Chronic conditions in women: the development of a National Institutes of health framework

Abstract

Rising rates of chronic conditions were cited as one of the key public health concerns in the Fiscal Year (FY) 2021 U.S. Senate and House of Representatives appropriations bills, where a review of current National Institutes of Health (NIH) portfolios relevant to research on women's health was requested. Chronic conditions were last defined by the US Department of Health and Human Services (HHS) in 2010. However, existing definitions of chronic conditions do not incorporate sex or gender considerations. Sex and gender influence health, yet significant knowledge gaps exist in the evidence-base for prevention, diagnosis, and treatment of chronic diseases amongst women. The presentation, prevalence, and long-term effects of chronic conditions and multimorbidity differs in women from men. A clinical framework was developed to adequately assess the NIH investment in research related to chronic conditions in women. The public health needs and NIH investment related to conditions included in the framework were measured. By available measures, research within the NIH has not mapped to the burden of chronic conditions among women. Clinical research questions and endpoints centered around women can be developed and implemented; clinical trials networks with expanded or extended eligibility criteria can be created; and data science could be used to extrapolate the effects of overlapping or multiple morbidities on the health of women. Aligning NIH research priorities to address the specific needs of women with chronic diseases is critical to addressing women's health needs from a life course perspective.

Keywords: Chronic disease; Gender; Multimorbity; Sex differences; Women’s health.

Fig. 1

Age- standardized incidence rates of the accumulation of morbidity and multimorbidity disaggregated by race and gender. Adapted from St Sauver JL, et al. BMJ Open 2015;5:e006413 http://dx.doi.org/10.1136/bmjopen-2014-006413

Fig. 2

Conceptual model and research framework for multimorbidity, depicting relationships among causal factors, disease conditions and interactions, and outcomes of multimorbidity. Source: Salive ME, Suls J, Farhat T, Klabunde CN. 2021. National Institutes of Health Advancing Multimorbidity Research. Med Care. 2021;59(7):622–624. 10.1097/MLR.0000000000001565. PMID: 33,900,269

Fig. 3

Exclusion of subjects with multimorbidities decreases the validity and generalizability of research throughout the pipeline. Disparate funding is a telescoping problem: The relevance of new data is focused on the population that we already know the most about; important disease-relevant, mechanistic information revealed by studying across populations is missed. Therefore less information is available on any given chronic condition in women, because fewer women meet the diagnostic criteria making them eligible for clinical research