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 Researchers don't know whether the later diagnoses are due to
genetics, the environment, possible biases in the healthcare system
- or some combination of reasons.
The study of health data from 6.9 million Danish people found that
across hundreds of diseases, women on average were diagnosed when
they were about four years older than the age at which the
conditions were recognized in men.
"We're not just looking at one disease here, we're looking at all
diseases and we are looking at an entire population, from cradle to
grave," lead author Søren Brunak from the University of Copenhagen
told Reuters Health by phone.
On average, women received cancer diagnoses 2.5 years after men.
They received diagnoses for metabolic diseases like diabetes 4.5
years later.
"(This) actually surprised us quite a lot," Brunak said. "Men
generally have a tendency to get to the doctor later... So
presumably the difference in onset is even larger."
Brunak and his team considered incidence rates of diseases in the 18
broad categories of the ICD-10 diagnosis system managed by the World
Health Organization.
The study wasn't designed to explain the causes of the differences.
Another limitation is that researchers only looked at diagnoses made
in hospitalized patients.
Dr. Noel Bairey Merz, director of the Barbra Streisand Women's Heart
Center at the Cedars-Sinai Smidt Heart Institute, who was not
involved in the study, pointed out to Reuters Health that the study
therefore lacks information on age at diagnosis for people who
didn't require hospitalization.
"On the other hand," she said, "being hospitalized is a sign of a
serious illness, so (that) adds significance to the diagnosis and
supports that disease onset may be later in women."
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Brunak's study, published in Nature Communications, showed that the
bone-thinning disease osteoporosis was a notable exception to the
trend. Here, women were typically diagnosed before they suffered a
fracture, while the opposite was true for men.
"I am fascinated by this study, which generally confirms all that I
present in my Stanford course on Sex and Gender in Human Physiology
and Disease," said Marcia Stefanick, Director of Stanford
University's Women's Health and Sex Differences in Medicine Center.
"When men get diseases that most healthcare professionals consider
'women's diseases,' they are diagnosed at later, more serious
stages, and vice versa," Stefanick, who was not involved with the
study, told Reuters Health in an email.
"For example, women are diagnosed later for heart disease, not only
because it is still largely considered a 'man's disease', but also
because our diagnostic tests are male-biased, in terms in terms of
'typical' being the male presentation. All medical schools and
healthcare training should emphasize both biological sex differences
and gender biases so healthcare professionals are aware of
unconscious biases."
Bairey Merz agreed, adding that more research is needed to determine
if the gender differences in age at diagnosis are "real" and whether
they are linked to gender bias, actual biological sex differences or
random error associations.
SOURCE: https://go.nature.com/2OosMJF Nature Communications, online
February 8, 2019.
(Reporting by Tamara Mathias in Bengaluru)
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