Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Apr;6(4):e005413.
doi: 10.1136/bmjgh-2021-005413.

Identification and inclusion of gender factors in retrospective cohort studies: the GOING-FWD framework

Valeria Raparelli  1   2 , Colleen M Norris  2 , Uri Bender  3 , Maria Trinidad Herrero  4 , Alexandra Kautzky-Willer  5 , Karolina Kublickiene  6   7 , Khaled El Emam  8   9   10 , Louise Pilote  11   12 ; GOING‑FWD Collaborators
Collaborators, Affiliations
Review

Identification and inclusion of gender factors in retrospective cohort studies: the GOING-FWD framework

Valeria Raparelli et al. BMJ Glob Health. 2021 Apr.

Abstract

Gender refers to the socially constructed roles, behaviours, expressions and identities of girls, women, boys, men and gender diverse people. Gender-related factors are seldom assessed as determinants of health outcomes, despite their powerful contribution. The Gender Outcomes INternational Group: to Further Well-being Development (GOING-FWD) project developed a standard five-step methodology applicable to retrospectively identify gender-related factors and assess their relationship to outcomes across selected cohorts of non-communicable chronic diseases from Austria, Canada, Spain, Sweden. Step 1 (identification of gender-related variables): Based on the gender framework of the Women Health Research Network (ie, identity, role, relations and institutionalised gender), and available literature for a certain disease, an optimal 'wish-list' of gender-related variables was created and discussed by experts. Step 2 (definition of outcomes): Data dictionaries were screened for clinical and patient-relevant outcomes, using the International Consortium for Health Outcome Measurement framework. Step 3 (building of feasible final list): a cross-validation between variables per database and the 'wish-list' was performed. Step 4 (retrospective data harmonisation): The harmonisation potential of variables was evaluated. Step 5 (definition of data structure and analysis): The following analytic strategies were identified: (1) local analysis of data not transferable followed by a meta-analysis combining study-level estimates; (2) centrally performed federated analysis of data, with the individual-level participant data remaining on local servers; (3) synthesising the data locally and performing a pooled analysis on the synthetic data and (4) central analysis of pooled transferable data. The application of the GOING-FWD multistep approach can help guide investigators to analyse gender and its impact on outcomes in previously collected data.

Keywords: cohort study; epidemiology; health policies and all other topics; public health.

PubMed Disclaimer

Conflict of interest statement

Competing interests: VR, CNM, UB, MTH, AKW, KK, and LP have nothing to disclose; KEE is co-founder, director, and investor in Replica Analytics Ltd, a CHEO Research Institute / University of Ottawa spinoff company that develops data synthesis software.

Figures

Figure 1
Figure 1
The GOING-FWD multistep methodology on identification and inclusion of gender factors in retrospective cohort studies. GOING-FWD, Gender Outcomes INternational Group: to Further Well-being Development.
Figure 2
Figure 2
Domains that gender encompasses.
Figure 3
Figure 3
Data structure and potential options for analysis based on transferability of data.
See this image and copyright information in PMC

References

    1. CIHR, Online Training Modules . Integrating Sex & Gender in Health Research, 2019. Available: https://cihr-irsc.gc.ca/e/49347.html [Accessed 23 Apr 2020].
    1. Norris CM, Murray JW, Triplett LS, et al. . Gender roles in persistent sex differences in health-related quality-of-life outcomes of patients with coronary artery disease. Gend Med 2010;7:330–9. 10.1016/j.genm.2010.07.005 - DOI - PubMed
    1. Weber AM, Cislaghi B, Meausoone V, et al. . Gender norms and health: insights from global survey data. Lancet 2019;393:2455–68. 10.1016/S0140-6736(19)30765-2 - DOI - PubMed
    1. , Forouzanfar MH, Alexander L, et al. , GBD 2013 Risk Factors Collaborators . Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the global burden of disease study 2013. Lancet 2015;386:2287–323. 10.1016/S0140-6736(15)00128-2 - DOI - PMC - PubMed
    1. Bartz D, Chitnis T, Kaiser UB, et al. . Clinical advances in sex- and Gender-Informed medicine to improve the health of all: a review. JAMA Intern Med 2020;180:574–83. 10.1001/jamainternmed.2019.7194 - DOI - PubMed