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. 2019 Mar 15;19(1):169.
doi: 10.1186/s12913-019-4001-9.

Consideration of sex and gender in Cochrane reviews of interventions for preventing healthcare-associated infections: a methodology study

Jesús López-Alcalde  1   2   3   4 , Elena Stallings  5 , Sheila Cabir Nunes  6 , Abelardo Fernández Chávez  7 , Mathilde Daheron  6 , Xavier Bonfill Cosp  8   9 , Javier Zamora  5   9
Affiliations

Consideration of sex and gender in Cochrane reviews of interventions for preventing healthcare-associated infections: a methodology study

Jesús López-Alcalde et al. BMC Health Serv Res. .

Abstract

Background: Healthcare-associated infections (HAIs) are common and increase morbidity, mortality, and healthcare costs. Their control continues to be an unresolved issue worldwide. HAIs epidemiology shows sex/gender differences. Thus the lack of consideration of sex/gender in Cochrane reviews will limit their applicability and capacity to support informed decisions. This study aims to describe the extent to which Cochrane reviews of interventions for preventing HAIs consider sex and gender.

Methods: Methodology study appraising Cochrane reviews of interventions to prevent HAIs.

Search methods: Cochrane Database of Systematic Reviews from 1995 (launch of the journal) to 31 December 2016. Two authors independently extracted data with EPPI-Reviewer 4 software, and independently appraised the sex/gender content of the reviews with the Sex and Gender Appraisal Tool for Systematic Reviews (SGAT-SR).

Results: This study included 113 reviews assessing the effects of interventions for preventing HAIs. 100 reviews (88%) used at least one sex or gender-related term. The terminology used was heterogeneous, being "sex" the term used in more reviews (51%). No review defined neither sex nor gender. Thus we could not assess the definitions provided. Consideration of sex and gender was practically absent in the included reviews; in fact, no review met all the applicable items of the SGAT-SR, and 51 reviews (50%) fulfilled no item. No review provided a complete description of the sex and the gender of the samples of the included studies. Only ten reviews (10%) planned to perform sex- and gender-based analysis and only three (3%) could complete the analysis. The method chosen was always the subgroup analysis based on sex (one review) or gender (two reviews). Three reviews (3%) considered sex or gender-related findings in the conclusions.

Conclusion: Consideration of sex and gender in Cochrane reviews of interventions for preventing HAIs was practically absent. This lack of attention to sex and gender reduces the quality of Cochrane reviews, and their applicability for all people: women and men, boys and girls, and people of diverse gender identities. Cochrane should attempt to address the shortfalls detected.

Keywords: Cochrane; Data extraction; Equity; Gender; Gender bias; Healthcare-associated infection; Sex; Sex/gender; Systematic reviews.

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Conflict of interest statement

Authors’ informations

JLA is a PhD candidate in Methodology of Biomedical Research and Public (Department of Paediatrics, Obstetrics & Gynaecology and Preventative Medicine at the Universitat Autònoma de Barcelona, Spain). This study is part of his PhD.

SCN, as part of her dissertation for the MSc Research for Public Policy and Practice at the Institute of Education (IOE), University College London (UCL), analysed a subgroup of the included reviews. The dissertation, presented September 1st, 2017, was titled “Sex and gender analysis in Cochrane reviews of interventions for preventing methicillin-resistant Staphylococcus aureus (MRSA)”, MSc, Institute of Education, University College London, London UK. Thus, the dissertation had common elements with our study, in particular, the selection process of the reviews (screening for titles/abstracts and full texts assessment), and the development of the data extraction templates. From the total number of reviews included in the study, SCN identified those reviews evaluating interventions to prevent MRSA transmission. Moreover, the data extraction templates and processes used in the dissertation represented a pilot of the whole study.

The SEXCOMPLEX Working Group leads the two-year project (2017–2019) titled “Influence of sex and sex hormones on human chronic disorders of complex etiology” (SEXCOMPLEX). The project is coordinated by Hospital Ramón y Cajal (Madrid, Spain) and funded by the Institute of Health Carlos III (Ministry of Economy, Industry, and Competitiveness, Spain). SEXCOMPLEX aims to assess the influence of sex/gender differences and sex hormones on the pathogenesis, clinical presentation, course and prognosis of chronic disorders of complex multifactorial aetiology. This manuscript is the deliverable of one of the work packages of the SEXCOMPLEX project.

We published a prior abstract (less than 400 words) and poster presenting the preliminary results of this study as part of Global Evidence Summit, Cape Town, South Africa (2017) [117].

Ethics approval and consent to participate

Not applicable. The Ethics Committee of Hospital Universitario Ramón y Cajal (Madrid, Spain) did not require ethical approval for this study, as it does not report on or involve the use of any animal or human data or tissue.

Consent for publication

Not applicable. The manuscript does not contain data from any individual person.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram of the selection process
Fig. 2
Fig. 2
Appropriateness of the sex and gender terminology
Fig. 3
Fig. 3
Sex and gender appraisal graph. Judgements across reviews for each item of the tool
See this image and copyright information in PMC

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