Sex Concordance Research Articles

Shared aetiology underlying multiple sclerosis and other immune mediated inflammatory diseases: Swedish familial co-aggregation and large-scale genetic correlation analyses

BackgroundWhile multiple sclerosis (MS) affects less than 1 % of the general population, immune mediated inflammatory diseases (IMIDs) collectively influence 5–10 % of the population. Understanding familial co-aggregation of MS and other IMIDs carries important clinical and public health implications that will enable early detection and personalized treatment. ObjectiveTo estimate the familial association between MS and other IMIDs and to quantify their shared genetic basis. DesignRegister-based multi-generational nested case-control familial co-aggregation study and genetic correlation study. SettingSweden. Participants24,995 individuals with MS matched with 253,870 controls and 1,283,502 first-degree relatives (mothers, fathers, full siblings, and offspring) for familial co-aggregation analysis; population of European ancestry for genetic correlation analysis. MeasurementsLogistic regressions with adjustment for covariates were used to estimate the odds ratios (ORs) of developing MS in individuals with first-degree relatives diagnosed with IMIDs compared to those without such family history. Pairwise genome-wide genetic correlations were estimated with linkage-disequilibrium score regression. ResultsWe observed an OR for familial co-aggregation of MS of 1.09 (95 % confidence interval (95%CI) = 1.07−1.11) in families with IMIDs history compared to families without. The association remained broadly consistent after stratification by sex concordance of relative pairs and by kinships. 18 IMID subtypes showed a familial association with MS, 7 of which including other acute widespread myelin destruction, encephalitis or myelitis or encephalomyelitis, inflammatory bowel disease, autoimmune thyroid diseases, systemic lupus erythematosus, other inflammatory system diseases, and sarcoidosis withstood multiple correction. Genetic correlations further revealed a shared genetic basis between 7 IMID subtypes with MS. ConclusionWe demonstrated a modest familial co-aggregation of MS with several IMIDs, and such association is likely due to shared genetic factors.

Association of surgeon's sex, and surgeon-patient dyad with financial outcomes among patients undergoing cancer surgery.

Surgeon sex has been associated with perioperative clinical outcomes among patients undergoing oncologic surgery. There may be variations in financial outcomes relative to the surgeon-patient dyad. We sought to define the association of surgeon's sex with perioperative financial outcomes following cancer surgery. Patients who underwent resection of lung, breast, hepato-pancreato-biliary (HPB), or colorectal cancer between 2014 and 2021 were identified from the Medicare Standard Analytic Files. A generalized linear model with gamma regression was utilized to characterize the association between sex concordance and expenditures. Among 207,935 Medicare beneficiaries (breast: n = 14,753, 7.1%, lung: n = 59,644, 28.7%, HPB: n = 23,400, 11.3%, colorectal: n = 110,118, 53.0%), 87.8% (n = 182,643) and 12.2% (n = 25,292) of patients were treated by male and female surgeons, respectively. On multivariable analysis, female surgeon sex was associated with slightly reduced index expenditures (mean difference -$353, 95%CI -$580, -$126; p = 0.003). However, there were no differences in 90-day post-discharge inpatient (mean difference -$-225, 95%CI -$570, -$121; p = 0.205) and total expenditures (mean difference $133, 95%CI -$279, $545; p = 0.525). There was minor risk-adjusted variation in perioperative expenditures relative to surgeon sex. To improve perioperative financial outcomes, a diverse surgical workforce with respect to patient and surgeon sex is warranted.

Sex concordance between physicians and patients and discharge opioid prescribing.

Inpatient pain management is challenging for clinicians and inequities are prevalent. We examined sex concordance between physicians and patients to determine if discordance was associated with disparate opioid prescribing on hospital discharge. We examined 15,339 hospitalizations from 2013 to 2021. Adjusting for patient, clinical, and hospitalization-level characteristics, we calculated the odds of a patient receiving an opioid on discharge and the days of opioids prescribed across all hospitalizations and for patients admitted with a common pain diagnosis. We did not find an overall association between physician-patient sex concordance and discharge opioid prescriptions. Compared to concordant sex pairs, patients in discordant pairs were not significantly less likely to receive an opioid prescription (odds ratio: 1.04; 95% confidence interval [CI]: 0.95, 1.15) and did not receive significantly fewer days of opioids (2.1 fewer days of opioids; 95% CI: -4.4, 0.4). Better understanding relationships between physician and patient characteristics is essential to achieve more equitable prescribing.

Factors Impacting Physician Prognostic Accuracy in Heart Failure Patients With Reduced Left Ventricular Ejection Fraction

BackgroundA recent study showed that the accuracy of heart failure (HF) cardiologists and family doctors to predict mortality in outpatients with HF proved suboptimal, performing less well than models. ObjectivesThe authors sought to evaluate patient and physician factors associated with physician accuracy. MethodsThe authors included outpatients with HF from 11 HF clinics. Family doctors and HF cardiologists estimated patient 1-year mortality. They calculated predicted mortality using the Seattle HF Model and followed patients for 1 year to record mortality (or urgent heart transplant or ventricular assist device implant as mortality-equivalent events). Using multivariable logistic regression, the authors evaluated associations among physician experience and confidence in estimates, duration of patient-physician relationship, patient-physician sex concordance, patient race, and predicted risk, with concordant results between physician and model predictions. ResultsAmong 1,643 patients, 1-year event rate was 10% (95% CI: 8%-12%). One-half of the estimates showed discrepant results between model and physician predictions, mainly owing to physician risk overestimation. Discrepancies were more frequent with increasing patient risk from 38% in low-risk to ∼75% in high-risk patients. When making predictions on male patients, female HF cardiologists were 26% more likely to have discrepant predictions (OR: 0.74; 95% CI: 0.58-0.94). HF cardiologist estimates in Black patients were 33% more likely to be discrepant (OR: 0.67; 95% CI: 0.45-0.99). Low confidence in predictions was associated with discrepancy. Analyses restricted to high-confidence estimates showed inferior calibration to the model, with risk overestimation across risk groups. ConclusionsDiscrepant physician and model predictions were more frequent in cases with perceived increased risk. Model predictions outperform physicians even when they are confident in their predictions. (Predicted Prognosis in Heart Failure [INTUITION]; NCT04009798)

International study of physicians' opinion on physician-patient sex concordance when treating athletes.

The effect of physician-patient sex concordance in medicine has been reported in many studies. Whether physicians believe that the sex concordance between physician and athlete influences treatment has not been investigated. To determine whether physicians believe that the sex concordance between physician and athlete influences treatment. Cross-sectional study. Online survey. One thousand one hundred ninety-three sports medicine physicians in 51 countries. Participants were sports medicine physicians trained in orthopedics (n = 443 [37.1%]) and nonorthopedics (n = 750 [62.9%]). Not applicable. Participants were asked to decide whether sex of the physician made them better suited to care for athletes of concordant or different sexes along with their personal background. Orthopedic sports medicine physicians agreed less than nonorthopedic sports medicine physicians regarding the statement "MALE sports medicine physicians are better suited than their female counterparts to care for MALE athletes" (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.35-0.91, p = .02), and compared to sports medicine physicians based in Europe, those based in Asia agreed more to this statement (OR 7.91, 95% CI 4.60-13.60, p < .01). In addition, regarding the statement "FEMALE sports medicine physicians are better suited than their male counterparts to care for FEMALE athletes," compared to sports medicine physicians based in Europe, those based in Asia (OR 9.12, 95% CI 5.63-14.79, p < .01) and North America (OR 2.18, 95% CI 1.46-3.25, p < .01) agreed more and orthopedic sports medicine physicians agreed less than nonorthopedic sports medicine physicians (OR 0.61, 95% CI 0.39-0.93, p = .02) to this statement. Sports medicine physicians trained in orthopedics felt sex concordance was less important than physicians trained in other specialties. Asian sports medicine physicians believed sex concordance was more important compared to physicians in other regions.

Factors Associated with Chronic Rejection in Liver Transplant Recipients: A Retrospective Cohort Study From Shiraz Organ Transplant Center.

Identification of chronic rejection risk factors in liver transplant recipients is critical for early detection and prevention of further graft loss. We investigated characteristics of liver transplant recipients who had experienced chronic rejection and the associated risk factors versus patients without chronic rejection. Data from 3022 adult liver transplant recipients between 2011 and 2018 were analyzed; of these, 80 patients had experienced chronic rejection. The control group included 98 randomly selected liver transplant recipients who did not have chronic rejection. The age of the recipients and the donors was significantly lower in the group with chronic rejection versus the group without chronic rejection.The results indicated that chronic rejection was significantly associated with the sex of the recipients (hazard ratio 3.2, 95% CI 1.77-6.08; P < .001) and with the sex concordance between the recipients and donors (hazard ratio 2.93, 95% CI 1.67-5.13; P < .001, respectively). Also, in the group without chronic rejection, there were no male donors; however, the group with chronic rejection had mostly male donors (P <.001). Cold ischemia time was longer in patients with chronic rejection versus that shown in the control group (P = .031), and there was a significant difference between the 2 groups in acute rejection frequency (P < .001). Recipient sex and sex concordance were independent risk factors for chronic rejection. Most transplantrecipients with chronic rejection responded to medicaltreatment, and the rate of graftloss was low among our recipients.

CO132 A Real-World Evidence Analysis of the Impact of Patient-Physician Sex Concordance on Cancer Treatment Practices and Outcomes

CO132 A Real-World Evidence Analysis of the Impact of Patient-Physician Sex Concordance on Cancer Treatment Practices and Outcomes

Association of surgeon-patient sex concordance with postoperative outcomes following complex cancer surgery.

Sex concordance may impact the therapeutic relationship and provider-patient interactions. We sought to define the association of surgeon-patient sex concordance on postoperative patient outcomes following complex cancer surgery. Patients who underwent surgery for lung, breast, hepato-pancreato-biliary,or colorectal cancer between 2014 and 2020 were identified from the Medicare Standard Analytic Files. The impact of surgeon-patient sex concordance or discordance on achieving an optimal postoperative textbook outcome (TO) was assessed using multivariable logistic regression. Among 495 628 patients, 241 938 (48.8%) patients were sex concordant with their surgeon while 253 690 (51.2%) patients were sex discordant. Sex discordance between surgeon and patient was associated with a decreased likelihood to achieve a postoperative TO(odds ratio[OR]: 0.95, 95%CI: 0.93-0.97; p < 0.001). Sex discordance was associated with a higher risk of complications (OR: 1.05, 95%CI: 1.03-1.07; p < 0.001) and 90-day mortality (OR: 1.05, 95%CI: 1.01-1.09; p = 0.011). Of note, male patients treated by female surgeons (OR: 0.96, 95%CI: 0.93-0.99;p = 0.017) had a similar lower likelihood to achieve a TO as female patients treated by male surgeons (OR: 0.90, 95%CI: 0.86-0.93; p < 0.001). Sex discordance was associated with a reduced likelihood of achieving an "optimal" postoperative course following complex cancer surgery.

Association of patient-practitioner sex concordance with specialist referral in primary hyperparathyroidism

BackgroundPrior research has demonstrated barriers to the workup and management of primary hyperparathyroidism. As recent data have suggested that patient and practitioner sex concordance is associated with lower surgical complications, we sought to evaluate the effect of sex concordance on referral for primary hyperparathyroidism. MethodsWe queried an institutional database for patients with first-incident hypercalcemia and subsequent biochemical evidence of primary hyperparathyroidism between 2010 and 2018. Primary care practitioner and endocrinologist sex, laboratory values, and complications of primary hyperparathyroidism were collected. Sex concordance (male patient/male practitioner or female patient/female practitioner) was evaluated as a binary predictor of specialist evaluation using logistic regression and Cox proportional hazards modeling. ResultsAmong 1,100 patients, mean age was 62.5 (standard deviation 13.6), and 74% were female sex. Primary care practitioner sex was 52% female, and 63% of patients had sex concordance with their primary care practitioner. Endocrinologist sex was 59% female, and 45% of patients had sex concordance with their endocrinologist. Patients with sex concordance with their primary care practitioner (70 vs 80%, P = .001) and endocrinologist (71 vs 82%, P < .001) were less likely to be female sex compared to those with discordance. After adjusting for demographics and clinical covariates, those patients with primary care practitioner sex concordance had 32% higher odds of endocrinologist evaluation (odds ratio 1.32, 95% confidence interval 1.003–1.734, P = .047). Similarly, those patients with endocrinologist sex concordance had a 48% higher rate of surgeon evaluation (hazard ratio 1.48, confidence interval 1.1–2.0, P = .009). Stratified analysis revealed that sex discordance reduced the rate of surgeon referral for female patients (hazard ratio 0.63, confidence interval 0.44–0.89, P = .008) but not male patients (hazard ratio 1.06, CI 0.58–1.93, P = .861). ConclusionSex discordance between patients and their health care professionals may contribute to under-referral in primary hyperparathyroidism. Further evaluation of the effect of patient and practitioner identities on communication and decision-making in surgery are needed.

Association of patient sex with use of palliative care in Ontario, Canada: a population-based study.

It is unclear whether there are sex-based differences in use of palliative care near the end of life. The objective of this study was to measure the association between sex and palliative care use. We performed a population-based retrospective cohort study of all patients aged 18 years or older in the last year of life who died in Ontario, Canada, between 2010 and 2018. The primary exposure was patient biologic sex (male or female). The primary outcome was receipt of physician-delivered palliative care; secondary outcomes were approach to in-hospital palliative care and sex concordance of the patient and referring physician. We used multivariable modified Poisson regression to measure the association between patient sex and palliative care receipt, as well as patient-physician sex concordance. There were 706 722 patients (354 657 females [50.2%], median age 80 yr [interquartile range 69-87 yr]) in the study cohort, 377 498 (53.4%) of whom received physician-delivered palliative care. After adjustment for age and selected comorbidities, female sex was associated with a 9% relative increase (adjusted relative risk [RR] 1.09, 95% CI 1.08-1.10) in receipt of physician-delivered palliative care. Female patients were 16% more likely than male patients (adjusted RR 1.14, 95% CI 1.14-1.18) to have had their first hospital admission in their final year of life categorized as having a likely palliative intent. Female patients were 18% more likely than male patients (RR 1.18, 95% CI 1.17-1.19) to have had a female referring physician, and male patients were 20% more likely than female patients (adjusted RR 1.20, CI 1.19-1.21) to have had a male referring physician. After adjustment for age and comorbidities, male patients were slightly less likely than female patients to have received physician-delivered palliative care, and female patients were more likely than male patients to have had their first hospital admission in their final year of life categorized as having a likely palliative care intent. These results may reflect a between-sex difference in overall end-of-life care preferences or sex differences in decision-making influenced by patient-specific factors; further studies exploring how these factors affect end-of-life decision-making are required.

Relationship between Satisfaction Scores and Racial/Ethnic and Sex Concordance in Primary Care.

Satisfaction data for encounters from August 2016 to August 2019 were matched to data from the medical record for patient demographics and comorbidities. Data on 33 providers were also obtained, and racial/ethnic and sex concordance between patients and providers was determined for each of the 3672 unique encounters. The primary outcome was top-box scoring on the CGCAHPS overall satisfaction scale (0-8 vs. 9-10). Generalized mixed-effects logistic regression, including provider- and patient-level factors as fixed effects and a random intercept effect for providers, were used to determine whether concordance had an independent relationship with satisfaction. 89.0% of the NHW-concordant pairs and 90.4% of the Minority Race/Ethnicity-concordant pairs indicated satisfaction, while 90.1% of the male-concordant and 85.1% of the female-concordant pairs indicated satisfaction. When fully adjusted, the female-concordant (OR = 0.58, 95% CI 0.35-0.94) and male-discordant (OR = 0.68, 95% CI 0.51-0.91) pairs reported significantly lower top-box satisfaction compared to the male-concordant pairs. Significant differences did not exist in racial/ethnic concordance. In this sample, differences in sex concordance were noted; however, patient- and provider-level factors may be more influential in driving patient satisfaction than race/ethnicity in this health system.

Do Sex-Specific Factors Influence the Surgical Treatment of Facial Skin Cancer?

Facial skin cancer (FSC) is prone to incomplete excision due to the sophisticated anatomy and the aesthetic importance of the face. In this study, we sought to investigate to what extent sex-specific differences and other operation-, patient-, and cancer-specific factors influence the re-resection rate in FSC surgery, in order to provide personalized treatment strategies to patients. In this retrospective study, patients (>18 years) undergoing surgical excision of an FSC were enrolled. Each patient's demographic data, cancer location, the surgical team, primary and secondary surgeries were analyzed. Overall, 469 patients (819 surgeries) were included. The mean age was 69 ± 15 years. No significant association between sex-specific factors (surgeon's sex (OR: 1.09, 95% CI: 0.76-1.56) or patient's sex (OR: 0.85, 95% CI: 0.62-1.17), surgeon-patient sex concordance and discordance) and the likelihood of secondary surgery were found. However, healing by secondary intention (OR: 4.28; 95% CI: 1.94-9.45) and cancer location showed an increased re-resection rate. In conclusion, FSC surgery is a safe method unaffected by sex-specific factors, which had no impact on the re-resection rate. However, in further analysis, the likelihood of a re-resection was influenced by other factors such as healing by secondary intention and cancer location. This knowledge might be useful to provide an algorithm for personalized treatment strategies in the future.

Real-world associations among patient-physician sex concordance, treatment practices, and cancer outcomes.

e18511 Background: Prior research has linked patient-physician sex discordance with inferior surgical and cardiac outcomes. The impact of such sex inequities may be magnified in medical oncology, where patients often face a life-limiting illness and physicians assume the role of primary healthcare provider. This study examined cancer treatment practices and survival outcomes in sex-concordant vs. discordant patient-physician dyads. Methods: This was a population-based, retrospective cohort study of adults diagnosed with stage II-IV colon or lung cancer in 2013-2020 in Alberta, Canada and referred to a medical oncologist. Study data included physician- and patient-level demographics and cancer disease characteristics. Patient-physician dyads were classified as sex-concordant (female-female, male-male) or discordant (female-male, male-female). Time-to-event data were analysed using Kaplan-Meier methods and associations were assessed with Cox and logistic regression. Results: A total of 11,131 patients and 188 medical oncologists were included. Among patients, 49% were female and 50% were in sex-concordant patient-physician dyads. The median age was 68 years, 7615 (68%) had lung cancer, and 6016 (54%) had stage IV disease. In sex-concordant and discordant dyads, respectively, median overall survival (OS) was 17.1 and 18.7 months ( p = 0.047) while median cancer-specific survival (CSS) was 20.2 and 22.4 months ( p = 0.21). In multivariable analysis, sex-concordance was not significantly associated with OS or CSS in the overall cohort and in female patients. However, among male patients, sex-discordance was significantly associated with lower OS (hazard ratio [HR], 1.11; 95% CI, 1.04-1.19) and CSS (HR, 1.12; 95% CI 1.04 -1.21), largely driven by differences in survival outcomes in stage IV disease. Older age, higher comorbidity burden, lung cancer, and advanced stage correlated with worse outcomes in all multivariable models. Sex concordance was not significantly associated with adjuvant systemic anti-cancer therapy (SACT) use in stage II-III disease or with SACT use in stage IV disease. Treatment practices are summarized in the table. Conclusions: Sex concordance between patients and medical oncologists did not generally correlate with differential SACT use and survival. However, male patients treated by female physicians had worse outcomes compared to those treated by male physicians. Cancer outcomes may be prone to the effects of sex bias in specific patient-physician relationships. [Table: see text]

P-16 Associations among patient-physician sex concordance, treatment practices, and survival outcomes in a population-based colon cancer cohort

P-16 Associations among patient-physician sex concordance, treatment practices, and survival outcomes in a population-based colon cancer cohort

Performance of prenatal cfDNA screening for sex chromosomes

PurposeThe aim of this study was to assess the performance of cell-free DNA (cfDNA) screening to detect sex chromosome aneuploidies (SCAs) in an unselected obstetrical population with genetic confirmation. MethodsThis was a planned secondary analysis of the multicenter, prospective SNP-based Microdeletion and Aneuploidy RegisTry (SMART) study. Patients receiving cfDNA results for autosomal aneuploidies and who had confirmatory genetic results for the relevant sex chromosomal aneuploidies were included. Screening performance for SCAs, including monosomy X (MX) and the sex chromosome trisomies (SCT: 47,XXX; 47,XXY; 47,XYY) was determined. Fetal sex concordance between cfDNA and genetic screening was also evaluated in euploid pregnancies. ResultsA total of 17,538 cases met inclusion criteria. Performance of cfDNA for MX, SCTs, and fetal sex was determined in 17,297, 10,333, and 14,486 pregnancies, respectively. Sensitivity, specificity, and positive predictive value (PPV) of cfDNA were 83.3%, 99.9%, and 22.7% for MX and 70.4%, 99.9%, and 82.6%, respectively, for the combined SCTs. The accuracy of fetal sex prediction by cfDNA was 100%. ConclusionScreening performance of cfDNA for SCAs is comparable to that reported in other studies. The PPV for the SCTs was similar to the autosomal trisomies, whereas the PPV for MX was substantially lower. No discordance in fetal sex was observed between cfDNA and postnatal genetic screening in euploid pregnancies. These data will assist interpretation and counseling for cfDNA results for sex chromosomes.

Donor, Recipient and Surgeon Sex and Sex-Concordance and their Impact on Liver Transplant Outcome.

(1) Background: Patient sex is associated with differential outcome of many procedures although the exact mechanisms remain unknown. Especially in transplant surgery, surgeon-patient sex-concordance is rarely present for female patients and outcome may be negatively affected. (2) Methods: In this single-center retrospective cohort study, recipient, donor, and surgeon sex were evaluated and short- and long-term outcome was analyzed with regards to sex and sex-concordance of patients, donors, and surgeons. (3) Results: We included 425 recipients in our study; 50.1% of organ donors, 32.7% of recipients, and 13.9% of surgeons were female. Recipient-donor sex concordance was present in 82.7% of female recipients and in 65.7% of male recipients (p = 0.0002). Recipient-surgeon sex concordance was present in 11.5% of female recipients and in 85.0% of male recipients (p < 0.0001). Five-year patient survival was comparable between female and male recipients (70.0% vs. 73.3%, p = 0.3978). Five-year patient survival of female recipients treated by female surgeons was improved without reaching significance (81.3% vs. 68.4%, p = 0.3621). (4) Conclusions: Female recipients and female surgeons are underrepresented in liver transplant surgery. Societal factors influencing outcome of female patients suffering from end-stage organ failure need to be further examined and acted upon to possibly improve the outcome of female liver transplant recipients.

Concordance of PGT for aneuploidies between blastocyst biopsies and spent blastocyst culture medium

Research questionNon-invasive preimplantation genetic testing for aneuploidies (niPGT-A) avoids the possible detrimental impact of invasive PGT-A on embryo development and clinical outcomes. Does cell-free DNA (cfDNA) from spent blastocyst culture medium (BCM) reflect embryonic chromosome status better than trophectoderm (TE) biopsy? DesignIn this study, 35 donated embryos were used for research and the BCM, TE biopsy, inner cell mass (ICM) and residual blastocyst (RB) were individually picked up from these embryos. Whole genome amplification (WGA) was performed and amplified DNA was subject to next-generation sequencing. Chromosome status concordance was compared among the groups of samples. ResultsThe WGA success rates were 97.0% (TE biopsy), 100% (ICM), 97.0% (RB) and 88.6% (BCM). Using ICM as the gold standard, the chromosomal ploidy concordance rates for BCM, TE biopsy and RB were 58.33% (14/24), 68.75% (22/32) and 78.57% (22/28); the diagnostic concordance rates were 83.33% (20/24), 87.50% (28/32) and 92.86% (26/28); and the sex concordance rates were 92.31% (24/26), 100% (32/32) and 100% (28/28), respectively. Considering RB the gold standard, the chromosome ploidy concordance rates for BCM and TE biopsy were 61.90% (13/21) and 81.48% (22/27); the diagnostic concordance rates were 71.43% (15/21) and 88.89% (24/27); and the sex concordance rates were 91.30% (21/23) and 100% (27/27), respectively. ConclusionsThe results of niPGT-A of cfDNA of spent BCM are comparable to those of invasive PGT-A of TE biopsies. Modifications of embryo culture conditions and testing methods will help reduce maternal DNA contamination and improve the reliability of niPGT-A.

Abstract P076: Correlations In Hispanic/Latino Siblings’ Physical Activity And Sedentary Behavior: Results From The Hispanic Community Children’s Health Study/Study Of Latino Youth (SOL Youth)

Background: Hispanic/Latino youth in the United States are at an elevated risk for not meeting national guidelines for physical activity (PA). Siblings have the potential to influence each other’s PA and sedentary behavior (SB) through means such as role modeling and co-participation. However, to our knowledge, no study has examined correlations in Hispanic/Latino siblings’ PA and SB behavior using objective measures. Objective: To examine correlations in siblings’ total PA, moderate-to-vigorous physical activity (MVPA), and SB, and to explore whether social and environmental measures explain differences in siblings’ PA and SB. Methods: Hispanic/Latino 8-16-year-olds from the cross-sectional Hispanic Community Children’s Health Study/Study of Latino Youth (SOL Youth) with at least one sibling enrolled in the study were examined ( n =537). Frequency, duration, and intensity of PA were assessed using the ActiCal TM accelerometer. PA-related social and environmental measures were assessed using validated, interviewer-administered questionnaires. Mixed effects linear regression models were used with total PA, MVPA, or SB as the outcome, individual and family-level socio-demographic variables as fixed effects, and family as a random effect. Correlations between siblings’ PA and SB were assessed with intraclass correlation coefficients (ICCs). All models were examined stratified by siblings’ sex concordance and age difference. PA-related social and environmental measures were subsequently added as fixed effects. Results: Mean total PA was 257.4 counts/minutes. On average, youth spent 35.9 minutes in MVPA and 599.4 minutes (10.0 hours) in SB per day. Overall correlations in siblings’ PA and SB were slight to fair, with ICCs of 0.28 (95% CI: 0.18, 0.38), 0.31 (95% CI: 0.22, 0.39), and 0.46 (95% CI: 0.38, 0.54) for total PA, MVPA, and SB, respectively. Siblings who were all brothers had the strongest correlations in total PA (0.61 [95% CI: 0.47, 0.74]) and MVPA (0.62 [95% CI: 0.48, 0.75]) compared to siblings who were all sisters (total PA only) or of differing sexes (total PA and MVPA). Correlations in SB did not differ according to siblings’ sex concordance. Correlations in PA and SB did not differ by siblings’ age difference. Friend support for PA, the after-school PA environment, and workout equipment use at home did not explain differences in siblings’ PA or SB. Conclusions: Correlations in Hispanic/Latino siblings’ PA and SB were slight to fair, with siblings who were all brothers having the strongest correlations in PA. Future research should examine how role-modeling, caregiving responsibilities, and sibling-specific familial support contribute to similarities in siblings’ PA and SB and sex-specific differences in PA correlations.

Shared Decision Making and Human Bias

Surrogate decision makers play an important role in the shared decision making process. Attending the surgical consultation with a family member or a close friend is frequent and also recommendable as often patients struggle to retain all the information conveyed by the surgeon and would benefit from a person to assist them. In particular, elderly and high-risk patients commonly defer the treatment decision until after further reflection and discussion with family members. In this context, the importance of nonclinical surrogate decision makers appear crucial in influencing the treatment choice. In this issue of The Annals of Thoracic Surgery, Lee and colleagues 1 Lee A.C.H. Madariaga M.L.L. Liao C. Ferguson M.K. Gender bias in judging frailty and fitness for lung surgery. Ann Thorac Surg. 2023; 115: 356-362 Abstract Full Text Full Text PDF Scopus (2) Google Scholar have shown that the general population display sex and race biases in judging frailty and fitness for major surgery. This is a timely study complementing the recent evidence confirming how possible sex-related factors influence patient-physician communication, relationship, and ultimately, postoperative clinical outcomes. 2 Wallis C.J.D. Jerath A. Coburn N. et al. Association of surgeon-patient sex concordance with postoperative outcomes. JAMA Surg. 2022; 157: 146-156 Crossref PubMed Scopus (53) Google Scholar Gender Bias in Judging Frailty and Fitness for Lung SurgeryThe Annals of Thoracic SurgeryVol. 115Issue 2PreviewDisparities in surgical care for lung cancer have been well documented, and unconscious bias may be a source of inequity. We assessed whether gender biases exist when nonclinical decision makers render decisions about major lung surgery. Full-Text PDF

The Impact of Age and Sex Concordance Between Patients and Physicians on Medication Adherence: A Population-Based Study.

PurposeAge or sex concordance (same sex or same age range) may also be associated with medication adherence but was not fully investigated. We aim to quantify the impact of age and sex concordance on optimal adherence to statin medications.Patients and MethodsA retrospective cohort study was conducted using population-based health administrative data from Saskatchewan, Canada. Participants were individuals newly initiated on statin medications between January 1, 2012, and December 31, 2017. The outcome was optimal adherence (proportion of days covered ≥ 80%) measured at one year after the first statin claim. The independent variables were sex and age concordance (age within five years) between patients and prescribers. The association between adherence outcome and sex/age concordance was analyzed by multivariable logistic regression models using generalized estimating equations controlled by a package of potential confounding factors.ResultsAmong 51,874 new statin users, 20.6% (n = 10,710) were age concordant with prescriber. The vast majority of age concordance occurred in patients younger than 66 years (88.6%, 9,486/10,710). Sex concordance was observed in 62.8% (n = 32,551) of patients and age-sex combined concordance in 13.2% (n = 6,856). Among patients younger than 66 years (n = 36,641/51,874, 70.6%), age concordance did not have a significant impact on optimal adherence [adjusted OR (aOR) = 1.02, 95% CI 0.97 to 1.07]. Weak association between sex concordance (aOR = 1.05, 95% CI 1.00 to 1.11), and age-sex combined concordance (aOR = 1.05, 95% CI 0.99 to 1.12) was observed.ConclusionAge and sex concordance were not statistically significant predictors of optimal statin adherence. However, a weak association was detected for sex concordance. Future studies should examine this factor in different health care settings.