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.

慢性衰弱性疾病对女性健康构成重大负担，部分原因是女性预期寿命更长。在 2018 年全国健康访谈调查中，超过 50% 的美国成年人至少报告了 10 种常见慢性病（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、中风和肾功能障碍）中的一种，并且超过四分之一的成年人报告了不止一种此类疾病。这些疾病包括一生中的一系列疾病和病症，并且男性和女性慢性病的患病率和临床表现都存在差异。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），而另一些慢性病在女性中发病率较高（例如心脏病）或女性比男性更常见（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，并且对药物有不同的反应（例如，对一线治疗的反应率较低）。此外，荷尔蒙变化（例如怀孕和更年期）对这些病症的影响尚不清楚。患者与提供者互动中的性别差异也会影响女性慢性病的诊断和治疗。 多重发病是指两种或两种以上慢性病的发生，这些慢性病可能具有相同的原因，也可能不同。女性比男性更有可能患有多种疾病，而且当她们患有多种疾病时，更有可能涉及多个器官系统。最初诊断的慢性病和多种疾病的累积模式也因性别而异。女性多发病中慢性病的累加性和相互作用性质尚不清楚，因此这些疾病往往得不到充分治疗。多种疾病的危险因素包括较低的教育程度和社会经济地位；历史上代表性不足的人群中的妇女面临着额外的风险。 女性慢性病的预防、诊断和治疗的证据基础尚不完善。这在很大程度上是因为缺乏对女性健康的有意研究，并且历史上男性在临床研究中所占比例过高。例如，临床研究传统上并未经过适当设计来获取女性数据（例如研究终点和纳入标准）；关于女性特有的慢性病的研究也很有限。 2010 年 IOM 报告（女性健康研究：进展、陷阱和承诺）强调了女性健康研究某些领域的进步； IOM 报告强调的许多差距仍然存在，并在 2022 年 NASEM 报告（改善临床试验和研究的代表性：为女性和代表性不足群体建立研究公平性）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。例如，细胞水平上性别差异的基础生物学研究（IOM，2001，探索对人类健康的生物学贡献：性别重要吗？）可能会带来理解不同慢性病表现和经历以及治疗和预防方法的创新。 NIH 认识到需要关注女性慢性衰弱性疾病，并将其作为 2021 年推进 NIH 妇女健康研究会议的优先主题。最终报告强调了会议讨论，指出了定义女性慢性衰弱性疾病和制定考虑这些疾病的框架所面临的挑战。还确定了与这些条件相关的具体研究差距和机会。会议报告还强调了女性慢性病研究中类似的挑战和差距，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）中所述。 NIH 寻求美国国家科学院、工程院和医学院的帮助，审查有关女性特有的慢性衰弱性疾病的文献，汇总基于证据的研究结果，描述当前的证据差距，并提供未来的研究议程。