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
. 2025 Jul 17;3(2):e002510.
doi: 10.1136/bmjph-2024-002510. eCollection 2025.

Are sex and gender dimensions accounted for in NICE guidelines? A systematic review of 223 clinical guidelines

Rachel Hulme  1 , Owen Wilkinson  2 , Ella Haythornthwaite  2 , Veronia Benjamin  2 , Hemali Matharu  2 , Marina Politis  1 , Kate Womersley  1   2   3 , Robyn Norton  2   4   5 , Alice Witt  1
Affiliations

Are sex and gender dimensions accounted for in NICE guidelines? A systematic review of 223 clinical guidelines

Rachel Hulme et al. BMJ Public Health. .

Abstract

Introduction: The importance of sex and gender in the diagnosis and management of health conditions is well established, but the extent to which sex and gender disaggregated evidence is integrated into UK clinical practice guidelines remains unknown. Recent reviews of clinical guidelines in Canada and Europe identified that limited and inconsistent attention was paid to sex and gender dimensions of health and illness. This study aimed to determine how the UK's National Institute of Clinical Excellence (NICE) clinical guidelines account for sex and gender.

Methods: The study reviewed all NICE guidelines categorised as 'clinical guidelines' by NICE (223), excluding those solely linked to single-sex conditions (26). Reviewers evaluated whether they included information on sex and/or gender dimensions of disease risk, presentation, investigations and management. They also examined if sex and/or gender dimensions were considered outside of pregnancy, and how the gender of guideline committee chairs and members corresponded to how well sex and/or gender were accounted for.

Results: Of 197 guidelines reviewed, 120 (61%) referenced sex and/or gender dimensions, with 81 (41%) referencing these dimensions outside of pregnancy and childbearing. A minority of guidelines mentioned sex and/or gender dimensions related to disease pathophysiology (2%), clinical presentation (9%), investigations (15%) and epidemiology (19%). 162 guidelines published details of their committee chairs, and 126 (76%) were men. Committees chaired by women tended to produce guidelines, which scored better for consideration of sex and gender.

Conclusion: This study highlights key gaps in NICE guidelines which must be addressed through systematic, whole-sector progress to integrate sex and gender disaggregated research into clinical guidelines. As the single focal point responsible for guideline development in England and Wales, NICE has a unique opportunity to establish robust mechanisms to routinely embed this important evidence in guidelines. Multiple initiatives are recommended to identify relevant existing evidence across all clinical specialties.

Keywords: Female; Health Personnel; Public Health; Sex Factors; Sociodemographic Factors.

PubMed Disclaimer

Conflict of interest statement

RN, KW, AW, MP and RH work on the Medical Science Sex and Gender Equity (MESSAGE) project; RN, KW and AW receive funding from Wellcome for MESSAGE. KW is on the advisory board of BMJ Public Health. Within the past 36 months, RN received funding from an anonymous philanthropic donor to support The George Institute’s Sex and Gender Policy research.

Figures

Figure 1
Figure 1. PRISMA flowchart recording data sources and inclusion criteria. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Figure 2
Figure 2. Number of NICE clinical guidelines according to the rating category which they achieved. NICE, National Institute of Clinical Excellence.
Figure 3
Figure 3. Number of NICE clinical guidelines considering the sex and/or gender dimensions of different disease components. NICE, National Institute of Clinical Excellence.
Figure 4
Figure 4. Gender of recent guideline committee chairs.
See this image and copyright information in PMC

References

    1. Mauvais-Jarvis F, Bairey Merz N, Barnes PJ, et al. Sex and gender: modifiers of health, disease, and medicine. The Lancet. 2020;396:565–82. doi: 10.1016/S0140-6736(20)31561-0. - DOI - PMC - PubMed
    1. Williams A, Lyeo JS, Geffros S, et al. The integration of sex and gender considerations in health policymaking: a scoping review. Int J Equity Health. 2021;20:69. doi: 10.1186/s12939-021-01411-8. - DOI - PMC - PubMed
    1. Women are 50% more likely than men to be given incorrect diagnosis following a heart attack. [1-Dec-2024]. https://www.bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2016/au... Available. Accessed.
    1. Wilkinson C, Bebb O, Dondo TB, et al. Sex differences in quality indicator attainment for myocardial infarction: a nationwide cohort study. Heart . 2019;105:516–23. doi: 10.1136/heartjnl-2018-313959. - DOI - PMC - PubMed
    1. Kannegaard PN, van der Mark S, Eiken P, et al. Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing. 2010;39:203–9. doi: 10.1093/ageing/afp221. - DOI - PubMed

LinkOut - more resources