Sex differences in the trajectories to diagnosis of patients presenting with common somatic symptoms in primary care..., 2021, Ballering et al

Full title: Sex differences in the trajectories to diagnosis of patients presenting with common somatic symptoms in primary care: an observational cohort study

Highlights

• Sex differences exist in diagnostic trajectories of patients with somatic symptoms.
• Men with somatic symptoms receive more primary care diagnostic interventions than women.
• Fewer diagnostic interventions mediate fewer disease diagnoses in women.
• FPs should be aware of these sex inequalities to provide equal care for all patients.

Abstract

Objective
Little insight exists into sex differences in diagnostic trajectories for common somatic symptoms. This study aims to quantify sex differences in the provided primary care diagnostic interventions for common somatic symptoms, as well as the consequences hereof for final diagnoses.

Methods
In this observational cohort study, we used real-world clinical data from the Dutch Family Medicine Network (N = 34,268 episodes of care related to common somatic symptoms; 61,4% female). The association between patients' sex on the one hand, and diagnostic interventions and disease diagnoses on the other hand, were assessed using multilevel multiple logistic regression analyses. Structural equation modelling was used to estimate a mediation model with multiple parallel mediators to assess whether the fewer disease diagnoses given to female patients were mediated by the fewer diagnostic interventions female patients receive, compared to male patients.

Results
Women received fewer physical examinations (OR = 0.84, 95%CI = 0.79–0.89), diagnostic imaging (OR = 0.92, 95%CI = 0.84–0.99) and specialist referrals (OR = 0.85, 95%CI = 0.79–0.91) than men, but more laboratory diagnostics (OR = 1.27, 95%CI = 1.19–1.35). Women received disease diagnoses less often than men for their common somatic symptoms (OR = 0.94, 95%CI = 0.89–0.98). Mediation analysis showed that the fewer disease diagnosis in female patients were mediated by the fewer diagnostic interventions conducted in women compared to men.

Conclusion
This study shows that sex inequalities are present in primary care diagnostic trajectories of patients with common somatic symptoms and that these lead to unequal health outcomes in terms of diagnoses between women and men. FPs have to be aware of these inequalities to ensure equal high-quality care for all patients.

Open access, https://www.sciencedirect.com/science/article/pii/S0022399921002348

 

Although modes of employment for males and females have become increasingly similar type of job still provides a major 'effect modifer' (aka confound !).

Employment related health impairment is more common in both males and females in less wealthy socioeconomic groups than wealthier groups but there is also a greater degree of variation between the type of work carried out by males and females in those less wealthy groups so there is a potential confound not only across class/gender but within class as well. Someone who operates a drill 8 hours a day and seeks medical attention for tingling fingers has a very high likelihood of suffering a recognised condition such as hand-arm vibration syndrome than is someone who works in an office.

Males are more likely to operate machinery, those falling into less wealthy socioeconomic groups are also more likely to operate machinery - so working class men are more likely to have their tingling fingers ascribed to hand-arm vibration syndrome. This might not alter the authors' conclusions about discrimination but it is a good example of how not fully understanding the population under examination can potentially skew findings.

 

Not sure why this is needed as it's been known for a long time, especially as it's so superficial. Problem is no one ever does anything, so obviously looking again shows the same issues. Largely because sexism is baked in the culture and practice of medicine. The only way to fix this issue is to remove the sexism throughout the system, but that's unacceptable because it means acknowledging medicine's fault in actively perpetuating this.

I was thinking the other day. For about a decade, ME was moved to the women's institute at the NIH. Where no research on the obvious role of women's reproductive cycles on symptoms was done. It's blatantly obvious to me, all I need to do is read what patients are reporting, and the significant worsening of symptoms near ovulation is as obvious as it gets.

And yet when a disease predominantly, though far from exclusively, affecting women was relegated, as a punishment, to the women's institute, which is non-funding and tiny, they did absolutely no research on the most obvious things they could research.

But instead we get this, telling us water is wet. Feels very similar to all those reports of climate disaster, followed by no one doing much about it. That oughta solve it. Until then, drill, baby drill, those profits can't stop won't stop.

 

Here is a blatant example of inequalities of access to diagnostics in the ME/ FM context. Word for word,it is said in clinical guidelines for doctors, for ME and FM: a 50 year old man should receive cardiac testing for chest pain and while it is not necessary for women. The thought behind that is apparently men in their fifties and on are more at risk for heart attack when apparently women are supposedly at lesser risk, and then women complaining of chest pain typically have costochondritis, or are somatizing. I discussed this policy with a cardiologist and she pretty much flipped.