Understanding How the Diagnostic Delay of Spondyloarthritis Differs Between Women and Men: A Systematic Review and Metaanalysis

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Title: Understanding How the Diagnostic Delay of Spondyloarthritis Differs Between Women and Men: A Systematic Review and Metaanalysis
Authors: Jovaní, Vega | Blasco-Blasco, Mar | Ruiz-Cantero, María Teresa | Pascual, Eliseo
Research Group/s: Salud Pública
Center, Department or Service: Universidad de Alicante. Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia
Keywords: Spondyloarthritis | Sex differences | Sex bias | Diagnostic delay
Knowledge Area: Medicina Preventiva y Salud Pública
Issue Date: 1-Feb-2017
Publisher: The Journal of Rheumatology Publishing Company Limited
Citation: The Journal of Rheumatology. 2017, 44(2): 174-183. doi:10.3899/jrheum.160825
Abstract: Objective. To identify empirical evidence of diagnostic delay in spondyloarthritis (SpA), determine whether sex-related differences persist, and conduct an analysis from that perspective of the possible causes, including the influence of quality research, in this group of inflammatory rheumatic diseases. Methods. A systematic review was done of delay in diagnosis of SpA in MEDLINE and EMBASE and other sources. Study quality was determined in line with the Strengthening The Reporting of OBservational studies in Epidemiology (STROBE) statement. A metaanalysis of 13 papers reporting sex-disaggregated data was performed to evaluate sex-related differences in diagnostic delay. The global effect of diagnostic delay by sex was calculated using means difference (D) through a fixed effects model. Results. The review included 23,883 patients (32.3% women) from 42 papers. No significant differences between the sexes were detected for symptoms at disease onset or during evolution. However, the mean for delay in diagnosis of SpA showed sex-related differences, being 8.8 years (7.4–10.1) for women and 6.5 (5.6–7.4) for men (p = 0.01). Only 40% of papers had high quality. A metaanalysis included 12,073 participants (31.2% women). The mean global effect was D = 0.6 years (0.31–0.89), indicating that men were diagnosed 0.6 year (7 months) before women. Conclusion. Delay in diagnosis of SpA persists, and is longer in women than in men. There are no significant sex-related differences in symptoms that could explain sex-related differences in diagnostic delay. Methodological and possible publication bias could result in sex-biased medical practice.
Sponsor: Supported by FEDER-Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Spain (grant PI11/00865).
URI: http://hdl.handle.net/10045/63569
ISSN: 0315-162X (Print) | 1499-2752 (Online)
DOI: 10.3899/jrheum.160825
Language: eng
Type: info:eu-repo/semantics/article
Rights: © 2017 by The Journal of Rheumatology Publishing Company Limited
Peer Review: si
Publisher version: http://dx.doi.org/10.3899/jrheum.160825
Appears in Collections:INV - SP - Artículos de Revistas

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