Gender Outcomes and Well-being Development Group (GOING-FWD GNP78)

Background: Beyond biological sex, gender is increasingly recognized as a pivotal determinant of health. However, there are no standardized gender measurements. We hypothesize that gender-related factors and their effect will vary substantially between countries and diseases. Aims: GOING-FWD proposes the application of a multidimensional gender-based framework across multiple chronic disease cohorts in five countries to measure and more importantly understand sex and gender-related determinants of health outcomes contributing to patients well-being and health system sustainability. Our aim is to consolidate sex and gender-related determinants of health and well-being knowledge in Noncommunicable Diseases and apply this knowledge using technological innovations across cohorts and countries. As a consortium, GOING-FWD will build upon a multinational expert community to establish an international knowledge and expertise-sharing platform for health care providers, researchers and patients. The overarching aims of this large Consortium are to integrate sex and gender dimensions in applied health research, to evaluate their impact on clinical cost-sensitive outcomes and patients reported outcomes related to quality of life in noncommunicable diseases including cardiovascular disease, metabolic disease, chronic kidney disease and neurological disease. We also aim to construct innovative ways to disseminate the application of gender measurement towards personalized approaches to chronic disease prevention, diagnosis and treatment. Methods: With a five-country transatlantic network comprised of 30 investigators, we will benchmark innovative solutions to measure gender in retrospective cohorts. Based on consensus, we will develop a framework to identify gender-related factors, as well as cost-sensitive and patients reported outcomes and measure their associations in 32 accessible cohorts of patients affected by cardiovascular, chronic kidney and neurological diseases and metabolic syndrome. Large database analysis and when appropriate machine learning approaches will allow the derivation of pan and within country disease specific gender scores which will be validated through e-Health and m-Health applications in prospective disease groups. Educational modules will be developed to promote awareness, implementation and dissemination. Innovation: As a five-country multidisciplinary Consortium with access to granular large databases, we are uniquely positioned to harness an innovative methodology that will provide a framework to close gender gaps in chronic disease management and promote knowledge transfer in the scientific community and clinical practice. 1

In the last years the awareness of the effect of biological sex on disease prevalence, prognosis, symptoms and response to therapy has increased. Nevertheless, the literature on sociocultural gender on disease outcome, prognosis, symptoms and response to treatment is rare. Therefore, the aim of our project, financed by the Austrian Science Fund, carried out by an international consortium, was to analyze the effect of biological sex and sociocultural gender on chronic diseases and if there are any differences between the different countries. Moreover, we included the novel Covid-19 to our research. With a five-country transatlantic network comprised of 30 investigators, we benchmark innovative solutions to measure gender in retrospective cohorts. Based on consensus, we developed a framework to identify gender-related factors, as well as cost-sensitive and patient reported outcomes and measure their associations in cohorts of patients affected by cardiovascular, chronic kidney and neurological diseases and metabolic syndrome. Educational modules will be developed to promote awareness, implementation and dissemination. In order to be able to differentiate between the effect of sex and gender, we created a gender score specific for each database. This score is independent from sex and measures gender. With our gender score we showed that females have a better general and cardiovascular health. Nevertheless, individuals with a female gender score report worse general and cardiovascular health. Moreover, a better diabetes mellitus outcome was reported in females compared to males, namely a lower hospitalization rate and lower risk of development of cardiovascular diseases. Still a female gender score was associated with worse diabetes mellitus outcome. This could be ascribed to the fact that individuals with a female gender score may experience greater levels of stress as they also have to take care of their children and household tasks besides their job. Moreover, also financial problems could lead to more stress and to decreased ability to afford a healthy lifestyle. With our analyses we could show that females have a worse mental health during the Covid-19 pandemic and that in countries with less gender equality males have a higher rate of positive Covid-19 cases, at least at the beginning of the pandemic. These findings could be caused by a higher rate of Covid-19 tests in males compared to females as they might have an easier access to testing in countries with worse gender equality. In summary our project showed new insights to the effect of sociocultural gender on chronic diseases. Moreover, caused by the collaboration with our international partners we could learn and benefit from each other and expand our international collaboration network. Nevertheless, it is necessary to do further research in the field of gender medicine to provide the best treatment for females and all patients.