Is it really real? Facts & figures of the Gender Health Gap
In the first blog post of Project Fifty One (👏) I’m going to outline the main contributors to the Gender Health Gap that will be explored in more depth throughout the Project’s mission.
I would like to preface this article by saying the biases found in our healthcare system are a result of many many years of systemic prejudice and do not arise from the individual opinions of our fantastic healthcare workers.
For your ease, I have broken down the Gender Health Gap into 3 main umbrella areas:
Diagnostic and treatment bias
2. Research & education bias
3. Funding bias
Diagnostic and treatment bias
The diagnostic and treatment bias refers to the higher rates of misdiagnosis and under-diagnosis of health-related conditions in women compared to men, and the unequal level of treatment that also differs based on gender.
Initial experience with doctors
Symptoms experienced by women are less likely to be taken seriously
34% of women feel as though they are not taken seriously by medical professionals
84% of women feel this way when the symptoms are female health-specific
Symptoms that severely affect a woman’s life are commonly dismissed as ‘normal’
Diagnosis waiting times
Women are diagnosed at a later age than men for the same disease
47% of women receive a pain diagnosis in 11 months compared to 67% of men in a study conducted by Nurofen
On average, it takes 8 years for women to receive a diagnosis of endometriosis, with 40% of women needing 10 or more GP appointments before being referred to a specialist. This is a condition that effects over 1.5 million women in the UK.
Under/misdiagnosis
Heart attack
Women may experience other symptoms as well as chest pain, such as pain in the upper body which leads to underdiagnosis
Women are 50% less likely to receive the correct diagnosis after a heart attack
Endometriosis
1/10 women suffer in the UK (1.5 million women) however a diagnosis on average takes 8 years and 10 months
Endometriosis is a condition where tissue similar to the uterus lining grows outside of the uterus. It is excrutiatingly painful and can impact a woman’s chances of getting pregnant.
Autism
Women are better at ‘masking’ (a strategy used by autistic people to appear non-autistic) which hides the symptoms of Autism, leading to a male-to-female diagnosis ratio of 3:1
ADHD
Like Autism, women present different symptoms than men with ADHD
Autoimmune diseases
13% of the female population suffer from autoimmune diseases compared to 7% of the male population. However, likely due to insufficient funding, there is a lack of research focused on these complicated conditions
Chronic pain
Women are more likely to experience chronic pain than men but are less likely to be taken seriously by medical professionals, often finding their symptoms attributed to hormonal fluctuations or psychological factors.
What’s the risk?
Women who have been misdiagnosed are likely to be given incorrect treatment which may be harmful.
Underdiagnosis of conditions can lead to serious illness being missed which results in medical negligence.
Treatment
Heart attack
A study by the University of Leeds found that women were twice as likely to die in the 30 days following a heart attack than men. This was thought to be due to women not receiving accurate guideline care.
Women who had suffered a certain sort of heart attack (known as an NSTEMI) were found to be 34% less likely to receive a coronary angiography (which creates a video showing parts of the heart that may have narrowed or blocked)
Women were 2.7% less likely to be prescribed statins (87.6% of women compared to 89.6% of men) and 7.4% less likely to be prescribed beta blockers (62.6% of women compared to 67.6% of men) when leaving the hospital, drugs which help to lower their risk of having a second heart attack.
Dementia
A study released by UCL found that women with dementia have ‘fewer visits to the GP, receive less health monitoring and take more potentially harmful medicine than men with dementia’.
Pain
When females present with symptoms of pain, they are less likely to be taken seriously or given the correct pain medication, the most common medication prescribed is sedatives and antidepressants, as opposed to men who are more likely to receive painkillers.
Research and education bias
Research in medicine involves many different parts. There is preclinical research where drugs are tested on cells and animal models and clinical research which involves people. For drugs to be released to the population, they must go through rigorous testing to ensure they are safe to be used by everybody who needs them. So why is there a research bias?
Preclinical research
Drugs are initially tested on cell lines, groups of cells that divide indefinitely, to show their effect. Now, every cell has a sex (they have either a XX or XY chromosome) and responds differently to a drug due to said sex because of different metabolic pathways. Here lies the issue.
Studies have shown that 71% of trials studied male cells only
If male and female cells are both used, there is also a lack of analysis on how the different cells respond. Often, the sex of the cell used is not disclosed.
It’s not only male cells that are used as default. There is also a male bias in the rodents used in Neuroscience, pain, and surgical methods to name a few.
79% of studies released in the Pain journal used male rodents
They have historically been preferred due to the lack of an oestrus cycle which repeats every 4 days for the sake of minimising variability. Interestingly, female mice show no more variation of measureable behaviours than male mice throughout their cycle, rendering this reasoning unimportant.
So… what’s the big deal? Well, there is a large data gap for the response of female cells and animal models to certain drugs. This can have serious consequences as side effects that will affect women more than men remain unknown. For example, 8 out of 10 drugs released in the US between 1990 and 2000 were recalled due to adverse side effects in women. Whilst this was a while ago now, it highlights the importance of sex-sensitive research.
Clinical research
Clinical research uses people to determine the efficacy of drugs and other treatments. Throughout history, men have been the preferred test subject due to the lack of menstrual cycle and delicate womb. After the thalidomide tragedies (where babies were born with severe defects due to thalidomide use during pregnancy to treat pregnancy symptoms), the FDA in America recommended that all women who were post-puberty or pre-menopausal should be excluded from clinical trials. Unfortunately, this led to every woman (regardless of their/ their parent’s fertility, sexual orientation, or sexual activity) being excluded from clinical trials, leading to a large data gap in how some drugs affect women.
Funding bias
A funding bias refers to the preferential allocation of money to one area of research over another. Less than 2.5% of the UK’s publicly funded research is dedicated to women’s reproductive health.
FemTech is a hot topic at the moment. This refers to technology and services designed for female health, improving care delivery, and diagnosis, and giving light to stigmatised areas. However, male founders of FemTech companies raise 8.3x more than female founders.