Sex differences in onset and prevalence of 108 diseases and multimorbidity across lifespan in Yichang, China: quantitative analysis of real-world linked electronic health records

Abstract

Objective: The magnitude and persistence of diseases and multimorbidity between females and males are different. This study comprehensively quantified sex differences in the onset and progression of 108 major physical and mental diseases to multimorbidity through adulthood in Chinese population.

Design: Quantitative analysis of real-world linked electronic health records.

Setting: Linked health records from 160 health facilities across primary, secondary and tertiary healthcare, comprising routinely collected electronic health records from the whole urban residents of Yichang, China between 1 January 2016 and 31 December 2019.

Participants: 684 455 urban residents aged 20 years and above with documented health records during the study period.

Main outcomes measures: The cumulative incidence, relative risks (RR) and 95% CIs, period prevalence, median age at disease diagnosis and the prevalence of multimorbidity of 108 major physical and mental diseases were computed. All analyses were stratified by sex and age groups.

Results: The analysis included 684 455 individuals (54.8% females, mean age: 46.9), among whom 46.3% had multimorbidity, with a higher prevalence in females (47.6%) than males (44.9%). The chronological disease map revealed stark differences between females and males, with notable lower risk of obstructive sleep apnoea-hypopnoea syndrome (OSAHS, RR: 0.03, 95% CI: 0.01 to 0.11) for young adults, oesophageal cancer (RR: 0.02, 95% CI: 0.0 to 0.17) for mid-age adults and remarkable higher risk of lupus (RR: 8.8, 95% CI: 2.7 to 29.0) for older adults of females. Males exhibited an incidence surge in hypertension, diabetes, coronary disease and chronic obstructive pulmonary disease a decade earlier than females, while females had a life-long higher prevalence in immune-mediated diseases and urinary disorders. For the new incident diseases, the manifestation of eating disorders, anaemia and urinary incontinence was recorded 20 years earlier in females; whereas, males were diagnosed with hyperuricaemia, OSAHS and schizophrenia at younger ages.

Conclusions: The significant variations in disease nature and trajectory between sexes underscore the urgent needs for tailored prevention strategies and appropriate health resources allocation. Sex differences in disease profile should be considered to delay disease and multimorbidity progression, ultimately promoting health equity.

Keywords: China; EPIDEMIOLOGY; Health Equity; PUBLIC HEALTH.

Figure 1. Cumulative incidence (%) of the top 50 diseases between 1 January 2016 and 31 December 2019, stratified by sex and ages. (A) 20-29 years, (B) 30-39 years, (C) 40-49 years, (D) 50-59 years, (E) 60-69 years, (F) 70-79 years, (G) 80 years or more; BPH, benign prostatic hyperplasia; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; DPN, disorders of peripheral neuropathy; GERD, gastro-oesophageal reflux disease; IBS, irritable bowel syndrome; LRTI, lower respiratory tract infection; TB, tuberculosis; URTI, upper respiratory tract infection.

Figure 2. Median age at first record for disease with median age of diagnosis, stratified by sex. BPH, benign prostatic hyperplasia; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; DPN, disorders of peripheral neuropathy; GERD, gastro-oesophageal reflux disease; HPV, human papilloma virus; IBD, inflammatory bowel disease; IBS, irritable bowel syndrome; ILD, interstitial pneumonia; OSAHS, sleep apnoea-hypopnoea syndrome; PAH, pulmonary hypertension; PTSD, post-traumatic stress disorder; TB, tuberculosis; UCTD, undifferentiated connective tissue disease; URTI, upper respiratory tract infection; VTE, venous thromboembolism.

Figure 3. Age-standardised relative risk for the top 50 diseases between females vs males. CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; IBD, inflammatory bowel disease; ILD, interstitial pneumonia; OSAHS, sleep apnoea-hypopnoea syndrome; PAH, pulmonary hypertension; PTSD, post-traumatic stress disorder; TB, tuberculosis; UCTD, undifferentiated connective tissue disease.

Figure 4. Number of diagnosed conditions per individual (from 108 health conditions), stratified by sex and age.