‘We’re flying blind’: Study calls for disaggregated health data

There is growing evidence to suggest that sex and gender significantly impact health outcomes, but despite that, many health policies continue to take a one-size-fits-all approach.
 
A new global study, published in PLOS Medicine, has added to the evidence base that there are sex differences when it comes to health risk factors, disease prevalence and mortality. But the authors are concerned that a lack of sex-based health data around healthcare access and outcomes may be obscuring significant health inequities.  
 
Health data was analysed from 204 countries for three common conditions – hypertension, diabetes and HIV/AIDS – and rates of disease were compared between males and females, along with differences in diagnosis and treatment.
 
They found that males are more likely than females to get sick, less likely to seek out medical care and adhere to treatment, and more likely to die from these conditions.
 
They also found that males and females received different care for hypertension in 200 countries, for diabetes in 39 countries, and for HIV/AIDS in 76 countries.
 
Further to that, they found other sex-based trends with potential health consequences, such as males being more likely to smoke, and females more likely to be obese.
 
Led by Angela Chang, an associate professor at the Danish Centre for Health Economics, she said the evidence is clear: sex differences persist at nearly every point along the health pathway – from exposure to a risk factor and development of the condition, to diagnosis, treatment and death.
 
‘Yet interventions rarely reflect this,’ she said.
 
‘Without sex-disaggregated cascade data, we’re flying blind, unable to detect who is falling through the cracks in prevention, diagnosis, and care.’
 
Dr Gary Deed, Chair of RACGP Specific Interests Diabetes, told newsGP the findings reflect what he sees in primary care.
 
‘Male engagement in active health assessments and preventive health initiatives is observed to be lower, mirroring what these authors have observed, making us all reflect on a more proactive positive approach to health supports aligned to cultural- and gender-based education and communication,’ he said.
 
Australian data shows men are less likely than women to seek healthcare services and to have a regular GP, despite having a shorter life expectancy and dying more often from preventable causes.
 
Dr Michael Tam, a member of the RACGP Expert Committee – Quality Care, agrees that greater access to disaggregated data for sex-based differences, as well as age groups, would be useful.
 
But as a clinician and researcher himself, he understands firsthand that there are complexities to consider – including the potential to reinforce certain stereotypes and cause harm.
 
‘This study found that men, for a number of conditions, often will have relatively poorer health outcomes and relatively slower or later engagement with health services. This is a well understood phenomenon – but well-understood phenomenon also means that it’s at risk of being an intuitive bias,’ Dr Tam told newsGP.  
 
‘Quite a few years ago, we actually did a study here in southwestern Sydney looking at older people presenting to emergency departments and their subsequent follow-up behaviours with general practice.
 
‘We actually found the opposite thing, that, in fact, older women were actually less likely to follow up with their GPs compared to older men, and that’s related to some gender beliefs about health and carer roles in the local area.
 
‘So, if we took a very broad-brush approach that only men are less likely to follow up and apply that without a critical eye, we could potentially be worsening a relatively disadvantage population. So, we do need to be careful.’
 
Considering this, Dr Tam says it is important to consider the disease itself, sex and gender, where appropriate, but also the local context, and any potential community and environmental factors.
 
In light of the findings, the study authors also recommend that public health professionals develop strategies to encourage males to participate in preventive and health care services.
 
Dr Deed encourages GPs to be mindful of strategies to recall and review male populations in their clinic datasets.
 
‘Utilise the RACGP Redbook to address known risks that affect both genders and be active in health promotion,’ he said.
 
‘Under both genders, work commitments and social inequity may play a role in health disengagement, such that working through our primary health networks to outreach into workplaces and populations at need, such as those with social disadvantage, for example offering vaccination services. 
 
‘These gender differences in access seem to also be linked to inequities in hard endpoints such as preventable morbidity and mortality, so the more we can look at discordant population characteristics the better we can provide high quality evidence-based health promotion, and service delivery to those that actually need it.
 
‘It will create a more positive framework rather than reactive, if such data sets were optimised.’ 
 
The authors conclude that there is a need for ‘more comprehensive datasets for these and other conditions so that we can monitor for sex differences and implement equitable health care policies’.
 
Dr Tam agrees with the premise that a lot of health policy doesn’t tend to have the health outcome differences between males and females in mind, and says having that data ‘could help, particularly from a public policy perspective’.
 
However, he is mindful of this data being overemphasised, bringing with it the potential to overcomplicate guidelines and treatment pathways. Rather, he says it is important for GPs to treat the individual person in front of them.
 
‘There are going to be important variations we need to make to their care and the treatment pathway,’ Dr Tam said.
 
‘Having treatment pathways and recommendations along gendered lines, where the evidence is strong that it makes a palpable difference to the population, that’s clearly a useful thing.
 
‘But if it doesn’t make a major difference, increasing the complexity of pathways and guidelines may not have a good return on investment. It also increases the likelihood of suboptimal care or just error.
 
‘So, it’s complicated.’
 
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AIDS diabetes health disparities health equity HIV hypertension men’s health