Are Women Really the Healthier Sex?
Published: Nov 12, 2013, By Michael Smith, North American Correspondent, MedPage Today
BALTIMORE -- Women in general are healthier than men and live longer, but the advantage comes at a price -- an increased risk of autoimmune diseases, a researcher said here.
Adult women are also at higher risk for allergies and asthma, even though young males have a higher burden of those chronic illnesses, according to Renata Engler, MD, of the Uniformed Services University of the Health Sciences in Bethesda, Md.
The reasons are complicated, not well understood, and require much more research, Engler said in a plenary session at the annual meeting of the American College of Allergy, Asthma, and Immunology.
"The immune system of women is more robust, which favors resistance against infections and some survival venues," Engler told MedPage Today after her presentation. "The downside is autoimmune disease, which is among the top 10 killers -- and there women lose."
Physicians and researchers need to take into account differences by sex, which, Engler said at the meeting, is a biological matter of genetics, hormones, and phenotypes. But they also need to be aware of differences by gender, which is a social construct and may lead to varying opportunities, resources, access to health care, and quality of care, Engler said.
The vogue for personalized medicine, she said, needs to take into account all the complexity involved in both aspects of the issue.
"The importance of sex differences in the practice of allergy-immunology cannot be overstated," Engler said, adding that better medicine and research practices "will benefit men and women alike."
Indeed, "many studies (of new drugs) are done in men and the results extrapolated to women," commented Richard Gower, MD, of Marycliff Allergy Specialists in Spokane, Wash., who moderated the session.
"That's probably wrong," he told MedPage Today, although the definitive data are often not there.
From the clinical perspective, he added, it's important for allergists and immunologists to be aware of possible sex and gender differences.
"Awareness is always a good thing," he said.
Autoimmune disease in the West, Engler said, is about 5% of the total disease burden, but for many diseases women make up 80% or more of the patients.
A table of such illnesses, she pointed out, would show that more than 90% of people withHashimoto's disease are female, ranging down to slightly more than 50% of people withvitiligo.
But in between are such important illnesses as Graves' disease,multiple sclerosis, lupus,rheumatoid arthritis, and Addison's disease, Engler noted.
Adult women also have a higher burden of asthma and atopic illness, she said, although earlier in life it's the boys who fare worst.
But the picture is not completely clear. The prevalence of atopic rhinitis increases steadily for the first 18 years in both sexes.
But non-atopic rhinitis is higher in boys than girls until puberty, when the prevalence in girls begins to predominate, likely because of changes in hormonal status or adipose tissue, she said.
A similar pattern has been observed with food allergies and eczema, she said.
"More prepubescent males have rhinitis, asthma and food allergy than females," Engler said. "However, roles change. When females enter young adulthood, they outnumber men in these chronic illness categories."