[Gender perspective in clinical epidemiology. Learning from spondyloarthritis]

Abstract

Objective: To illustrate some gender challenges and contributions which are more frequent in research and health care through a chronic disease such as spondyloarthritis.

Method: Using two of the main identified gender biases in research and health care (de-contextualization of diseases, especially in women, and problem definition and knowledge production in women's health), a cross-sectional study was used with 96 men and 54 women with spondyloarthritis of the Rheumatology Department of the Alicante University General Hospital, whose sources of information were semi-structured patient interviews and clinical records.

Results: We show how the gender perspective can contribute to contextualise the differences by sex of functional alterations and other social and health indicators, and highlight inequalities in the socioeconomic repercussions between patients of both sexes. It can contribute towards re-conceptualizing diseases, especially of women, specifying the profile of differential diagnosis according to sex, and provide knowledge about methodological challenges related to diagnostic tests.

Conclusions: Achieving scientific and professional excellence in health care is also a gender issue. Analysing from a gender perspective the history of the diseases, how their diagnosis criteria were established and the normality and abnormality cut-off points, especially identified diseases of men, such as spondyloarthritis, is a priority to re-conceptualize medicine; as well as providing information on how the gender norms and values of the context interact with the lives of those who suffer these diseases.

Keywords: Bias; Epidemiology; Epidemiología; Espondilitis anquilosante; Espondiloartritis; Gender and health; Género y salud; Salud de la mujer; Sesgo; Sex; Sexo; Spondylitis ankylosing; Spondyloarthritis; Women's health.