標題:[好文分享]Why sex and gender need to be considered in COVID-19 research
刊登日:2021/1/25內容
A guide for applicants and peer reviewers
First, sex-disaggregated data reveal that more males are dying from COVID-19 than femalesFootnote1. It remains unclear if biological factors and/or comorbid, occupational, behavioural or institutional factors are to blame.
Second, pandemics can compound differential exposures and outcomes for girls, women, sexual and gender minorities, caregivers and other essential workers involved in gendered occupations. It is essential that these populations are considered through an intersectional lens in order to create effective, equitable policies and interventions.
Applicants and peer reviewers should appropriately account for the following in COVID-19 research proposals:
Molecular Mechanisms of Viral Pathogenesis
Include both male and female cells, as the SARS-CoV-2 receptor, ACE2, is X-linked and escapes X chromosome inactivationFootnote2. Disaggregate results by sex.
Host Immune Response
Include male and female animals or humans, as sex differences in the host immune response to SARS-CoVFootnote3 and SARS-CoV-2Footnote4 infections have been reported. Disaggregate results by sex.
Diagnostic Tests and Serologic Antibody Testing
Measure sensitivity and specificity for males and females separately, as sex differences in viral titers and IgG antibodies have been reported for SARS-CoV and SARS-CoV-2 infections in humans and miceFootnote3Footnote5.
Vaccines and Therapeutics
Test and report sex-specific dosing of vaccines and other therapeutics. Efficacy, safety and toxicity for males and females differ for some drugsFootnote6, immunotherapiesFootnote7 and vaccinesFootnote8.
Clinical Trials
Stratify randomization by sex, age and race, as these variables influence the safety and efficacy of drugs and biologicsFootnote9. Disaggregate results by sex, age and race.
Medical Devices and Personal Protective Equipment
Incorporate sex-specific anatomical differences and gendered user preferences into the design of medical devices and personal protective equipment for COVID-19.
Social, Behavioural Observational and Seroprevalence Studies
Consider sex, gender, age, race, Indigeneity and other identity characteristics in survey questions and sampling strategies.
In studies of disease susceptibility, investigate:
- Gendered behaviours, as men are more likely to smoke than womenFootnote10 and less likely to seek healthcareFootnote11, whereas older women are more likely to live alone and experience social isolation.
- Gender roles, as 70% of the paid and unpaid global healthcare workforce are womenFootnote12. The risk of exposure increases for those on the frontline of the COVID-19 pandemic.
In research on the impact of the pandemic, investigate:
- Gender relations, as physical distancing puts women and girls at higher risk of domestic violenceFootnote13, while transgender and non-binary individuals are at higher risk of feeling unsafe due to heightened tensions and unsupportive environments in the householdFootnote14.
- Gender roles, as women disproportionately assume caregiving responsibilities. Lockdown measures and school closures have caused negative impacts on women’s wellbeingFootnote15.
Mental Health
Mental health effects may reasonably vary by sex, gender, sexual orientation and other identity characteristics, as the triggers, causes, signs and symptoms of depression and anxiety may differFootnote16.
Implementation Science
Sex, gender, age, immigrant, occupational and racialized community identities influence the way in which an implementation strategy works, for whom, under what circumstances and why. Consider how messaging should appropriately include and target different groups according to sex, gender and other identity characteristicsFootnote17.
Policy
The unintended outcomes of all COVID-19 policies, especially economic recovery policies, should be considered for groups such as Indigenous Peoples, women, sexual and gender minorities, racialized individuals, single parents, immigrants, unpaid workers, individuals with precarious work status, people with disabilities, the homeless and those living in rural and remote areasFootnote18.
References
- Footnote 1
Scully E.P. et al. Nat Rev Immunol. 20, 442-447 (2020).
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Tukiainen, T. et al. Nature 550, 244–248 (2017).
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Channappanavar, R. et al. J Immunol. 198, 4046-4053 (2017)
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Takahashi T. et al. Nature (2020). doi: 10.1038/s41586-020-2700-3
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Zeng, F. et al. J Med Virol. 92, 2050-2054 (2020).
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Zucker I. & Prendergast B.J. Biol Sex Differ. 11, 32 (2020).
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Conforti, F. et al. Lancet Oncol. 19, 737–746 (2018).
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Fink A.L. & Klein S.K. Curr Opin Physiol. 6, 16-20 (2019).
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Tannenbaum, C. & Day, D. Pharmacol. Res. 121, 83–93 (2017).
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World Health Organization. 10 facts on gender and tobacco. (2010) [ PDF (230 KB) - external link ]
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Thompson, A.E. et al. BMC Fam. Pract. 17, 38 (2016).
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World Health Organization. Gender equity in the health workforce: Analysis of 104 countries (2019)
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United Nations Population Fund. COVID-19: A Gender Lens (2020)
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The Trevor Project. How COVID-19 is impacting LGBTQ youth (2020) [ PDF (2.6 GB) - external link ]
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Gender and COVID-19 Working Group: Understanding the gendered dimensions of COVID-19 (2020)
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House of Commons Standing Committee on Health. The Health of LGBTQIA2 Communities in Canada (2019) [ PDF (2.9 GB) - external link ]
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Tannenbaum, C. et al. BMC Med. Res. Methodol. 16, 145 (2016).
18. Hankivsky, O. & Kapilashrami, A. Beyond sex and gender analysis: an intersectional view of the COVID-19 pandemic outbreak and response. (2020) [ PDF (591 KB) - external link ]
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資料來源
https://cihr-irsc.gc.ca/e/51939.html