Health Sciences Department, Université du Québec À Rimouski Campus de Lévis, Lévis, Québec, G6V 0A6, Canada.
Population Health and Optimal Health Practices Axis, Québec, Québec, Canada.
BMC Med. 2024 Oct 29;22(1):498. doi: 10.1186/s12916-024-03706-3.
Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality worldwide. Examining gender (socio-cultural) in addition to sex (biological) is required to untangle socio-cultural characteristics contributing to inequities within or between sexes. This study aimed to develop a gender measure including four gender dimensions and examine the association between this gender measure and CVD incidence, across sexes.
A cohort of 9188 white-collar workers (49.9% females) in the Quebec region was recruited in 1991-1993 and follow-up was carried out 28 years later for CVD incidence. Data collection involved a self-administered questionnaire and extraction of medical-administrative CVD incident cases. Cox proportional models allowed calculations of hazard ratios (HR) and 95% confidence intervals (CI), stratified by sex.
Sex and gender were partly independent, as discordances were observed in the distribution of the gender score across sexes. Among males, being in the third tertile of the gender score (indicating a higher level of characteristics traditionally ascribed to women) was associated with a 50% CVD risk increase compared to those in the first tertile (HR = 1.50; 95% CI: 1.24 to 1.82). This association persisted after adjustment for several CVD risk factors (HR = 1.42; 95% CI: 1.16 to 1.73). Conversely, no statistically significant association between the third tertile of the gender score and CVD incidence was observed in females (HR = 0.79, 95% CI: 0.60-1.05).
The findings suggested that males within the third tertile of the gender score were more likely to develop CVD, while females with those characteristics did not exhibit an increased risk. These findings underline the necessity for clinical and population health research to integrate both sex and gender measures, to further evaluate disparities in cardiovascular health and enhance the inclusivity of prevention strategies.
心血管疾病（CVD）是全球发病率和死亡率的主要原因。除了生物性别（sex），还需要检查社会文化性别（gender），以厘清导致男女之间不平等的社会文化特征。本研究旨在开发一个包含四个性别维度的性别衡量标准，并检验该性别衡量标准与 CVD 发病率之间的关系，涉及不同性别。
1991 年至 1993 年期间，在魁北克地区招募了 9188 名白领工人（女性占 49.9%）作为队列，并在 28 年后对 CVD 发病率进行了随访。数据收集包括一份自我管理问卷和提取医疗管理 CVD 发病病例。Cox 比例风险模型允许计算风险比（HR）和 95%置信区间（CI），按性别分层。
性别和社会性别部分独立，因为在性别评分的分布上存在性别差异。在男性中，与处于第一 tertile 的男性相比，处于性别评分第三 tertile（表示具有更高的传统上归因于女性的特征）的男性 CVD 风险增加了 50%（HR=1.50；95%CI：1.24 至 1.82）。这种关联在调整了几个 CVD 风险因素后仍然存在（HR=1.42；95%CI：1.16 至 1.73）。相反，在女性中，性别评分第三 tertile 与 CVD 发病率之间没有统计学上的显著关联（HR=0.79，95%CI：0.60-1.05）。
研究结果表明，在性别评分第三 tertile 的男性更有可能患上 CVD，而具有这些特征的女性则没有增加患病风险。这些发现强调了临床和人群健康研究必须整合性别和社会性别衡量标准，以进一步评估心血管健康方面的差异，并提高预防策略的包容性。
