Challenges to conquer from the gender perspective in medicine: The case of spondyloarthritis
Diagnostic delay is well-known in spondyloarthritis and studies have demonstrated a longer deferral in women. The aim of this study was to explore whether diagnostic delay of spondyloarthritis depends on clinical manifestations expressed by patients according to sex or whether it is related to a doc...
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| description | Diagnostic delay is well-known in spondyloarthritis and studies have demonstrated a longer deferral in women. The aim of this study was to explore whether diagnostic delay of spondyloarthritis depends on clinical manifestations expressed by patients according to sex or whether it is related to a doctor's misdiagnosis bias.
A cross-sectional study of 96 men and 54 women with spondyloarthritis was performed at Alicante University General Hospital in Spain using a semistructured interview and clinical records. Comparative sex analysis were done via Student's T and Mann-Whitney U tests for parametric and nonparametric continuous variables, chi-square and Fisher's exact tests for unpaired categorical variables, and McNemar's test for paired ones.
The median diagnostic delay in women 7.5 (11.5) years is higher than men 4 (11) years, with a difference close to statistical significance (p = 0.053). A total of 30.2% of men received a first correct diagnosis of spondyloarthritis versus 11.1% of women (p = 0.016), indicating that men have higher probability of not having a misdiagnosis of spondyloarthritis (odds ratio = 3.5; 1.3-9). Eleven different health services referred male patients to the rheumatology clinic but only six in the case of female. No sex differences were detected in patients' manifestations of back pain at onset. However, medical records registered differences (women 44.4%, men 82.1%; p < 0.001). There were differences between patients (women 57.7%, men 35.2%; p = 0.008) and medical records in peripheral signs/symptoms at onset (women 55.6%, men 17.9%; p < 0.001).
The few differences of self-reported manifestations between both sexes with spondyloarthritis as compared with their clinical records (more axial pain in men and more peripheral pain in women) suggests that the professionals' annotations reflect what they expect according to Literature, which could explain the higher misdiagnosis and diagnostic delay in women with spondyloarthritis. |
| doi_str_mv | 10.1371/journal.pone.0205751 |
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A cross-sectional study of 96 men and 54 women with spondyloarthritis was performed at Alicante University General Hospital in Spain using a semistructured interview and clinical records. Comparative sex analysis were done via Student's T and Mann-Whitney U tests for parametric and nonparametric continuous variables, chi-square and Fisher's exact tests for unpaired categorical variables, and McNemar's test for paired ones.
The median diagnostic delay in women 7.5 (11.5) years is higher than men 4 (11) years, with a difference close to statistical significance (p = 0.053). A total of 30.2% of men received a first correct diagnosis of spondyloarthritis versus 11.1% of women (p = 0.016), indicating that men have higher probability of not having a misdiagnosis of spondyloarthritis (odds ratio = 3.5; 1.3-9). Eleven different health services referred male patients to the rheumatology clinic but only six in the case of female. No sex differences were detected in patients' manifestations of back pain at onset. However, medical records registered differences (women 44.4%, men 82.1%; p < 0.001). There were differences between patients (women 57.7%, men 35.2%; p = 0.008) and medical records in peripheral signs/symptoms at onset (women 55.6%, men 17.9%; p < 0.001).
The few differences of self-reported manifestations between both sexes with spondyloarthritis as compared with their clinical records (more axial pain in men and more peripheral pain in women) suggests that the professionals' annotations reflect what they expect according to Literature, which could explain the higher misdiagnosis and diagnostic delay in women with spondyloarthritis.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0205751</identifier><identifier>PMID: 30312342</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Analysis ; Annotations ; Arthritis ; Back pain ; Bias ; Biology and Life Sciences ; Chi-Square Distribution ; Colleges & universities ; Continuity (mathematics) ; Cross-Sectional Studies ; Delay ; Delayed Diagnosis - statistics & numerical data ; Diagnosis ; Diagnostic errors ; Diagnostic Errors - statistics & numerical data ; Diagnostic systems ; Female ; Gender ; Gender aspects ; Gender differences ; Health aspects ; Hospitals ; Humans ; Inflammatory diseases ; Interviews as Topic ; Male ; Medical diagnosis ; Medical records ; Medical referrals ; Medicine and Health Sciences ; Men ; Middle Aged ; Pain ; Patients ; People and Places ; Physicians ; Public health ; Quality of life ; Rheumatic diseases ; Rheumatology ; Sex ; Sex differences ; Sex differences (Biology) ; Sex discrimination ; Sex Factors ; Spain ; Spondylarthritis - diagnosis ; Spondylarthritis - pathology ; Spondyloarthropathies ; Statistical analysis ; Statistical tests ; Studies ; Womens health</subject><ispartof>PloS one, 2018-10, Vol.13 (10), p.e0205751-e0205751</ispartof><rights>COPYRIGHT 2018 Public Library of Science</rights><rights>2018 Jovani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2018 Jovani et al 2018 Jovani et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-beaa256349f8d43ed77ede57e0c8c7a29ef127f4c56d4537a709591ec054419a3</citedby><cites>FETCH-LOGICAL-c692t-beaa256349f8d43ed77ede57e0c8c7a29ef127f4c56d4537a709591ec054419a3</cites><orcidid>0000-0001-8529-4551</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6185841/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6185841/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30312342$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jovani, Vega</creatorcontrib><creatorcontrib>Blasco-Blasco, Mar</creatorcontrib><creatorcontrib>Pascual, Eliseo</creatorcontrib><creatorcontrib>Ruiz-Cantero, M Teresa</creatorcontrib><title>Challenges to conquer from the gender perspective in medicine: The case of spondyloarthritis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Diagnostic delay is well-known in spondyloarthritis and studies have demonstrated a longer deferral in women. The aim of this study was to explore whether diagnostic delay of spondyloarthritis depends on clinical manifestations expressed by patients according to sex or whether it is related to a doctor's misdiagnosis bias.
A cross-sectional study of 96 men and 54 women with spondyloarthritis was performed at Alicante University General Hospital in Spain using a semistructured interview and clinical records. Comparative sex analysis were done via Student's T and Mann-Whitney U tests for parametric and nonparametric continuous variables, chi-square and Fisher's exact tests for unpaired categorical variables, and McNemar's test for paired ones.
The median diagnostic delay in women 7.5 (11.5) years is higher than men 4 (11) years, with a difference close to statistical significance (p = 0.053). A total of 30.2% of men received a first correct diagnosis of spondyloarthritis versus 11.1% of women (p = 0.016), indicating that men have higher probability of not having a misdiagnosis of spondyloarthritis (odds ratio = 3.5; 1.3-9). Eleven different health services referred male patients to the rheumatology clinic but only six in the case of female. No sex differences were detected in patients' manifestations of back pain at onset. However, medical records registered differences (women 44.4%, men 82.1%; p < 0.001). There were differences between patients (women 57.7%, men 35.2%; p = 0.008) and medical records in peripheral signs/symptoms at onset (women 55.6%, men 17.9%; p < 0.001).
The few differences of self-reported manifestations between both sexes with spondyloarthritis as compared with their clinical records (more axial pain in men and more peripheral pain in women) suggests that the professionals' annotations reflect what they expect according to Literature, which could explain the higher misdiagnosis and diagnostic delay in women with spondyloarthritis.</description><subject>Adult</subject><subject>Analysis</subject><subject>Annotations</subject><subject>Arthritis</subject><subject>Back pain</subject><subject>Bias</subject><subject>Biology and Life Sciences</subject><subject>Chi-Square Distribution</subject><subject>Colleges & universities</subject><subject>Continuity (mathematics)</subject><subject>Cross-Sectional Studies</subject><subject>Delay</subject><subject>Delayed Diagnosis - statistics & numerical data</subject><subject>Diagnosis</subject><subject>Diagnostic errors</subject><subject>Diagnostic Errors - statistics & numerical data</subject><subject>Diagnostic systems</subject><subject>Female</subject><subject>Gender</subject><subject>Gender aspects</subject><subject>Gender differences</subject><subject>Health aspects</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Inflammatory diseases</subject><subject>Interviews as Topic</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical records</subject><subject>Medical referrals</subject><subject>Medicine and Health Sciences</subject><subject>Men</subject><subject>Middle Aged</subject><subject>Pain</subject><subject>Patients</subject><subject>People and Places</subject><subject>Physicians</subject><subject>Public health</subject><subject>Quality of life</subject><subject>Rheumatic diseases</subject><subject>Rheumatology</subject><subject>Sex</subject><subject>Sex differences</subject><subject>Sex differences (Biology)</subject><subject>Sex discrimination</subject><subject>Sex Factors</subject><subject>Spain</subject><subject>Spondylarthritis - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jovani, Vega</au><au>Blasco-Blasco, Mar</au><au>Pascual, Eliseo</au><au>Ruiz-Cantero, M Teresa</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Challenges to conquer from the gender perspective in medicine: The case of spondyloarthritis</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2018-10-12</date><risdate>2018</risdate><volume>13</volume><issue>10</issue><spage>e0205751</spage><epage>e0205751</epage><pages>e0205751-e0205751</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Diagnostic delay is well-known in spondyloarthritis and studies have demonstrated a longer deferral in women. The aim of this study was to explore whether diagnostic delay of spondyloarthritis depends on clinical manifestations expressed by patients according to sex or whether it is related to a doctor's misdiagnosis bias.
A cross-sectional study of 96 men and 54 women with spondyloarthritis was performed at Alicante University General Hospital in Spain using a semistructured interview and clinical records. Comparative sex analysis were done via Student's T and Mann-Whitney U tests for parametric and nonparametric continuous variables, chi-square and Fisher's exact tests for unpaired categorical variables, and McNemar's test for paired ones.
The median diagnostic delay in women 7.5 (11.5) years is higher than men 4 (11) years, with a difference close to statistical significance (p = 0.053). A total of 30.2% of men received a first correct diagnosis of spondyloarthritis versus 11.1% of women (p = 0.016), indicating that men have higher probability of not having a misdiagnosis of spondyloarthritis (odds ratio = 3.5; 1.3-9). Eleven different health services referred male patients to the rheumatology clinic but only six in the case of female. No sex differences were detected in patients' manifestations of back pain at onset. However, medical records registered differences (women 44.4%, men 82.1%; p < 0.001). There were differences between patients (women 57.7%, men 35.2%; p = 0.008) and medical records in peripheral signs/symptoms at onset (women 55.6%, men 17.9%; p < 0.001).
The few differences of self-reported manifestations between both sexes with spondyloarthritis as compared with their clinical records (more axial pain in men and more peripheral pain in women) suggests that the professionals' annotations reflect what they expect according to Literature, which could explain the higher misdiagnosis and diagnostic delay in women with spondyloarthritis.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>30312342</pmid><doi>10.1371/journal.pone.0205751</doi><tpages>e0205751</tpages><orcidid>https://orcid.org/0000-0001-8529-4551</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Public Library of Science (PLoS) Journals Open Access; MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adult Analysis Annotations Arthritis Back pain Bias Biology and Life Sciences Chi-Square Distribution Colleges & universities Continuity (mathematics) Cross-Sectional Studies Delay Delayed Diagnosis - statistics & numerical data Diagnosis Diagnostic errors Diagnostic Errors - statistics & numerical data Diagnostic systems Female Gender Gender aspects Gender differences Health aspects Hospitals Humans Inflammatory diseases Interviews as Topic Male Medical diagnosis Medical records Medical referrals Medicine and Health Sciences Men Middle Aged Pain Patients People and Places Physicians Public health Quality of life Rheumatic diseases Rheumatology Sex Sex differences Sex differences (Biology) Sex discrimination Sex Factors Spain Spondylarthritis - diagnosis Spondylarthritis - pathology Spondyloarthropathies Statistical analysis Statistical tests Studies Womens health |
| title | Challenges to conquer from the gender perspective in medicine: The case of spondyloarthritis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-01T15%3A01%3A24IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Challenges%20to%20conquer%20from%20the%20gender%20perspective%20in%20medicine:%20The%20case%20of%20spondyloarthritis&rft.jtitle=PloS%20one&rft.au=Jovani,%20Vega&rft.date=2018-10-12&rft.volume=13&rft.issue=10&rft.spage=e0205751&rft.epage=e0205751&rft.pages=e0205751-e0205751&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0205751&rft_dat=%3Cgale_plos_%3EA559617800%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2118787973&rft_id=info:pmid/30312342&rft_galeid=A559617800&rft_doaj_id=oai_doaj_org_article_b3a9153061c04afe92d6dd51b0780699&rfr_iscdi=true |