A global analysis identified significant sex-based differences in disease risk, care access, and mortality for hypertension, diabetes, and HIV.
The investigators examined data from over 200 countries using international datasets on risk factors, disease prevalence, diagnosis, treatment, and mortality.
For hypertension, sex-disaggregated data on risk factors, prevalence, and mortality were available from 204 countries, with care cascade data from 200 countries. Smoking was more common among males in 176 countries, while obesity was more prevalent among females in 130 countries. Overweight rates were higher in males among 18 countries and among females in 58. High sodium intake showed sex differences in select countries but was generally similar overall. Hypertension prevalence was largely similar between sexes, though males had higher rates in 8 countries, and females had higher rates only in India among older adults. Mortality from hypertension was higher among males in 107 countries and higher among females only in the United Arab Emirates at older ages.
The hypertension care cascade showed limited sex differences. In some countries, females were more likely to receive diagnosis, treatment, and achieve control. Diagnosis rates were higher for females in 8 countries, treatment rates in 4 countries, and control rates in 3 countries, including Peru, Iran, and Uzbekistan. No countries showed higher rates for males in these care stages.
For diabetes, data were more limited. Risk factor, prevalence, and mortality data were collected from 204 countries, but care cascade data were available for only 39 countries. Males had higher smoking rates in 176 countries, while obesity was more prevalent in females in 130 countries. Diabetes prevalence was higher among males in 61 countries and among females in 10 countries. Mortality from diabetes was higher among males in 100 countries and among females in 9 countries.
Diabetes care cascade data showed almost no sex differences. Only in Cape Verde did females have higher diagnosis and treatment rates for individuals aged 45 and older. No other significant differences were observed in treatment or control between sexes.
For HIV, the investigators assessed risk exposure, care access, and mortality across 76 countries for the care cascade. Drug use prevalence was higher among males in 139 countries. Unsafe sex exposure was higher among females in 113 countries. HIV prevalence was higher among males in 114 countries and among females in 28 countries. AIDS-related mortality was higher among males in 131 countries and among females in 25 countries.
In the HIV care cascade, females had higher diagnosis rates in 9 countries, higher treatment rates in 20 countries, and higher disease control in 21 countries. Males had higher treatment and control rates only in Lebanon.
The study applied strict statistical thresholds, comparing 95% confidence intervals between sexes with a significance level of 0.25%. Researchers noted that while risk exposures and mortality differed widely by sex, fewer differences were seen in care access and treatment outcomes. They emphasized the need for expanded global sex- and age-disaggregated data to better understand health disparities.
Full disclosures can be found in the study.
Source: PLOS Medicine
