Sex Differences in the Recognition, Monitoring, and Management of CKD in Health Care: An Observational Cohort Study
Abstract
Significance Statement In this study of people with probable CKD accessing health care, we observed profound sex differences in detection, recognition, and monitoring that persisted over time: women were less likely to receive a CKD diagnosis, to visit a nephrologist, to have their creatinine and albuminuria measured, or to receive guideline-recommended therapies. Differences in comorbidity did not explain these discrepancies and were similar among high-risk groups, among patients with evidence-based indications for medications, and among patients with confirmed CKD at retesting. Efforts to improve and ensure equitable health care between the sexes could have important implications for justice and could reduce the burden of CKD. Visual Abstract Introduction Reported sex differences in the etiology, population prevalence, progression rates, and health outcomes of people with CKD may be explained by differences in health care. Methods We evaluated sex as the variable of interest in a health care–based study of adults (n=227,847) with at least one outpatient eGFR<60 ml/min per 1.73 m2 measurement denoting probable CKD in Stockholm from 2009 to 2017. We calculated the odds ratios for diagnosis of CKD and provision of RASi and statins at inclusion, and hazard ratios for CKD diagnosis, visiting a nephrologist, or monitoring creatinine and albuminuria during follow-up. Results We identified 227,847 subjects, of whom 126,289 were women (55%). At inclusion, women had lower odds of…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 227,847 participants or records.
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