Sex and Gender Bias as a Mechanistic Determinant of Cardiovascular Disease Outcomes

Kim, Isabel; Field, Thalia S; Wan, Darryl; Humphries, Karin H.; Sedlak, Tara

doi:10.1016/j.cjca.2022.09.009

Cited by 25 publications

(5 citation statements)

References 133 publications

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“…Similar findings about women's experiences of health care more broadly have also been reported, for example, there is evidence that women experiencing chronic pain feel dismissed by clinicians (55)(56)(57). Furthermore, several studies show that men and women presenting with the same or similar symptoms are treated differently, with women more frequently receiving misdiagnosis or mismanagement of symptoms (58)(59)(60)(61)(62). This suggests that negative experiences of care experienced by women with gynaecological conditions or symptoms are part of a wider gender-related problem.…”

Section: Comparison With Existing Literaturesupporting

confidence: 55%

Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions: a systematic review

Briscoe,

Thompson Coon,

Melendez-Torres

et al. 2023

BJGP Open

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BackgroundStudies have found that women with gynaecological conditions and symptoms do not feel listened to by primary care clinicians. Less understood is whether primary care clinicians perceive that there are challenges around listening to and interacting with this patient group.AimThis study aims to understand primary care clinicians’ perspectives on the challenges of listening to and interacting with women patients with gynaecological conditions and symptoms.Design & settingSystematic reviewMethodWe searched ASSIA, CINAHL, Embase, HMIC and MEDLINE from inception to July 2023. We also conducted forward and backward citation searches of included studies. Identified records were screened independently by two reviewers. Data-extraction was undertaken by one reviewer and checked by a second. Quality appraisal used the Wallace checklist. “Best-fit” framework synthesis was used to synthesise findings around themes which explore the challenges of patient-clinician interaction.ResultsWe identified 25 relevant papers. Perceived challenges associated with listening to and interacting with patients with gynaecological conditions and symptoms were identified at four ‘levels’: Individual clinician factors; structural and organisational factors; community and external factors; and factors related to gynaecological conditions. Interpretive analysis identified specific challenges relating to socio-cultural factors affecting the consultation experience; the need for further education, training or guidance for clinicians; factors affecting referral decisions; and factors related to service structure and organisation.ConclusionsPrimary care clinicians acknowledge that empathy, respect and attentive listening are important when interacting with women patients with gynaecological conditions and symptoms. However, these ideals are impeded by several factors.

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Section: Comparison With Existing Literaturesupporting

confidence: 55%

Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions: a systematic review

Briscoe,

Thompson Coon,

Melendez-Torres

et al. 2023

BJGP Open

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“…There are previously documented sex and gender disparities in atrial fibrillation investigation and management, as well as the quality of overall stroke prevention management. 32 Thus, further work may point to opportunities to reduce sex and gender biases in care and improve both primary and secondary prevention.…”

Section: Discussionmentioning

confidence: 99%

Sex-Based Analysis of Workflow and Outcomes in Acute Ischemic Stroke Patients Treated With Alteplase Versus Tenecteplase

Kim,

Singh,

Catanese

et al. 2024

Stroke

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BACKGROUND: Understanding sex differences in stroke care is important in reducing potential disparities. Our objective was to explore sex differences in workflow efficiency, treatment efficacy, and safety in the AcT trial (Alteplase Compared to Tenecteplase). METHODS: AcT was a multicenter, registry-linked randomized noninferiority trial comparing tenecteplase (0.25 mg/kg) with alteplase (0.9 mg/kg) in acute ischemic stroke within 4.5 hours of onset. In this post hoc analysis, baseline characteristics, workflow times, successful reperfusion (extended Thrombolysis in Cerebral Infarction score ≥2b), symptomatic intracerebral hemorrhage, 90-day functional independence (modified Rankin Scale score, 0–1), and 90-day mortality were compared by sex. Mixed-effects regression analysis was used adjusting for age, stroke severity, and occlusion site for outcomes. RESULTS: Of 1577 patients treated with intravenous thrombolysis (2019–2022), 755 (47.9%) were women. Women were older (median, 77 [68–86] years in women versus 70 [59–79] years in men) and had a higher proportion of severe strokes (National Institutes of Health Stroke Scale score >15; 32.4% versus 24.9%) and large vessel occlusions (28.7% versus 21.5%) compared with men. All workflow times were comparable between sexes. Women were less likely to achieve functional independence (31.7% versus 39.8%; unadjusted relative risk, 0.80 [95% CI, 0.70–0.91]) and had higher mortality (17.7% versus 13.3%; unadjusted relative risk, 1.33 [95% CI, 1.06–1.69]). Adjusted analysis showed no difference in outcomes between sexes. CONCLUSIONS: Differences in prognostic factors of age, stroke severity, and occlusion site largely accounted for higher functional dependence and mortality in women. No sex disparities were apparent in workflow quality indicators. Given the integration of the AcT trial into clinical practice, these results provide reassurance that no major sex biases are apparent in acute stroke management throughout participating Canadian centers. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03889249.

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“…Patients with cardiovascular disease show differences in disease perception according to sex, and emotional conditions such as individual anxiety and anger affect health information search behavior [ 28 , 29 ]. Considering these points, additional studies are needed to determine the sex and emotional states of CAD patients.…”

Section: Discussionmentioning

confidence: 99%

Health information-seeking behavior in patients with coronary artery disease: Activating methods

Kim,

Kim

2024

PLoS ONE

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Introduction Coronary artery disease (CAD) has a high mortality rate worldwide, and continuous health behavior practice and careful management are required owing to risks such as rapid changes in symptoms and emergency hospitalization. The utilization of health-related information is an important factor for long-term disease management in patients with CAD. For this purpose, an understanding of health information-seeking behavior is needed first. Methods This study analyzed data from the 2021 Korea Medical Panel Survey, and logistic regression analysis was conducted to confirm the factors influencing the health information-seeking behavior of patients with CAD. Results The health information-seeking behavior of patients with CAD differed according to demographic characteristics, and differences in preferred information use were confirmed. Finally, it was identified that insufficient levels of health literacy were a major reason for CAD patients not engaging in health information-seeking behaviors (OR, 0.17; 95% CI, 0.09–0.33; p < 0.001). Conclusion This study suggests that to improve health information-seeking behaviors, the application of education and intervention programs to increase the level of health literacy is necessary.

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Sex and Gender Bias as a Mechanistic Determinant of Cardiovascular Disease Outcomes

Cited by 25 publications

References 133 publications

Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions: a systematic review

Primary care clinicians’ perspectives on interacting with patients with gynaecological conditions: a systematic review

Sex-Based Analysis of Workflow and Outcomes in Acute Ischemic Stroke Patients Treated With Alteplase Versus Tenecteplase

Health information-seeking behavior in patients with coronary artery disease: Activating methods

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