Sex and gender are important determinants of disease and injury. They may affect incidence and natural history, the utility of diagnostic tests and prognostic markers, the effectiveness and safety of prevention and treatment strategies, access to and use of health care, and the response of the health care system. Sex and gender also strongly interact with other social determinants of health, such as ethnicity, cultural identity, education, work and income. Humans experience the health-related effects of their sex and gender simultaneously, making it difficult to unravel the effects of sex and gender on the incidence of exposures and outcomes, and the incidence of outcomes given the exposures. Recently researchers and organisations that support research have become vitally interested in ensuring that research addresses the health needs of both women and men. Most research studies looking for new treatments are open to both women and men, yet women continue to be under-represented as participants in medical research.
The burden of disease is different in males and females, for example cardiovascular disease is less common in women, but women with cardiovascular disease continue to experience higher mortality than men. Women are more likely to suffer anaemia then men, usually due to iron deficiency. Sex and gender also affect all elements on the immune response pathway, through genetically-mediated responses and gender-based exposure to antigens, access to health care, and prioritization of health needs. As a result women have more autoimmune disease than men but are less susceptible to sepsis, including in the perioperative period. There are also sex-based differences in the pharmacokinetics and dynamics of commonly used drugs and in the incidence of adverse drug reactions.
The Australian and New Zealand College of Anaesthetists (ANZCA) Clinical Trials Network (CTN) has led or participated in eleven large studies that have included nearly 55,000 patients presenting for major non-cardiac surgery. Information was collected about death and major complications within 30 days of the operation in each study. This unique collection of patients presents an outstanding opportunity to see whether women and men are participating equally, whether they are equally fit at baseline and whether outcomes are different. With several ANZCA CTN studies concluding soon and an explosion of interest in sex/gender issues in health and more generally, the time is right to undertake these exploratory analyses, generate new ideas and plan new studies.
Professor Kate Leslie, The Royal Melbourne Hospital, Melbourne
Jessica Kasza, Monash University, Melbourne
The project was awarded $65,281 funding through the ANZCA research grants program for 2020.
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