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Female patients less likely to receive invasive care
Review identifies recurring sex-based differences across specialties, including lower use of intensive and guideline-compliant treatment among female patients.
To examine sex-based differences in patient management across medical specialties, particularly the likelihood of receiving invasive or intensive treatments.
Approach:
Study Selection: Investigators searched PubMed and Embase for English-language, peer-reviewed studies published from 2018 to 2023 that reported measurable differences in care received by patients of different sexes or genders.
Inclusion Criteria: Studies had to involve actual patients and primary data on clinical management. Both researchers independently screened studies against prespecified criteria and conducted quality appraisal.
Data Analysis: Of 1,112 records identified, 41 studies were included, primarily retrospective case series, covering multiple specialties.
Key Findings:
87% of retrospective case series reported a statistically significant treatment difference between male and female patients.
Lower use of invasive or intensive management among female patients was the most consistent pattern.
In cardiovascular studies, female patients were more likely to receive conservative medical management rather than invasive procedures.
Male patients with Parkinson disease were more likely to be referred for deep brain stimulation.
Female patients requiring dialysis spent longer with central venous catheters and were less likely to transition to permanent access.
Interpretation:
Differences in treatment could reflect clinical considerations, patient preferences, or systemic inequities.
Limitations:
Few studies referred to sex-specific clinical guidelines.
Retrospective studies predominated, limiting the ability to assess treatment according to gender.
Incomplete adjustment for confounders such as ethnicity and socioeconomic status.
Concentration of evidence in the US may limit generalizability.
Heterogeneity across included literature complicated synthesis and interpretation.
The review documented persistent sex-based differences in treatment but could not determine whether these patterns reflected appropriate clinical variation or systemic inequities.
