gms | German Medical Science

Background and state of research: Women and men differ in their disease manifestations and outcomes due to their biological and physiological preconditions. In addition, gender, as a social determinant of health, plays a central role regarding perception of disease, help-seeking and coping strategies. To understand the effect models of holistic treatment such as the XXX Breathlessness Service, the interaction of sex and gender must be examined.

Research questions and aim: How does the analysis of sex-related behavior contribute to a more differentiated understanding of the effect model of the MBS compared to a sex analysis?

Methods: With data of an RCT on a breathlessness support service, a secondary data analysis was conducted on pre-post intervention data, irrespective of the patient’s group allocation. Inspired by Pelletier et al. (2015), 25 dichotomized variables were included in a primary and the resulting factor scores in a second-order principal component analysis (PCA). Those secondary factor scores with significant power to predict female sex were identified with a logistic regression model that included biological sex as the dependent variable. To evaluate the increment validity of the composite sex-related behavior index (SRBI) compared to biological sex, linear regression models were calculated. The explanatory power of the SRBI was tested with the change score of the CRQ Mastery domain as the dependent variable.

Results: Data were assessed for n = 183 patients (90 males, 93 females) with a median age of 71,8 years (range 39.5; 94.2), n = 151 who had completed the treatment and provided data pre- and after the intervention. The SRBI fulfilled a discriminatory power and identified n=17 participants as tending to be associated with male-related behavior, whereas n=59 as rather being associated with female-related behavior, and n=107 were categorized in between. In the linear regression models, SRBI but not biological sex had a significant influence on the change score of mastery of breathlessness. Adjusted R2 was decisive concerning the benefit of the SRBI allowing for gender assessment (34,1%). Overall, biologically male patients and variables read as more male-related behavior by the index were significantly associated with a better mastery after the intervention.

Discussion and implications for further research: By evaluating subgroups of patients based on sex-related behavior decisive characteristics associated with a benefit of the breathlessness support service are recognized. The introduction of SRBI revealed that medical research must focus on sex-disaggregated data and attempt to include aspects of gender, even as a post-hoc analysis, as it provides additional explanatory value. Awareness for gender medicine especially within implementation research is necessary and suitable guidelines for research and medical practice must follow.

Funding: Individual funding (BMG, DRV, BMBF, DFG, etc); 01GY1331