Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada; Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada; Arthritis Research Centre of Canada, Vancouver, Canada.
School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, British Columbia, Canada.
Value Health. 2023 Sep;26(9):1413-1424. doi: 10.1016/j.jval.2023.04.002. Epub 2023 Apr 15.
Medication taking is a complex multidimensional behavior that may be impeded by a range of biological and psychosocial factors, including sex and gender. We aimed to synthesize how sex and gender have been reported and analyzed in pharmacoepidemiologic studies of medication.
We searched for English-language peer-reviewed articles of observational studies (eg, cross-sectional, cohort, and case-control) that examined medication adherence among adults and included sex or gender in their reporting.
We included 937 studies among 530 537 287 participants published between the year 1979 and 2021. Most studies were cross-sectional (47%), lasted ≤ 1 year (35%), examined self-reported adherence (53%), did not assess specific adherence problem(s) (40%), and included medications for cardiovascular conditions (24%) or systemic infections (24%). A quarter of studies (25%) used sex and gender interchangeably, more than one third of studies (36%) that reported gender data likely collected data on sex, and < 1% of studies described sex and gender as distinct variables. Studies of cisgender participants more often reported that females/women experienced greater adherence problems often than males/men (31% vs 20%), particularly discontinuation and cost-related nonadherence. Only 21 studies (2%) reported on transgender individuals, and these predominantly examined antiretroviral medications for HIV.
Our review revealed substantial conflation of sex and gender in studies of medication adherence and a paucity of research among transgender individuals. Moreover, our synthesis showed sex/gender disparities in medication taking with studies reporting greater medication adherence problems among cisgender women and transgender participants than cisgender men.
用药是一种复杂的多维行为，可能会受到一系列生物和社会心理因素的影响，包括性别。我们旨在综合分析性别在药物流行病学研究中如何被报告和分析。
我们搜索了 1979 年至 2021 年间发表的观察性研究（如横断面、队列和病例对照）的英文同行评审文章，这些研究检查了成年人的药物依从性，并在报告中包括了性别。
我们纳入了 937 项研究，涉及 530 537 287 名参与者，发表时间在 1979 年至 2021 年之间。大多数研究为横断面研究（47%），持续时间≤1 年（35%），检查了自我报告的依从性（53%），未评估特定的依从性问题（40%），并包括心血管疾病（24%）或全身感染（24%）的药物。四分之一的研究（25%）混用了性别，超过三分之一（36%）报告性别数据的研究可能收集了性别的数据，不到 1%的研究将性别和性别描述为不同的变量。研究顺性别参与者的研究更经常报告女性经历更大的依从性问题，往往比男性更常见（31%比 20%），尤其是停药和与费用相关的不依从。只有 21 项研究（2%）报告了跨性别者，这些研究主要检查了 HIV 用的抗逆转录病毒药物。
我们的综述显示，在药物依从性研究中，性别存在大量混淆，跨性别者的研究很少。此外，我们的综合分析表明，在药物使用方面存在性别差异，报告称顺性别女性和跨性别参与者比顺性别男性的药物依从性问题更大。
