Sex and gender aspects in diabetes mellitus: Focus on access to health care and cardiovascular outcomes

• Main Authors: Teresa Gisinger (Author), Zahra Azizi (Author), Pouria Alipour (Author), Jürgen Harreiter (Author), Valeria Raparelli (Author), Karolina Kublickiene (Author), Maria Trinidad Herrero (Author), Colleen M. Norris (Author), Khaled El Emam (Author), Louise Pilote (Author), Alexandra Kautzky-Willer (Author)
• Format: Book
• Published: Frontiers Media S.A., 2023-02-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 2296-2565; 10.3389/fpubh.2023.1090541
• Keywords: diabetes mellitus; sex differences; gender medicine; cardiovascular health; public health; Public aspects of medicine; RA1-1270
• Source: Frontiers in Public Health, Vol 11 (2023)

AimsThe aim of this study was to elucidate whether sex and gender factors influence access to health care and/or are associated with cardiovascular (CV) outcomes of individuals with diabetes mellitus (DM) across different countries.MethodsUsing data from the Canadian Community Health Survey (8.4% of respondent reporting DM) and the European Health Interview Survey (7.3% of respondents reporting DM), were analyzed. Self-reported sex and a composite measure of socio-cultural gender was constructed (range: 0-1; higher score represent participants who reported more characteristics traditionally ascribed to women). For the purposes of analyses the Gender Inequality Index (GII) was used as a country level measure of institutionalized gender.ResultsCanadian females with DM were more likely to undergo HbA1c monitoring compared to males (OR = 1.26, 95% CI: 1.01-1.58), while conversely in the European cohort females with DM were less likely to have their blood sugar measured compared to males (OR = 0.88, 95% CI: 0.79-0.99). A higher gender score in both cohorts was associated with less frequent diabetes monitoring. Additionally, independent of sex, higher gender scores were associated with higher prevalence of self-reported heart disease, stroke, and hospitalization in all countries albeit European countries with medium-high GII, conferred a higher risk of all outcomes and hospitalization rates than low GII countries.ConclusionRegardless of sex, individuals with DM who reported characteristics typically ascribed to women and those living in countries with greater gender inequity for women exhibited poorer diabetes care and greater risk of CV outcomes and hospitalizations.