Clinical Advances in Sex- and Gender-Informed Medicine to Improve the Health of All

作者：Deborah Bartz, Tanuja Chitnis, Ursula B. Kaiser, Janet W. Rich‐Edwards, Kathryn M. Rexrode, Page B. Pennell, Jill M. Goldstein, M. Angela O’Neal, Meryl S. LeBoff, Maya Behn, Ellen W. Seely, Hadine Joffe, JoAnn E. Manson · 发表于：JAMA Internal Medicine · 年份：2020 · DOI：10.1001/jamainternmed.2019.7194 · 被引用次数：240 · 研究领域：Sex and Gender in Healthcare、Diversity and Career in Medicine、Menopause: Health Impacts and Treatments

Importance: Biological sex and sociocultural gender represent major sources of diversity among patients, and recent research has shown the association of sex and gender with health. A growing body of literature describes widespread associations of sex and gender with cells, organs, and the manner in which individual patients interact with health care systems. Sex- and gender-informed medicine is a young paradigm of clinical practice and medical research founded on this literature that considers the association of sex and gender with each element of the disease process from risk, to presentation, to response to therapy. Observations: Characteristics that underlie sex and gender involve both endogenous and exogenous factors that change throughout the life course. This review details clinical examples with broad applicability that highlight sex and gender differences in the key domains of genetics, epigenomic modifiers, hormonal milieu, immune function, neurocognitive aging process, vascular health, response to therapeutics, and interaction with health care systems. These domains interact with one another in multidimensional associations, contributing to the diversity of the sex and gender spectra. Novel research has identified differences of clinical relevance with the potential to improve care for all patients. Conclusions and Relevance: Clinicians should consider incorporating sex and gender in their decision-making to practice precision medicine that integrates fundamental c...