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. 2016 Aug 2;165(3):184-93.
doi: 10.7326/M15-2877. Epub 2016 Apr 26.

Reporting of Sex Effects by Systematic Reviews on Interventions for Depression, Diabetes, and Chronic Pain

Wei Duan-Porter, Karen M Goldstein, Jennifer R McDuffie, Jaime M Hughes, Megan E B Clowse, Ruth S Klap, Varsha Masilamani, Nancy M Allen LaPointe, Avishek Nagi, Jennifer M Gierisch, John W Williams Jr

Reporting of Sex Effects by Systematic Reviews on Interventions for Depression, Diabetes, and Chronic Pain

Wei Duan-Porter et al. Ann Intern Med. .

Abstract

Systematic reviews (SRs) have the potential to contribute uniquely to the evaluation of sex and gender differences (termed "sex effects"). This article describes the reporting of sex effects by SRs on interventions for depression, type 2 diabetes mellitus, and chronic pain conditions (chronic low back pain, knee osteoarthritis, and fibromyalgia). It includes SRs published since 1 October 2009 that evaluate medications, behavioral interventions, exercise, quality improvement, and some condition-specific treatments. The reporting of sex effects by primary randomized, controlled trials is also examined. Of 313 eligible SRs (86 for depression, 159 for type 2 diabetes mellitus, and 68 for chronic pain), few (n = 29) reported sex effects. Most SRs reporting sex effects used metaregression, whereas 9 SRs used subgroup analysis or individual-patient data meta-analysis. The proportion of SRs reporting the sex distribution of primary studies varied from a low of 31% (n = 8) for low back pain to a high of 68% (n = 23) for fibromyalgia. Primary randomized, controlled trials also infrequently reported sex effects, and most lacked an adequate sample size to examine them. Therefore, all SRs should report the proportion of women enrolled in primary studies and evaluate sex effects using appropriate methods whenever power is adequate.

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Figures

Appendix Figure.
Appendix Figure.
Primary studies included in the largest eligible SR for key interventions addressing conditions of interest. SR = systematic review. * Some reviews included studies with other depressive disorders.
Figure 1.
Figure 1.
Summary of evidence search and selection. * 114 of 159 eligible diabetes reviews were fully abstracted. The remaining 45 reviews received a keyword text search and were not further abstracted because of negative search results.
Figure 2.
Figure 2.
Proportion of eligible SRs reporting sex effects for depression and diabetes. In addition, 2 diabetes reviews reported sex effects for bariatric surgery; 1 depression review examined sex effects for combined medications and psychotherapy; 1 depression review reported on guided self-help; and 2 reviews on chronic low back pain looked at sex effects for medications and pain rehabilitation programs, respectively. No reviews on knee osteoarthritis or fibromyalgia reported sex effects. SR = systematic review.
Figure 3.
Figure 3.
Proportion of eligible SRs reporting sex effects for depression and diabetes from 2010 to 2014. SR = systematic review.
See this image and copyright information in PMC

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