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The Health Gap: why focus on women's health when men get sick too?

One of the reasons Women’s College Hospital launched the Health Gap campaign was to start a conversation about important issues in women’s health, so we’re very excited about the feedback we’ve received and the opportunity to talk about what we’re hearing.

Several people asked why Women’s College focuses on women’s health when men get sick, too – often with the same conditions.

Focusing on women’s health does not mean ignoring men’s health, nor does it mean taking resources away from men’s health. It’s about acknowledging that women and men are different. While that may seem obvious, past medical research often worked on the assumption that, with the exceptions of breast cancer, obstetrics and gynecology, women are just like men. It was not unusual for medical studies and drug trials to exclude women, even though women were affected by the condition being studied or would be prescribed the drugs that were being tested.

One example is the American Heart Association’s 2007 guidelines for preventing cardiovascular disease in women. These guidelines were, of course, based on high quality research including 156 randomized clinical trials. However, in 2010 Duke University researchers looked more closely at the research used to establish the guidelines. The Duke researchers found that less than one-third of all of the study participants in all of the included trials were women, even though women account for about half of heart disease patients. A few of the trials – about 13 per cent – didn’t include any women. Of the trials that included both men and women, only 31 per cent provided results that were specific to women and men. 

That means that much of the data used to develop guidelines for women were not specific to women. The review authors concluded that in order to provide evidence-based recommendations specifically for women, more effort is needed to ensure that women are adequately represented in clinical trials.

That’s a health gap.

Heart health was one of the topics that drew specific questions about our campaign information. Several people expressed surprise or doubt that heart disease kills more women than men in Canada. A headline-making study from members of the Canadian Cardiovascular Outcomes Research Team was published in CMAJ in 2010. While heart disease had traditionally killed more men, the researchers showed how that changed in 2000, when women caught up to men in deaths from heart disease. By 2004, 50.4 per cent of heart disease deaths occurred in women. 

The fact that many people expressed doubt when they first read our Health Gap statistics on heart health tells us that the conversations started by our campaign are ones we need to be having.

Research that uses a gender lens benefits everyone. If something is affecting women and men differently, that’s vital information. For example, Statistics Canada data indicate that diabetes rates increased by nine per cent in Canada in 2014. That’s important for researchers to know. However, without analysis by sex, researchers would not know that those diabetes rates actually increased by 13 per cent in women and 6 per cent in men, which could be important information for targeting diabetes programs, policies and future research.

An excellent example is research by Dr. Paula Rochon, vice-president of research at Women’s College Hospital, on antipsychotic drug treatment in older adults with dementia. Her research found that 8.8 per cent of these patients were either hospitalized or died within 30 days of starting antipsychotic treatment. However, by looking at the results by gender, Dr. Rochon made the crucial discovery that these poor outcomes were almost 50 per cent higher in men compared to women.

Important findings like these cannot be made without developing research studies that analyze the results for both men and women. That means not only including a representative number of women and men in studies, but also examining the study results by sex. Often, that has not been the case. That means some health research findings – and treatment recommendations – may not be as accurate as they could be, for women or for men.

That’s a health gap. That’s why Women’s College Hospital, Women’s College Research Institute and Women’s College Hospital Foundation are working to close those gaps.

 

References:

Melloni C, Berger JS, Wang TY, Gunes F, Stebbins A, Pieper KS, et al., Representation of women in randomized clinical trials of cardiovascular disease prevention Circ Cardiovasc Qual Outcomes. 2010 Mar;3(2): 135-42.  Doi: 10.1161/CIRCOUTCOMES.110.868307 http://circoutcomes.ahajournals.org/content/3/2/135.long

Rochon PA, Gruneir A, Gill SS, Wu W, Fischer HD, Bronskill SE, Normand SL, Austin PC, Seitz DP, Bell CM, Fu L, Lipscombe L, Anderson GM, Gurwitz JH. Older men with dementia are at greater risk than women of serious events after initiating antipsychotic therapy. J Am Geriatr Soc 61:55–61, 2013. doi: 10.1111/jgs.12061.  http://www.ncbi.nlm.nih.gov/pubmed/23301833

Statistics Canada. Health Fact Sheets: Diabetes, 2014http://www.statcan.gc.ca/pub/82-625-x/2015001/article/14180-eng.htm

Tu, J.V., L. Nardi, J. Fang, J. Liu, L. Khalid and H. Johansen for the Canadian Cardiovascular Outcomes Research Team. National Trends in Rates of Death and Hospital Admissions Related to Acute Myocardial Infarction, Heart Failure and Stroke, 1994–2004. Canadian Medical Association Journal June 23, 2009 vol. 180 no. 13 doi: 10.1503/cmaj.081197 http://www.cmaj.ca/content/180/13/E118.full

 

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