Gender Biases and Diagnostic Delay in Inflammatory Bowel Disease: Multicenter Observational Study

• Published in: Inflammatory bowel diseases Vol. 29; no. 12; pp. 1886 - 1894
• Main Authors: Sempere, Laura, Bernabeu, Purificación, Cameo, José, Gutiérrez, Ana, García, María Gloria, García, Mariana Fe, Aguas, Mariam, Belén, Olivia, Zapater, Pedro, Jover, Rodrigo, van-der Hofstadt, Carlos, Ruiz-Cantero, María Teresa
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 05.12.2023
• Subjects: Clinical Research; diagnostic delay; misdiagnosis; gender biases; inflammatory bowel disease
• ISSN: 1078-0998; 1536-4844
• DOI: 10.1093/ibd/izad001

Abstract Background Female gender could be a cause of diagnostic delay in inflammatory bowel disease (IBD). The aim of this study was to investigate the diagnostic delay in women vs men and potential causes. Methods This multicenter cohort study included 190 patients with recent diagnosis of IBD (disease duration <7 months). Reconstruction of the clinical presentation and diagnostic process was carried out in conjunction with the semistructured patient interview, review, and electronic medical records. Results The median time from symptom onset to IBD diagnosis was longer in women than in men: 12.6 (interquartile range, 3.7-31) vs 4.5 (2.2-9.8) months for Crohn’s disease (CD; P = .008) and 6.1 (3-11.2) vs 2.7 (1.5-5.6) months for ulcerative colitis (UC; P = .008). Sex was an independent variable related to the time to IBD diagnosis in Cox regression analysis. The clinical presentation of IBD was similar in both sexes. Women had a higher percentage of misdiagnosis than men (CD, odds ratio [OR], 3.9; 95% confidence [CI], 1.5-9.9; UC, OR 3.0; 95% CI, 1.2-7.4). Gender inequities in misdiagnosis were found at all levels of the health system (emergency department, OR 2.4; 95% CI, 1.1-5.1; primary care, OR 2.5; 95% CI, 1.3-4.7; gastroenterology secondary care, OR 3.2; 95% CI, 1.2-8.4; and hospital admission, OR 4.3; 95% CI, 1.1-16.9). Conclusions There is a longer diagnostic delay in women than in men for both CD and UC due to a drawn-out evaluation of women, with a higher number of misdiagnoses at all levels of the health care system. Lay Summary This paper shows a longer delay in the diagnosis of inflammatory bowel disease in women compared with men for both Crohn’s disease and ulcerative colitis. These differences are present at all levels of the health care system, and misdiagnosis is also more common in women. Graphical Abstract Graphical Abstract