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

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.

Psychological burden and quality of life in newly diagnosed inflammatory bowel disease patients

“…Based on our results, although psychological support should be offered to all individuals with a recent diagnosis of IBD, people with special susceptibility to emotional disorders should be intensively monitored for emotional impairment and prioritized for early psychological support. Gender differences in the course and presentation of IBD have already been reported (Greuter et al, 2020;Sempere et al, 2023). Women are more prone to develop anxiety and mood disorders than men (Asher et al, 2017) However, this specific frailty found in women with IBD regarding psychological impairment should be specifically addressed.…”

Diagnostic Delay in Crohn’s Disease: Reality Today and Strategies to Overcome It

“…Gender inequities leading to delayed diagnosis or misdiagnosis were found on all levels of the healthcare system. 29 Other studies did not find gender to be a risk factor for DD. 8,9,12,[22][23][24] LOCALIZATION OF DISEASE Ileal localization of the disease was found to be a significant risk factor for DD, largely attributable to the ileal CD presenting with mild and unspecific symptoms, including abdominal pain, less frequent diarrhea, and absence of rectal bleeding.…”