Are we moving the dial? Canadian health research funding trends for women's health, 2S/LGBTQ + health, sex, or gender considerations

Abstract

Background: Sex and gender impacts health outcomes and disease risk throughout life. The health of women and members of the Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer or Questioning (2S/LGBTQ +) community is often compromised as they experience delays in diagnosis. Distinct knowledge gaps in the health of these populations have prompted funding agencies to mandate incorporation of sex and gender into research. Sex- and gender-informed research perspectives and methodology increases rigor, promotes discovery, and expands the relevance of health research. Thus, the Canadian Institutes of Health Research (CIHR) implemented a sex and gender-based analysis (SGBA) framework recommending the inclusion of SGBA in project proposals in 2010 and then mandating the incorporation of SGBA into grant proposals in 2019. To examine whether this mandate resulted in increased mention of sex or gender in funded research abstracts, we searched the publicly available database of grant abstracts funded by CIHR to analyze the percentage of abstracts that mentioned sex or gender of the population to be studied in the funded research. To better understand broader health equity issues we also examined whether the funded grant abstracts mentioned either female-specific health research or research within the 2S/LGBTQ + community.

Results: We categorized a total of 8,964 Project and Operating grant abstracts awarded from 2009 to 2020 based on their study of female-specific or a 2S/LGBTQ + populations or their mention of sex or gender. Overall, under 3% of grant abstracts funded by CIHR explicitly mentioned sex and/or gender, as 1.94% of grant abstracts mentioned sex, and 0.66% mentioned gender. As one of the goals of SGBA is to inform on health equity and understudied populations with respect to SGBA, we also found that 5.92% of grant abstracts mentioned female-specific outcomes, and 0.35% of grant abstracts focused on the 2S/LGBTQ + community.

Conclusions: Although there was an increased number of funded grants with abstracts that mentioned sex and 2S/LGBTQ + health across time, these increases were less than 2% between 2009 and 2020. The percentage of funded grants with abstracts mentioning female-specific health or gender differences did not change significantly over time. The percentage of funding dollars allocated to grants in which the abstracts mentioned sex or gender also did not change substantially from 2009 to 2020, with grant abstracts mentioning sex or female-specific research increasing by 1.26% and 3.47%, respectively, funding allocated to research mentioning gender decreasing by 0.49% and no change for 2S/LGBTQ +-specific health. Our findings suggest more work needs to be done to ensure the public can evaluate what populations will be examined with the funded research with respect to sex and gender to advance awareness and health equity in research.

Keywords: 2S/LGBTQ + health; CIHR; Canada; Female; Gender; Research funding; Sex; Women’s health.

Fig. 1

Timeline of mandates for inclusion and analysis of women/females in research from 1993 to 2020 from the National Institutes of Health (NIH) in the United States, the Canadian Institutes of Health Research (CIHR), and Horizon Europe. Prior to 1993 all premenopausal females were banned by the Food and Drug Administration (FDA) from participating in drug trials in the United States

Fig. 2

Mean percentage of grant abstracts and funding awarded to each category of health research that mentioned the terms listed. A Pie chart of the percentages of Canadian Institutes of Health Research (CIHR) grants in each category (% of total grant abstracts) from 2009 to 2020. N = 8964. Sex: 1.94% (n = 170); 2S/LGBTQ +: 0.35% (n = 33); female-specific: 5.92% (n = 517); gender: 0.66% (n = 60); “Sex/Gender omitted”: 91.65% (n = 8,230). Additionally, 4.07% of the grant abstracts were female-specific excluding cancer grants (n = 367). B Pie chart of the percentage of CIHR funding dollars (% of total funding amounts) for categorized grants abstracts from 2009 to 2020. Sex: 1.67%; 2S/LGBTQ +: 0.36%; female-specific: 5.65%; gender: 0.46%; Sex/gender omitted: 92.27%. Additionally, 3.81% of the grants were female-specific excluding cancer grants

Fig. 3

Mean percentage of grants awarded to each category of health research. A–C Percentage of total grants funded by Canadian Institutes for Health Research (CIHR) binned in three time points: 2009–2012, 2013–2016, and 2017–2020. Data points indicate individual years within the range and error bars represent standard error of the mean (SEM). A Percentage of grants funded by year that mentioned sex (yellow) and gender (green) in their abstracts remained below 2% throughout the years. Grant abstracts that mentioned sex increased over time (R² = 0.56, F (1, 10) = 12.91, p = 0.005, β = 0.75) but grant abstracts that mentioned gender did not (R² = 0.18, F (1, 10) = 2.20, p = 0.17, β = − 0.042). B Percentage of grant funding amounts (funded by year) that mentioned female-specific health or disease factors (red), or with female-specific health without cancer research (purple). The percentage of grants awarded in either category did not increase over time [Female-specific: R² = 0.08, F (1, 10) = 0.82, p = 0.39, β = 0.28; female-specific without cancer: R² = 0.10, F (1, 10) = 1.15, p = 0.32, β = 0.32]. The percentage of grants that mentioned 2S/LGBTQ + health (blue) in their abstracts funded by year remained below 1% across all years but increased significantly over time [R² = 0.36, F (1, 10) = 5.53, p = 0.04, β = 0.60]

Fig. 4

Keyword search for mentions of sex, gender, or female health, in given proposal keywords separated by subject category. Data obtained from search of “keywords” associated with grant abstract. A In grants with Human subjects (obtained by key word search): 11% (n = 34) also had a keyword of “sex”, 3% (n = 10) had a keyword of “female”, 3% (n = 9) had a keyword of gender, and 83% had no keyword mention of sex, gender, or female health. (B) In grants with keywords that mentioned cell lines, cell culture or in vitro subjects: 3% (n = 7) also had a keyword of “sex”, 1% (n = 3) had a keyword of “female”, 4% (n = 9) had a keyword of gender, and 92% had no keyword mention of sex, gender, or female health. C In grants with mice subjects (obtained by keyword search): 5% (n = 37) also had a keyword of “sex”, 3% (n = 25) had a keyword of “female”, 2% (n = 17) had a keyword of gender, and 89% had no keyword mention of sex, gender, or female health

Fig. 5

An infographic depicting the change in percentage of grants and funding between 2009 and 2020 for awarded Canadian institutes of Health Research (CIHR) grants for the different categories. The change in percentage (%) of grants (A) and funding amount (B) in the years 2009 and 2020 that did not mention of sex and gender in their grant abstracts or mentioned female-specific health, female-specific health not including cancer based grants, sex, gender, or 2S/LGBTQ + health