Sex-disaggregated data along the gendered health pathways: A review and analysis of global data on hypertension, diabetes, HIV, and AIDS

Background Health data disaggregated by sex is vital for identifying the distribution of illness, and assessing risk exposures, service access, and utilization. Disaggregating data along a health pathway, i.e., the measurable continuum from risk factor exposure to final health outcome (death), and including disease prevalence and a three-step care cascade (diagnosis, treatment, and control), has the potential to provide a holistic and systematic source of information on sex- and gender-based health inequities and identify opportunities for more tailored interventions to reduce those inequities. Methods and findings We collected sex- and age-disaggregated data along the health pathway. We searched for papers using global datasets on the sex-disaggregated care cascade for eight major conditions and identified cascade data for only three conditions: hypertension, diabetes, and HIV and AIDS. For each condition, we collected risk factor prevalence, disease prevalence, cascade progression, and death rates. We assessed the sex difference for all steps along the pathway and interpreted inequities through a lens of gender analysis. Sex-disaggregated data on risk factors, disease prevalence, and mortality were found for all three conditions across 204 countries. Sex-disaggregated care cascades for hypertension, diabetes, and HIV and AIDS were found only for 200, 39, and 76 countries, respectively. Significant sex differences were found in each step along the pathways. In many countries, males exhibited higher disease prevalence and death rates than females, while in some countries, they also reported lower rates of healthcare seeking, diagnosis, and treatment adherence. Smoking prevalence was higher among males in most countries, whereas prevalence of obesity and unsafe sex were higher in females in most countries. Conclusions Findings support the increasing need to develop strategies that encourage greater male participation in preventive and healthcare service and underscore the importance of sex-disaggregated data in understanding health inequities and guiding gender-responsive interventions at different points along the pathway. Despite limitations in data availability and completeness, this study elucidates the need for more comprehensive and harmonized datasets for these and other conditions to monitor sex differences and implement sex-/gender-responsive interventions along the health pathway