Across countries and disciplines, studies show male researchers receive more research funding than their female peers. Because most studies have been observational, it is unclear whether imbalances ...stem from evaluations of female research investigators or of their proposed research. In 2014, the Canadian Institutes of Health Research created a natural experiment by dividing investigator-initiated funding applications into two new grant programmes: one with and one without an explicit review focus on the calibre of the principal investigator.
We analysed application success among 23 918 grant applications from 7093 principal investigators in all investigator-initiated Canadian Institutes of Health Research grant programmes between 2011 and 2016. We used generalised estimating equations to account for multiple applications by the same applicant and compared differences in application success between male and female principal investigators under different review criteria.
Overall application success across competitions was 15·8%. After adjusting for age and research domain, the predicted probability of success in traditional programmes was 0·9 percentage points lower for female applicants than male applicants (95% CI 2·0 lower–0·2 higher; odds ratio 0·934, 95% CI 0·854–1·022). In the new programme, in which review focused on the proposed science, the gap remained 0·9 percentage points (3·2 lower–1·4 higher; 0·998, 0·794–1·229). In the new programme with an explicit review focus on the calibre of the principal investigator, the gap was 4·0 percentage points (6·7 lower–1·3 lower; 0·705, 0·519–0·960).
Gender gaps in grant funding are attributable to less favourable assessments of women as principal investigators, not of the quality of their proposed research. We discuss reasons less favourable assessments might occur and strategies to foster fair and rigorous peer review.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
A male bias in mortality has emerged in the COVID-19 pandemic, which is consistent with the pathogenesis of other viral infections. Biological sex differences may manifest themselves in ...susceptibility to infection, early pathogenesis, innate viral control, adaptive immune responses or the balance of inflammation and tissue repair in the resolution of infection. We discuss available sex-disaggregated epidemiological data from the COVID-19 pandemic, introduce sex-differential features of immunity and highlight potential sex differences underlying COVID-19 severity. We propose that sex differences in immunopathogenesis will inform mechanisms of COVID-19, identify points for therapeutic intervention and improve vaccine design and increase vaccine efficacy.
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FZAB, GEOZS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
There has been a recent swell in activity by health research funding organizations and science journal editors to increase uptake of sex and gender considerations in study design, conduct and ...reporting in order to ensure that research results apply to everyone. However, examination of the implementation research literature reveals that attention to sex and gender has not yet infiltrated research methods in this field.
The rationale for routinely considering sex and gender in implementation research is multifold. Sex and gender are important in decision-making, communication, stakeholder engagement and preferences for the uptake of interventions. Gender roles, gender identity, gender relations, and institutionalized gender influence the way in which an implementation strategy works, for whom, under what circumstances and why. There is emerging evidence that programme theories may operate differently within and across sexes, genders and other intersectional characteristics under various circumstances. Furthermore, without proper study, implementation strategies may inadvertently exploit or ignore, rather than transform thinking about sex and gender-related factors. Techniques are described for measuring and analyzing sex and gender in implementation research using both quantitative and qualitative methods. The present paper describes the application of methods for integrating sex and gender in implementation research. Consistently asking critical questions about sex and gender will likely lead to the discovery of positive outcomes, as well as unintended consequences. The result has potential to strengthen both the practice and science of implementation, improve health outcomes and reduce gender inequities.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Over the past decade, the Canadian Institutes of Health Research (CIHR) has implemented multicomponent interventions to increase the uptake of sex and gender in grant applications. Interventions ...included mandatory reporting on applicant forms, development of resources for applicants and evaluators, and grant review requirements. Here, we aim to inform science policy implementation by describing the 10-year outcomes and lessons learned from these interventions. This is a prospective longitudinal study. The population is all applicants across 15 investigator-initiated CIHR competitions from 2011 to 2019 and grant evaluators from 2018 to 2019. Quantitative data were derived from applicants' and grant evaluators' mandatory reporting of sex and gender integration in the grants management database. The application was the unit of analysis. Trends in sex and gender uptake in applications were plotted over time, stratified by research area. Univariate logistic regression was used to assess associations between the sex of the applicant and the uptake of sex and gender, and the latter with funding success. Qualitative review of the quality and appropriateness of evaluators' comments informed the development of discipline-specific training to peer review committee members. Feedback was compiled from a subset of evaluators on the perceived usefulness of the educational materials using a brief questionnaire. Since 2011, 39,390 applications were submitted. The proportion that reported integration of sex rose from 22 to 83%, and gender from 12 to 33%. Population health research applications paid the greatest attention to gender (82%). Across every competition, applications with female principal investigators were more likely to integrate sex (odds ratio OR 1.60, 95% confidence interval CI 1.50-1.63) and gender (OR 2.40, 95% CI 2.29-2.51) than those who identified as male. Since 2018, applications that scored highly for the integration of sex (OR 1.92, 95% CI 1.50-2.50) and gender (OR 2.53, 95% CI 1.83-3.50) were more likely to be funded. Qualitative observations revealed persistent conflation of the terms sex and gender. Eighty-six percent of evaluators appreciated the tailored discipline-specific coaching. A number of policy interventions improved sex and gender uptake in grant applications, with higher success rates observed over time for applications that integrated sex and gender. Other funders' action plans around sex and gender integration may be informed from our experiences of the timing, type and targets of the different interventions, specifically those directed at evaluators.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
With more time being spent on caregiving responsibilities during the COVID-19 pandemic, female scientists' productivity dropped. When female scientists conduct research, identity factors are better ...incorporated in research content. In order to mitigate damage to the research enterprise, funding agencies can play a role by putting in place gender equity policies that support all applicants and ensure research quality. A national health research funder implemented gender policy changes that included extending deadlines and factoring sex and gender into COVID-19 grant requirements. Following these changes, the funder received more applications from female scientists, awarded a greater proportion of grants to female compared to male scientists, and received and funded more grant applications that considered sex and gender in the content of COVID-19 research. Further work is urgently required to address inequities associated with identity characteristics beyond gender.
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BFBNIB, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
Integrating sex and gender in health research is essential to produce the best possible evidence to inform health care. Comprehensive integration of sex and gender requires considering these ...variables from the very beginning of the research process, starting at the proposal stage. To promote excellence in sex and gender integration, we have developed a set of metrics to assess the quality of sex and gender integration in research proposals. These metrics are designed to assist both researchers in developing proposals and reviewers in making funding decisions. We developed this tool through an iterative three-stage method involving 1) review of existing sex and gender integration resources and initial metrics design, 2) expert review and feedback via anonymous online survey (Likert scale and open-ended questions), and 3) analysis of feedback data and collective revision of the metrics. We received feedback on the initial metrics draft from 20 reviewers with expertise in conducting sex- and/or gender-based health research. The majority of reviewers responded positively to questions regarding the utility, clarity and completeness of the metrics, and all reviewers provided responses to open-ended questions about suggestions for improvements. Coding and analysis of responses identified three domains for improvement: clarifying terminology, refining content, and broadening applicability. Based on this analysis we revised the metrics into the Essential Metrics for Assessing Sex and Gender Integration in Health Research Proposals Involving Human Participants, which outlines criteria for excellence within each proposal component and provides illustrative examples to support implementation. By enhancing the quality of sex and gender integration in proposals, the metrics will help to foster comprehensive, meaningful integration of sex and gender throughout each stage of the research process, resulting in better quality evidence to inform health care for all.
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Women and men, female and male animals and cells are biologically different, and acknowledgement of this fact is critical to advancing medicine. However, incorporating concepts of sex-specific ...analysis in basic research is largely neglected, introducing bias into translational findings, clinical concepts and drug development. Research funding agencies recently approached these issues but implementation of policy changes in the scientific community is still limited, probably due to deficits in concepts, knowledge and proper methodology. This expert review is based on the EUGenMed project (www.eugenmed.eu) developing a roadmap for implementing sex and gender in biomedical and health research. For sake of clarity and conciseness, examples are mainly taken from the cardiovascular field that may serve as a paradigm for others, since a significant amount of knowledge how sex and oestrogen determine the manifestation of many cardiovascular diseases (CVD) has been accumulated. As main concepts for implementation of sex in basic research, the study of primary cell and animals of both sexes, the study of the influence of genetic vs. hormonal factors and the analysis of sex chromosomes and sex specific statistics in genome wide association studies (GWAS) are discussed. The review also discusses methodological issues, and analyses strength, weaknesses, opportunities and threats in implementing sex-sensitive aspects into basic research.
New knowledge about male–female differences in pathophysiology, diagnosis, and treatment is shifting the practice of medicine from a one-size-fits all approach to a more individualized process that ...considers sex-specific interventions at the point of care. In this article, we review how clinical practice guideline committees can incorporate a structured framework to determine whether sex-specific assessments of the quality of the evidence or the particular recommendations should be made. The process can be operationalized by societies who author clinical practice guidelines by developing formal policies to approach biological sex in a systematic way, and by ensuring that writing committees include an individual who will champion the formal appraisal of the literature for associations between sex and the outcomes of interest. Ongoing challenges are discussed, and solutions are provided for how to disaggregate the evidence, how to assess bias, how to improve search strategies, and what to do when the data are insufficient to make sex-specific recommendations. Application of sex-specific recommendations will involve routinely asking whether the presentation, diagnostic workup, or management might change for each patient if they were the opposite sex.
Les nouvelles connaissances sur les différences homme-femme en matière de physiopathologie, de diagnostic et de traitement réorientent la pratique de la médecine pour passer d’une approche universelle à un processus plus individualisé qui considère les interventions en fonction du sexe au point d’intervention. Dans le présent article, nous passons en revue la façon dont les comités sur les lignes directrices de pratique clinique peuvent intégrer un cadre structuré pour déterminer si des évaluations de la qualité des données probantes en fonction du sexe ou si des recommandations particulières devraient être faites. Le processus peut être mis en œuvre par les sociétés qui rédigent les lignes directrices de pratique clinique en élaborant des politiques formelles pour aborder de manière systématique le sexe biologique et en s’assurant que les comités de rédaction regroupent des individus qui soutiendront l’évaluation formelle de la littérature sur les associations entre le sexe et les critères d’intérêt. Nous traitons des enjeux actuels, et nous donnons des solutions sur la manière de désagréger les données probantes, sur la manière d’évaluer les biais, sur la manière d’améliorer les stratégies de recherche et sur ce qu’il faut faire lorsque les données sont insuffisantes pour formuler des recommandations en fonction du sexe. L’application de recommandations en fonction du sexe obligera à se demander systématiquement s’il est possible que le tableau clinique, le bilan diagnostique ou la prise en charge aient varié pour chacun des patients s’ils avaient été de sexe opposé.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes.
An economic ...(decision-tree) analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained associated with mild, moderate and severe hypoglycemic events for 6 glucose-lowering medication classes in type 2 diabetic adults aged 65-79 versus those 80 years and older. The national U.S. (Center for Medicare Services) and Canadian public health payer perspectives were adopted.
Incidence rates of drug-induced hypoglycemia were the highest for basal insulin and sulfonylureas: 8.64 and 4.32 events per person-year in 65-79 year olds, and 12.06 and 6.03 events per person-year for 80 years and older. In both the U.S. and Canada, metformin dominated sulfonylureas, basal insulin and glucagon-like peptide1 receptor agonists. Relative to sulfonylureas, thiazolidinediones had the lowest incremental cost-effectiveness ratios in the U.S. and dominated sulfonylureas in Canada for adults 80 years and older. Relative to sulfonylureas, dipeptidyl peptidase4 inhibitors were cost-effective for adults 80 years and older in both countries, and for 65-79 year olds in Canada. Annual costs of hypoglycemia for older adults attaining very tight glycemic control with the use of insulin or sulfonylureas were estimated at U.S.$509,214,473 in the U.S. and CAN$65,497,849 in Canada.
Optimizing drug therapy for older type 2 diabetic adults through the avoidance of drug-induced hypoglycemia will dramatically improve patient health while also generating millions of dollars by saving unnecessary medical costs.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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