A FRAMEWORK FOR THE CONSIDERATION OF CHRONIC DEBILITATING CONDITIONS IN WOMEN

考虑女性慢性衰弱状况的框架

• 批准号: 10710080
• 负责人: ROBERT DAY
• 金额: $ 7.5万
• 依托单位: NATIONAL ACADEMY OF SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-28 至 2024-09-27
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10710080
• 关键词: Adult; Affect; Aging; Area; Arthritis; Asthma; Autoimmune; Autoimmune Diseases; Basic Science; Biological; Chronic; Chronic Obstructive Pulmonary Disease; Clinical; Clinical Research; Clinical Trials; Coronary heart disease; Data; Dementia; Depressive disorder; Development; Diabetes Mellitus; Diagnosis; Disease; Engineering; Epidemiology; Ethnic Origin; Exhibits; Female; Functional disorder; Future; Gender; Gynecologic; Health; Heart Diseases; Hepatitis; Hormonal Change; Human; Hypertension; Immune system; Lead; Life Expectancy; Literature; Longevity; Malignant Neoplasms; Measures; Medicine; Menopause; Methods; Morbidity - disease rate; Muscle function; Muscular Atrophy; National Health Interview Survey; Nature; Osteoporosis; Outcome; Patients; Pattern; Pharmaceutical Preparations; Polycystic Ovary Syndrome; Pregnancy; Prevalence; Prevention; Provider; Race; Reporting; Research; Review Literature; Risk; Risk Factors; Rural Population; Sex Differences; Sexual and Gender Minorities; Skeletal Muscle; Social Impacts; Socioeconomic Status; Stroke; Therapeutic; Translational Research; Underrepresented Populations; United States National Academy of Sciences; United States National Institutes of Health; Woman; Women' s Group; Women' s Health; biological research; body system; design; disorder risk; economic impact; endometriosis; ethnic difference; evidence base; experience; frailty; gender difference; improved; inclusion criteria; innovation; kidney dysfunction; male; men; multiple chronic conditions; muscle form; muscle strength; persistent symptom; racial difference; response; rural underserved; sex; social health determinants; social influence; symposium

Chronic debilitating conditions are a significant burden on the health of women, in part because of longer life expectancies. More than 50 percent of U.S. adults reported at least 1 of 10 commonly diagnosed chronic conditions (arthritis, asthma, cancer, chronic obstructive pulmonary disease, coronary heart disease, diabetes, hepatitis, hypertension, stroke, and renal dysfunction) in the 2018 National Health Interview Survey, and more than a quarter of adults reported more than one such condition. These conditions include a range of diseases and disorders across the lifespan, and there are differences in both the prevalence and the clinical manifestation of chronic conditions among men and women. Some chronic conditions are specific to women (e.g., endometriosis or polycystic ovarian syndrome) while others have higher morbidity among women (e.g., heart disease) or are more common in women than in men (e.g., depressive disorders). Autoimmune diseases, arthritis, asthma, dementia, hypertension, and osteoporosis are also more common in women than in men; in fact, some autoimmune diseases have female-to-male ratios up to 6:1. Sex differences in the immune system may affect disease risk and response to preventative and therapeutic measures. Women may exhibit different symptoms of chronic conditions than men and can have different responses to medications (e.g., lower response-rate to first-line treatments). Further, the effects of hormonal changes (e.g., pregnancy and menopause) on the course of these conditions is not well understood. Gender differences in patient–provider interactions affect chronic condition diagnosis and treatment among women as well. Multimorbidity is the occurrence of two or more chronic conditions that may or may not have the same cause. Women are more likely than men to experience multimorbidity, and when they do, are more likely to have multiple organ systems involved. The initial chronic condition diagnosed and the pattern of accumulation within multimorbidity also differ by sex and gender. The additive and interactive nature of chronic conditions in multimorbidity among women are not well understood and therefore the conditions are often not adequately treated. Risk factors for multimorbidity include lower educational attainment and socioeconomic status; women of historically underrepresented populations are at additional risk. The evidence base for the prevention, diagnosis, and treatment of chronic conditions among women is underdeveloped. This is in large part because of a lack of intentional research on the health of women and an historical overrepresentation of men in clinical research. For example, clinical research traditionally has not been appropriately designed to obtain data on women (e.g., study end points and inclusion criteria); there is also limited research on femalespecific chronic conditions. A 2010 IOM report (Women’s Health Research: Progress, Pitfalls, and Promise) highlighted advancements in some areas of women’s health research; many of the gaps the IOM report emphasized remain and are described in a 2022 NASEM report (Improving Representation in Clinical Trials and Research: Building Research Equity for Women and Underrepresented Groups). Additional basic, translational, and clinical research on chronic conditions in women is needed. Basic biological research on sex differences at the cellular level (IOM, 2001, Exploring the Biological Contributions to Human Health: Does Sex Matter?), for example, could lead to innovations in understanding different chronic condition manifestations and experiences, as well as treatment and prevention methods. NIH recognizes the need to focus on chronic debilitating conditions in women, including it as a priority topic at the Advancing NIH Research on the Health of Women conference in 2021. The resulting report highlighting conference discussions noted the challenges in defining chronic debilitating conditions in women and in developing a framework for considering them. Specific research gaps and opportunities related to these conditions were also identified. The conference report also highlights similar challenges and gaps in chronic condition research in women as described in a 2022 NASEM report on autoimmune research sponsored by NIH (Enhancing NIH Research on Autoimmune Disease, 2022). NIH seeks assistance from the National Academies of Sciences, Engineering, and Medicine in reviewing literature on chronic debilitating conditions specific to women, assembling evidence-based findings, describing current gaps in evidence, and providing a research agenda for the future.

慢性衰弱病是妇女健康的一个重大负担，部分原因是预期寿命较长。超过50%的美国成年人在2018年全国健康访谈调查中报告了10种常见慢性疾病（关节炎，哮喘，癌症，慢性阻塞性肺病，冠心病，糖尿病，肝炎，高血压，中风和肾功能不全）中的至少一种，超过四分之一的成年人报告了不止一种这样的情况。这些病症包括一系列贯穿整个生命周期的疾病和紊乱，男女之间慢性病的流行率和临床表现存在差异。一些慢性病是女性特有的（例如，子宫内膜异位症或多囊卵巢综合征）而其他疾病在女性中具有较高的发病率（例如，心脏病）或在女性中比在男性中更常见（例如，抑郁症）。自身免疫性疾病、关节炎、哮喘、痴呆、高血压和骨质疏松症在女性中也比男性更常见;事实上，一些自身免疫性疾病的女性与男性比例高达6：1。免疫系统的性别差异可能会影响疾病风险以及对预防和治疗措施的反应。女性可能表现出与男性不同的慢性病症状，并且可能对药物有不同的反应（例如，一线治疗的应答率较低）。此外，激素变化的影响（例如，怀孕和绝经）对这些病症的过程的影响尚不清楚。患者与提供者互动的性别差异也影响了女性慢性病的诊断和治疗。 多发性硬化症是两种或两种以上慢性疾病的发生，可能有或可能没有相同的原因。女性比男性更有可能经历多重死亡，当他们这样做时，更有可能涉及多个器官系统。最初诊断的慢性病和多发病中的积累模式也因性别而异。对妇女多重发病中慢性病的叠加和相互作用的性质还没有很好的了解，因此这些疾病往往得不到充分的治疗。多重死亡的风险因素包括教育程度和社会经济地位较低;历史上代表性不足的人口中的妇女面临额外风险。 预防、诊断和治疗妇女慢性病的证据基础不发达。这在很大程度上是因为缺乏对妇女健康的有意识的研究，以及历史上男性在临床研究中的比例过高。例如，临床研究传统上没有被适当地设计以获得关于妇女的数据（例如，研究终点和纳入标准）;对女性特异性慢性疾病的研究也很有限。2010年国际移民组织的一份报告（《妇女健康研究：进展、陷阱和希望》）强调了妇女健康研究某些领域的进步;国际移民组织报告强调的许多差距仍然存在，并在2022年NASEM报告（《提高临床试验和研究的代表性：为妇女和代表性不足的群体建立研究公平》）中进行了描述。需要对女性慢性病进行更多的基础、转化和临床研究。关于细胞水平性别差异的基础生物学研究（IOM，2001年，探索生物学对人类健康的贡献：性别重要吗？），例如，可能导致在理解不同慢性病表现和经历以及治疗和预防方法方面的创新。NIH认识到有必要关注女性的慢性衰弱状况，将其作为2021年推进NIH妇女健康研究会议的优先主题。由此产生的报告着重介绍了会议讨论情况，指出了在界定妇女的慢性衰弱状况和制定审议这些状况的框架方面的挑战。还确定了与这些条件有关的具体研究差距和机会。该会议报告还强调了女性慢性病研究中的类似挑战和差距，如NIH赞助的2022年NASEM自身免疫研究报告（增强NIH对自身免疫疾病的研究，2022年）所述。 NIH寻求美国国家科学院、工程院和医学院的帮助，审查有关女性慢性衰弱性疾病的文献，收集循证调查结果，描述目前的证据差距，并为未来提供研究议程。