Objective:

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.
• Limited evidence examining intersecting characteristics.

Conclusion:

The review documented persistent sex-based differences in treatment but could not determine whether these patterns reflected appropriate clinical variation or systemic inequities.

Sources:

• PLOS One