Influence of Sex in the Management of Ulcerative Colitis.

517 DISEASES OF THE COLON & RECTUM VOLUME 62: 5 (2019) Sex is considered a key variable in biomedical sciences. This is reflected in the observation that essentially every clinical study reports the distribution of sex (eg, number of included patients who were men and women), similar to what is done for age. Multiple studies have demonstrated sex-based variations in disease management and outcomes that span across various fields of medicine, with prominent examples in coronary artery disease and diabetes mellitus. Underlying causes for these variations are likely multifactorial and include sex-based differences in health-related quality of life, body image perception, sexuality, concern for fertility, social gender role, and patient–physician relationship. For the disease of ulcerative colitis (UC), where management can include surgery with potential to alter both body image and quality of life (eg, stoma formation and bowel function), as well as medications with systemic influences (eg, immunomodulators or steroids), the impact of patient sex on disease management may be especially pronounced. In the current issue of Diseases of the Colon & Rectum, Sceats et al examined variations in the medical and surgical management of UC between women and men. Based on a retrospective cohort analysis using a commercial insurance claims database, the authors identified that women were less likely than men to receive both definitive surgery and maintenance medication for the treatment of UC. One example of previous research on sex-based variations in care practices focused on the management of coronary artery disease. Management of coronary artery disease shares similarity with that of UC in that both medical and surgical interventions are available. In these studies, women were less likely to use coronary catheterization and/or coronary artery bypass compared to men of similar disease severity. In addition, multiple studies to date suggest that women were less likely to be on optimal drug therapies for the management of cardiovascular disease compared with men. Whether these differences were physicianor patient-driven remains to be determined. It is interesting, however, despite significant differences in the natural history (eg, age of onset) and treatment modalities between coronary artery disease and UC, that findings from previous studies in coronary artery disease echoed the results observed by Sceats et al for the treatment pattern of patients with UC. This suggests that the trend for sex-based variations is likely also present among other medical conditions. Sex-based variations in medical care are likely multifactorial. Previous studies have attributed sex-social role, sexed-based variation in risk averseness, views toward alternative/complementary medications, and physician–patient relationship to account for the observed variations. Given that sex-based variations are observed in a variety of medical conditions, common factors that lead to sex-based differences likely exist, in addition to disease-specific factors. Findings from the current article by Sceats et al clearly illustrate that women were less likely than men to receive both medical and surgical treatment for UC. However, the study was limited by the lack of sex-specific variables (eg, marital status, pregnancy and fertility history, and current caregiver for children) that could help further explain the observed variations. A better understanding of the sex-specific issues that lead to the observed treatment variations in UC will help identify potential treatment barriers. The natural history of inflammatory bowel disease (IBD) may be uniquely susceptible to sex-based differFunding/Support: None reported.