Published on: April 11, 2016
by Angela Colantonio for The Star:
Many would assume that gender equity in health has been achieved. But in subtle ways, medical research has a male bias that can leave women behind. Take my area of research as an example; traumatic brain injuries. Huge advances have been made in this field over the last few decades. We now know that for some, even seemingly minor hits to the head can have long-lasting effects, and we recognize the importance of proper recovery and rehabilitation. But we don’t fully know the differences of how women and men experience brain injury, and that has consequences for how women are diagnosed and treated.
Sex and Gender Knowledge Gap
Biological differences — including muscle strength, hormones and physiology — as well as social norms and stereotypes, can cause men and women to experience injury in diverse ways. For example, women are thought to suffer greater harm from a similar level of impact than men because of physical factors like neck strength. But it could also be that women may be reporting more symptoms than men, who face societal pressures to act tough. We need a lot more research focused on these nuances to be able to offer the most relevant care.
In February, I was guest editor for a special issue on sex and gender and traumatic brain injury in the journal Archives of Physical Medicine and Rehabilitation, which is the most highly cited journal in the rehabilitation field. In one of the articles — a systematic review of over 200 studies on mild traumatic brain injury — researchers found that only 7 per cent of the studies actually separated their data based on sex. It makes it hard to draw conclusions about sex and gender when this type of information is so often unavailable.
And the sex and gender knowledge gap is not limited to my area of brain injury alone. As just one example, it has long been the norm in preclinical medical research to use male rodents and cells. The National Institutes of Health in the U.S. has recently begun to require use of both sexes in cell and animal research. And despite major physiological and hormonal differences between men and women, I’m aware of only one pharmaceutical drug with sex-specific dosage (a sleeping pill called Ambien).
What we know
We are aware of certain sex and gender differences when it comes to traumatic brain injury. Men are more likely to be injured while engaging in high-risk activities involving driving, professional contact sports, construction work or military occupations. Women are more likely to be hurt in typically “female” occupations like health care or as a result of physical violence in these settings. In fact, even though hits to the head are common in intimate partner violence, we aren’t paying enough attention. For example, front-line providers in women’s shelters are not typically trained to look for signs of brain injury. I’m currently involved in a team of stakeholders developing a training program to address this.
Despite so much attention on male athletes, women account for approximately a third of traumatic brain injuries, based on hospitalization data. And among older populations, the rates are more equal among men and women. We also have some evidence showing that females report feeling more dizziness and headaches after an injury than males.
When it comes to recovery and navigating the health system, women also appear to be at a disadvantage. One study showed that women who are returning to unpaid work in the household reported being less likely to be referred for rehabilitation following a traumatic brain injury than those returning to paid work outside the home. This inequality in care could have huge repercussions for recovery.
Closing the knowledge gap
The more we understand the differences at play when it comes to sex and gender and traumatic brain injuries, the better care we’ll be able to provide. We need research to get past the stereotypes telling us, for example, to worry about male-dominated contact sports but pay little attention to more female-dominated activities like cheerleading, which also poses risks.
I am glad to see that researchers are starting to pay more and more attention to sex and gender differences. As the official sex and gender research champion for a newly funded Canadian Traumatic Brain Injury Research Consortium, an interdisciplinary national network of researchers, I will facilitate explicit consideration of sex and gender throughout the research process in order to improve clinical outcomes after a brain injury. And Canada’s Institute of Gender and Health — the first of its kind in the world — supports research that results in better science.
We are finally finding the right path to finding out more about women and traumatic brain injuries — and I think that will have a direct impact on how well we’ll be able to better support recovery and rehabilitation.
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