Registration Information http://www.clinicaltrials.gov unique identifier: NCT00303979.

Mortality in Adolescent Girls vs Boys Following Traumatic Shock

Female sex imparts a survival benefit after traumatic injury in children. Review of patients (aged 0-17 years) included in the National Pediatric Trauma Registry between April 1994 and September 2001. Multiple logistic regression was used to analyze the effect of sex on mortality, adjusting for age, severity of injury (New Injury Severity Score and Pediatric Trauma Score), severity of head or extremity injury, injury mechanism, intent, and comorbidities. Subset analysis focused on severely injured children (New Injury Severity Score >or= 16) with shock (systolic blood pressure <or= 90 mm Hg, adjusted for age). Adjusted odds of mortality between sexes. Of 46,859 children, 67% were boys. Girls had a higher crude mortality rate than boys (3.1% vs 2.7%, respectively; P < .05), but after adjustment, no significant difference was found in the odds of mortality between sexes (odds ratio, 1.16; 95% confidence interval, 0.89-1.37). Among children meeting the definition of severe injury with shock (n = 697), mortality was 39%. On regression analysis, sex did not predict outcomes in prepubescent children (aged <or= 11 years; n = 532; 95% confidence interval, 0.56-1.22). However, among adolescents (aged 12-17 years), girls demonstrated significantly decreased odds of death when compared with equivalently injured boys (odds ratio, 0.38; 95% confidence interval, 0.14-0.90; n = 165). Adolescent girls exhibit lower mortality than boys following traumatic shock. This effect is not seen in prepubescent children. These findings suggest that hormonal differences may play a role in the sex-based outcome disparities following traumatic shock in children.

SEX-BASED DISPARITIES IN FELONY DISPOSITIONS BEFORE VERSUS AFTER SENTENCING REFORM IN OHIO

Extending Koons-Witt's (2002) study of whether sex-based disparities in imprisonment likelihoods changed under sentencing guidelines in Minnesota, we examined similar models for Ohio with additional analyses of felony conviction likelihoods and sentence length for 5,472 felony defendants from twenty-four trial courts. The main effects of a defendant's sex on imprisonment were significant during both periods (unlike the Minnesota findings), consistent with a chivalry perspective. Random coefficient models revealed that these effects were similar across the twenty-four jurisdictions. Analyses also revealed significant postguideline reductions in sentence length disparities based on a woman's race and number of dependent children, yet increased disparities in imprisonment likelihoods postguidelines based on a woman's race and whether she was convicted on drug charges. These and other findings are discussed in the context of the Ohio legislature's implementation of a sentencing scheme that retains considerably more judicial discretion relative to Minnesota's template.

Sex differences in brain activation elicited by humor.

With recent investigation beginning to reveal the cortical and subcortical neuroanatomical correlates of humor appreciation, the present event-related functional MRI (fMRI) study was designed to elucidate sex-specific recruitment of these humor related networks. Twenty healthy subjects (10 females) underwent fMRI scanning while subjectively rating 70 verbal and nonverbal achromatic cartoons as funny or unfunny. Data were analyzed by comparing blood oxygenation-level-dependent signal activation during funny and unfunny stimuli. Males and females share an extensive humor-response strategy as indicated by recruitment of similar brain regions: both activate the temporal-occipital junction and temporal pole, structures implicated in semantic knowledge and juxtaposition, and the inferior frontal gyrus, likely to be involved in language processing. Females, however, activate the left prefrontal cortex more than males, suggesting a greater degree of executive processing and language-based decoding. Females also exhibit greater activation of mesolimbic regions, including the nucleus accumbens, implying greater reward network response and possibly less reward expectation. These results indicate sex-specific differences in neural response to humor with implications for sex-based disparities in the integration of cognition and emotion.

A Survey of Evidence and Discovery Rules in Civil Sexual Harassment Suits with Special Emphasis on California Law

Workplace sexual harassment creates a problem that extends beyond the specific injuries suffered by the individual victim. Insofar as sexual harassment is directed predominantly toward women, it serves to perpetu ate sex-based economic disparities. Sexual harassment plaintiffs have ex perienced an expansion of their substantive rights in recent years, through a variety of state and federal civil rights legislation and court decisions. The author contends, however, that defendants' use of discovery (and the corresponding introduction of evidence in open court) strips plaintiffs of their privacy to the extent that meritorious suits may be inhibited. The author focuses on two issues: the introduction of evidence regarding plain tiffs' past sexual behavior, and court-ordered psychiatric examinations of plaintiffs. The author suggests that legislation analogous to rape shield statutes be enacted to curb potential plaintiffs' fears of humiliation and embarrassment. The author further proposes that psychiatric examina tions be ordered only when a plaintiff is planning to introduce expert testi mony on her mental state. Alternately, the plaintiff could be accorded the right to have counsel present during psychiatric examinations.

Unite to end sex-based wage disparities.

Unite to end sex-based wage disparities.

Local government police management : 2nd edition, edited by Bernard L. Garmire. International City Management Association (1140 Connecticut Avenue, N.W., Washington, D.C. 20036), 1982, 447 pp., hardcover—$36.00 plus processing charge, $2.25.

While various perspectives have been offered to explain why females might be treated more leniently by the court system than males, very few studies have investigated sex-based disparities at stages of case processing prior to sentencing. Therefore, we examine outcomes at pretrial release and sentencing and investigate for cumulative disadvantage across the criminal court system.A sample of felony cases referred to the Prosecutor’s Office of a large northern urban jurisdiction in the United States during calendar year 2009 were analyzed and included violent, property, and drug offenses.In general, it was found that females were treated more leniently by the court system, although specific groups of female defendants were found to experience cumulative disadvantage across the criminal court system.While support for the chivalry/paternalism perspective was found, it is suggested that scholars revisit the many perspectives currently put forth to explain sex-based disparities.

Introduction to the criminal justice system: Principles, procedures, practice : by Gerald D. Robin. Harper & Row Publishers (10 East 53rd Street, New York, New York 10022), 1980, 558 pp., hardcover—$15.95

While various perspectives have been offered to explain why females might be treated more leniently by the court system than males, very few studies have investigated sex-based disparities at stages of case processing prior to sentencing. Therefore, we examine outcomes at pretrial release and sentencing and investigate for cumulative disadvantage across the criminal court system.A sample of felony cases referred to the Prosecutor’s Office of a large northern urban jurisdiction in the United States during calendar year 2009 were analyzed and included violent, property, and drug offenses.In general, it was found that females were treated more leniently by the court system, although specific groups of female defendants were found to experience cumulative disadvantage across the criminal court system.While support for the chivalry/paternalism perspective was found, it is suggested that scholars revisit the many perspectives currently put forth to explain sex-based disparities.

The Stars are (Re)Alinging: Extending Title IX to NCAA Conference Realignment in the NIL Era

Almost fifty years after Congress enacted Title IX, the NCAA adopted its interim Name, Image, and Likeness (NIL) policy, permitting college athletes to be compensated for use of their NIL. While some athletes gain significantly from the NIL regime, most athletes do not capture its benefits. Further, earnings under the NIL regime are distinctly stratified between men’s and women’s sports. The vast majority of NIL money flows to football and men’s basketball. Athletes in other programs—especially women’s sports—struggle to find space in the NIL market. Today, the NCAA is on the verge of a groundbreaking settlement that will reshape the NIL system. If approved, the proposed settlement in House v. NCAA, a class action lawsuit challenging the NCAA’s prior prohibition on compensating athletes for use of their NIL, will create two significant changes. First, universities will be allowed to facilitate NIL deals between student athletes and third parties. Second, universities will be allowed to participate in a revenue sharing program in which they can directly pay student athletes a portion of the schools’ annual athletic revenue, including money from television broadcast rights. Conference realignment, the process by which universities reorganize themselves into different athletic conferences for financial gain by bargaining for larger television broadcast deals, will amplify gendered consequences of the NIL regime and any inequities arising from the post-House revenue sharing system. Conference realignment will expose the NIL “winners” to larger media markets while imposing travel-based “human costs” on the NIL “losers,” who are unable to offset these costs by generating NIL money. Likewise, by increasing the revenue schools receive from selling their broadcast rights, conference realignment will directly impact inequities in revenue-sharing earnings between male and female athletes. This Comment explores the effects of NCAA conference realignment on student athletes in the NIL era and emphasizes that these effects should be considered when implementing a revenue sharing system like that proposed in the House settlement. This Comment argues that by exacerbating sex-based disparities baked into the current NIL regime and likely to be perpetuated by future policies, universities’ conference realignment decisions constitute disparate impact discrimination under Title IX. These decisions disproportionately impact women athletes by exacerbating NIL earning disparities and neglecting to consider travel-based costs for women athletes. Universities do not engage in conference realignment out of educational necessity, but rather to maximize profits generated from contracts for television broadcast rights. To ameliorate the gendered impacts of conference realignment, this Comment urges the NCAA to address the underlying gender disparities in the NIL regime. In doing so, this Comment analyzes the proposed House settlement and recommends that the House settlement confront looming Title IX problems by creating a revenue-sharing system for university-facilitated NIL and athletic revenue based on Title IX’s proportionate equality standard.