Two new GenderSci Lab articles: Social factors, rather than biological ones, drive higher numbers of adverse drug events in women
By: Annika Gompers, Katharine Lee, and Tamara Rushovich
The GenderSci lab has a new article out this week in Social Science and Medicine entitled “A Gender Hypothesis of sex disparities in adverse drug events,” which builds on findings from an article released in JAMA Network Open earlier this fall: “Adverse Drug Events by Sex After Adjusting for Baseline Rates of Drug Use.” Both articles interrogate canonical claims about the role of biological sex differences in observations of disparities between rates of adverse drug events (ADEs) in men and women.
An ADE is a side effect resulting from the use of a drug. It is commonly claimed that women have a rate of adverse drug events that is 1.5-2 times higher than the rate among men. Addressing this disparity has been an enduring priority of women’s health advocates, medical researchers, and institutions such as the National Institutes of Health.
“Addressing sex disparities in ADEs requires thinking beyond primarily biological sex-based factors to consider the many social and structural factors”
While many researchers interpret this disparity as indicating a need for more sex-based biological research, this pair of publications challenges that conclusion. First, by analyzing data from the US Federal Adverse Events Reporting System (FAERS), we show that baseline rates of medication usage are strongly correlated with ADE rates (Rushovich, Gompers, Lockhart, et al) - so much so that after accounting for rates of drug use, the probability of a population sex disparity of 1.5-1.7 drops to less than 5%.
Yet baseline drug usage is just one factor influencing ADE rates. In Lee, et al, we develop and propose a Gender Hypothesis for pathways by which gender shapes what may at first appear to be sex disparities in adverse drug events, including healthcare utilization, bias and discrimination in the clinic, experiencing or perceiving an event as adverse, and pre-existing gendered social and structural determinants of health.
Together, these papers demonstrate that the call for more biological research in order to mitigate sex disparities in ADEs stands on shaky ground. After accounting for rates of drug use, apparent sex differences in ADEs are much smaller than the 2:1 ratio that is often claimed. Addressing sex disparities in ADEs requires thinking beyond primarily biological sex-based factors to consider the many social and structural factors that interact to pattern men’s and women’s health. For example, we predicted - and found in FAERS - variation in the sex disparity across types of ADEs, in accordance with gendered experiences of an event as “adverse,” with cosmetically salient ADEs skewed heavily female and sexual dysfunction ADEs skewed male.
Moving forward, there are many other testable predictions generated by the Gender Hypothesis that can be fruitfully interrogated. We hope that other researchers will apply the Gender Hypothesis to other datasets and future studies in order to generate new, actionable insights into the drivers of gender/sex disparities in ADEs.
Statement of intellectual labor
Tamara Rushovich, Katie Lee, and Annika Gompers wrote the first draft. Sarah Richardson revised and edited the blog.
Recommended citation
Gompers, A, Lee, KMN, and Rushovich, T. “Two new GenderSci Lab articles: Social factors, rather than biological ones, drive higher numbers of adverse drug events in women” GenderSci Lab Blog. 2023 November 28. genderscilab.org/blog/social-factors-rather-than-biological-factors-in-adverse-drug-events