Chair Claudia Holzman presents her latest research on Epidemiology: Sex/Gender and Health at the Gender Matters interdisciplinary forum on February 26, 2016

1. Epidemiology: Sex/Gender and
Health
Claudia Holzman, Chair, Epidemiology &
Biostats
February 26, 2016

2. Epidemiology: Sex/Gender and Health
Descriptive Epidemiology: Person, Place, Time
Female Male
Jaw Necrosis (Radium Jaw) Mesothelioma
Migraine Autism
Thyroid Cancer Hepatocellular carcinoma
Osteoporosis Abdominal aortic aneurysm
Autoimmune diseases Pyloric stenosis
*Martins, Neighbors, Griffith, The Experience of Symptoms of Depression in Men vs Women
Analysis of the National Comorbidity Survey Replication. JAMA Psychiatry 2013:70 (10):
1100-1106
Sex/gender differences: Why is there a difference? Does it matter?
Depression Depression*
alternative and traditional
symptoms are combined

3. Same Disease, Variation in Symptoms by Sex/Gender:
Why is there a difference? Does it matter?
Symptom
Female Male
ACS
(n=77)
No ACS
(n=195) P Value*
ACS
(n=224)
No ACS
(n=240) P Value*
Chest pressure 66% 64% 0.682 63% 54% 0.035
Shoulder pain 44% 34% 0.112 27% 29% 0.716
Sweating 34% 32% 0.754 33% 30% 0.366
Palpitations 27% 34% 0.295 17% 23% 0.084
Chest discomfort 66% 69% 0.632 69% 64% 0.215
Upper back pain 34% 36% 0.740 13% 24% 0.004
Shortness of breath 58% 61% 0.754 41% 59% <0.0001
Arm pain 47% 32% 0.021 31% 28% 0.375
Unusual fatigue 39% 49% 0.146 32% 48% <0.001
Nausea 38% 42% 0.557 30% 30% 0.933
Lightheaded 40% 51% 0.118 34% 42% 0.088
Chest pain 68% 63% 0.442 72% 60% 0.005
Indigestion 30% 22% 0.147 18% 23% 0.177
DeVon et al. J Am Heart Assoc. 2014; Apr 3(2): e000586.

4. Same Disease, Different Prognosis by Sex/Gender
Zaitsu et al. Cancer Med. 2015 ; 4(3): 363–370
Lower hazard ratio for death in women with bladder cancer:
UC, urothelial carcinoma and non-UC, nonurothelial carcinoma.
Why is there a difference? Does it matter?

5. Sex/Gender as an Effect Modifier:
Risk of cardiovascular mortality in an elderly population during
80 months of follow-up
Variables Males Females
SNP of
adiponectin
Hazard
ratio
95 % CI p-value
Hazard
ratio
95 % CI p-value
Rs266729
C/C vs.
C/G or G/G
0.87 0.47-1.62 0.66 9.35 1.99-43.91 0.005
Alehagenet al. BMC Medical Genetics 2015:16:37
Why is there a difference? Does it matter?

6. Sex/Gender Differences:
Statistically Significant versus Clinically Significant
Why is there a difference? Does it matter?
Lower hazard ratio for death in
women with cerebral haemorrhage
Shiematsu et al. Acta Neurologica
Scandinavica 2015; 132 (1): 59-64,
Higher CRP levels in women vs. Men: medians
(25th and 75th percentiles); p<0.001
Khera et al. J American College of Cardiology
2005;46(3):464-9

7. Sex/Gender Differences: Pregnancy
Why is there a difference? Does it matter?
• Prolonged period of change in hormonal milieu
• Exposure to non-self cells/antigens
• Structural body changes that continue past pregnancy
• ‘window’ or ‘stress test’…..
Offers opportunity or early
detection of future health risks