Gastroenterology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
Health Psychology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
Inflamm Bowel Dis. 2023 Dec 5;29(12):1886-1894. doi: 10.1093/ibd/izad001.
Female gender could be a cause of diagnostic delay in inflammatory bowel disease (IBD). The aim of this study was to investigate the diagnostic delay in women vs men and potential causes.
This multicenter cohort study included 190 patients with recent diagnosis of IBD (disease duration <7 months). Reconstruction of the clinical presentation and diagnostic process was carried out in conjunction with the semistructured patient interview, review, and electronic medical records.
The median time from symptom onset to IBD diagnosis was longer in women than in men: 12.6 (interquartile range, 3.7-31) vs 4.5 (2.2-9.8) months for Crohn's disease (CD; P = .008) and 6.1 (3-11.2) vs 2.7 (1.5-5.6) months for ulcerative colitis (UC; P = .008). Sex was an independent variable related to the time to IBD diagnosis in Cox regression analysis. The clinical presentation of IBD was similar in both sexes. Women had a higher percentage of misdiagnosis than men (CD, odds ratio [OR], 3.9; 95% confidence [CI], 1.5-9.9; UC, OR 3.0; 95% CI, 1.2-7.4). Gender inequities in misdiagnosis were found at all levels of the health system (emergency department, OR 2.4; 95% CI, 1.1-5.1; primary care, OR 2.5; 95% CI, 1.3-4.7; gastroenterology secondary care, OR 3.2; 95% CI, 1.2-8.4; and hospital admission, OR 4.3; 95% CI, 1.1-16.9).
There is a longer diagnostic delay in women than in men for both CD and UC due to a drawn-out evaluation of women, with a higher number of misdiagnoses at all levels of the health care system.
女性可能是炎症性肠病（IBD）诊断延迟的一个原因。本研究的目的是调查女性与男性之间的诊断延迟及其潜在原因。
这是一项多中心队列研究，纳入了 190 例近期诊断为 IBD（病程<7 个月）的患者。通过对患者进行半结构化访谈、回顾和电子病历，对临床表现和诊断过程进行重建。
与男性相比，女性从症状出现到 IBD 诊断的中位时间更长：克罗恩病（CD）为 12.6（四分位间距，3.7-31）个月与 4.5（2.2-9.8）个月（P=0.008），溃疡性结肠炎（UC）为 6.1（3-11.2）个月与 2.7（1.5-5.6）个月（P=0.008）。在 Cox 回归分析中，性别是与 IBD 诊断时间相关的独立变量。两种性别之间的 IBD 临床表现相似。女性的误诊率高于男性（CD，比值比[OR]，3.9；95%置信区间[CI]，1.5-9.9；UC，OR 3.0；95% CI，1.2-7.4）。在卫生系统的各个层面都发现了性别导致的误诊不平等（急诊室，OR 2.4；95% CI，1.1-5.1；初级保健，OR 2.5；95% CI，1.3-4.7；二级保健胃肠病学，OR 3.2；95% CI，1.2-8.4；以及住院治疗，OR 4.3；95% CI，1.1-16.9）。
由于女性的评估时间较长，CD 和 UC 女性的诊断延迟均长于男性，且在卫生保健系统的各个层面上误诊率更高。
