Feraldi Alessandro, Zarulli Virginia, Buse Kent, Hawkes Sarah, Chang Angela Y
Department of Methods and Model for Economics, Territory, and Finance, Sapienza University of Rome, Rome, Italy.
Department of Statistical Sciences, University of Padova, Padova, Italy.
PLoS Med. 2025 May 1;22(5):e1004592. doi: 10.1371/journal.pmed.1004592. eCollection 2025 May.
Health data disaggregated by sex is vital for identifying the distribution of illness, and assessing risk exposures, service access, and utilization. Disaggregating data along a health pathway, i.e., the measurable continuum from risk factor exposure to final health outcome (death), and including disease prevalence and a three-step care cascade (diagnosis, treatment, and control), has the potential to provide a holistic and systematic source of information on sex- and gender-based health inequities and identify opportunities for more tailored interventions to reduce those inequities.
We collected sex- and age-disaggregated data along the health pathway. We searched for papers using global datasets on the sex-disaggregated care cascade for eight major conditions and identified cascade data for only three conditions: hypertension, diabetes, and HIV and AIDS. For each condition, we collected risk factor prevalence, disease prevalence, cascade progression, and death rates. We assessed the sex difference for all steps along the pathway and interpreted inequities through a lens of gender analysis. Sex-disaggregated data on risk factors, disease prevalence, and mortality were found for all three conditions across 204 countries. Sex-disaggregated care cascades for hypertension, diabetes, and HIV and AIDS were found only for 200, 39, and 76 countries, respectively. Significant sex differences were found in each step along the pathways. In many countries, males exhibited higher disease prevalence and death rates than females, while in some countries, they also reported lower rates of healthcare seeking, diagnosis, and treatment adherence. Smoking prevalence was higher among males in most countries, whereas prevalence of obesity and unsafe sex were higher in females in most countries.
Findings support the increasing need to develop strategies that encourage greater male participation in preventive and healthcare service and underscore the importance of sex-disaggregated data in understanding health inequities and guiding gender-responsive interventions at different points along the pathway. Despite limitations in data availability and completeness, this study elucidates the need for more comprehensive and harmonized datasets for these and other conditions to monitor sex differences and implement sex-/gender-responsive interventions along the health pathway.
按性别分类的健康数据对于识别疾病分布、评估风险暴露、服务可及性和利用情况至关重要。沿着健康路径（即从风险因素暴露到最终健康结果（死亡）的可测量连续体）对数据进行分类，并纳入疾病患病率和三步治疗级联（诊断、治疗和控制），有可能提供关于基于性别的健康不平等的全面而系统的信息来源，并确定更具针对性的干预措施以减少这些不平等的机会。
我们沿着健康路径收集了按性别和年龄分类的数据。我们使用关于八种主要疾病的按性别分类的治疗级联全球数据集搜索论文，仅确定了三种疾病的级联数据：高血压、糖尿病以及艾滋病毒和艾滋病。对于每种疾病，我们收集了风险因素患病率、疾病患病率、级联进展情况和死亡率。我们评估了路径上所有步骤的性别差异，并通过性别分析的视角来解读不平等现象。在204个国家中发现了所有三种疾病的按性别分类的风险因素、疾病患病率和死亡率数据。高血压、糖尿病以及艾滋病毒和艾滋病的按性别分类的治疗级联分别仅在200个、39个和76个国家中发现。在路径的每个步骤中都发现了显著的性别差异。在许多国家，男性的疾病患病率和死亡率高于女性，而在一些国家，男性寻求医疗服务、诊断和治疗依从性的比率也较低。在大多数国家，男性的吸烟患病率较高，而在大多数国家，女性的肥胖和不安全性行为患病率较高。
研究结果支持越来越需要制定鼓励男性更多参与预防和医疗服务的策略，并强调按性别分类的数据在理解健康不平等以及指导路径上不同点的性别针对性干预方面的重要性。尽管数据可用性和完整性存在局限性，但本研究阐明了需要更全面和统一的数据集来监测这些疾病及其他疾病的性别差异，并在健康路径上实施性别针对性干预措施。
