A FRAMEWORK FOR THE CONSIDERATION OF CHRONIC DEBILITATING CONDITIONS IN WOMEN

考虑女性慢性衰弱状况的框架

• 批准号: 10710310
• 负责人: ROBERT DAY
• 金额: $ 25万
• 依托单位: NATIONAL ACADEMY OF SCIENCES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-28 至 2024-09-27
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10710310
• 关键词: Activities of Daily Living; Adaptive Immune System; Age; Aging; Arthritis; Asthma; Autoimmunity; Chronic; Chronic Disease; Clinical; Clinical Research; Coronary heart disease; Data; Dementia; Development; Diabetes Mellitus; Diagnosis; Disadvantaged; Disease; Dysmenorrhea; Educational workshop; Epidemiology; Ethnic Origin; Fee-for-Service Plans; Female; Functional disorder; Future; Gender; Gynecologic; Health; Hormonal; Hypertension; Impaired cognition; Knowledge; Life Expectancy; Link; Literature; Longevity; Malignant Neoplasms; Menopause; Mental Depression; Morbidity - disease rate; Muscle function; Muscular Atrophy; Musculoskeletal; Natural History; Obesity; Osteoporosis; Outcome; Pattern; Performance; Polycystic Ovary Syndrome; Population; Prevalence; Prevention; Production; Puberty; Race; Reporting; Reproductive Health; Research; Review Literature; Risk Factors; Rural Population; Sex Differences; Sexual and Gender Minorities; Skeletal Muscle; Social Impacts; Socioeconomic Status; Underrepresented Populations; United States Dept. of Health and Human Services; Vaccination; Woman; Women' s Health; beneficiary; body system; bone loss; cancer therapy; chronic pain; cost; design; disadvantaged women; disorder risk; economic impact; endometriosis; ethnic difference; evidence base; experience; frailty; gender difference; inclusion criteria; low socioeconomic status; medical attention; men; multiple chronic conditions; muscle form; muscle strength; persistent symptom; racial difference; reproductive hormone; response; rural underserved; sarcopenia; sex; social health determinants; social influence; treatment effect

Background/Overview: With the aging of our population and longer life expectancies compared to men, chronic debilitating conditions pose an increasingly significant burden on the health of women. Chronic conditions include a wide array of diseases and disorders that occur across the lifespan, many of which are sex-specific.1 Although women are now routinely included in clinical research, research is infrequently designed to obtain data on women. Inclusion criteria and study end points are not often centered around the needs of women.2 Sex and gender differences in the prevalence and clinical presentation of chronic conditions have been documented. CMS data (fee-for-service beneficiaries, excluding Medicare Advantage enrollees), disaggregated by sex, notes six conditions that occur more frequently in women: hypertension, arthritis, depression, dementia, asthma, and osteoporosis.3 Lower socioeconomic status and lower educational attainment are additional risk factors for multimorbidity, defined as the simultaneous occurrence of two or more diseases that may or may not share a causal link, that further disadvantage women, with additional disadvantage impacting the health of women who identify with historically underrepresented populations.4, 5 Several evidence gaps in our understanding of chronic debilitating conditions in women have arisen from a historical over-reliance on men in clinical research. Symptoms of chronic conditions experienced by women are often different from men; women have lower response rates to many first-line treatments; and the effects of hormonal transitions, such as menopause, on the natural history of chronic diseases have not been well-described. Further, the broad assumption that women’s health is inexorably linked to reproductive health has limited research on female-specific chronic conditions such as dysmenorrhea, endometriosis, and polycystic ovarian syndrome. Sex differences in the innate and adaptive immune system after puberty may influence the risk for disease (e.g., asthma), autoimmunity, and response to vaccination and cancer therapies.6 Chronic disease risk—including for coronary heart disease, cancers, musculoskeletal conditions, chronic pain, obesity, diabetes, and cognitive impairment—accumulate with age and generally increase after menopause, when reproductive hormone production declines.7, 8 There is a pressing need to understand how aging-related skeletal muscle dysfunction, frailty and bone loss impact or is impacted by chronic conditions in women. Aging-related skeletal muscle function deficit (SMFD) or skeletal muscle dysfunction—including loss of muscle mass (sarcopenia), muscle strength, and muscle function—may negatively impact or be impacted by chronic conditions or chronic debilitating conditions in women. Women more commonly than men have multimorbidity.9 The “networks” of morbidity are different in women, with multimorbidity more likely to cross multiple organ systems compared to men.10 Additionally, the pattern of accumulation of morbidity, meaning what initial chronic conditions are diagnosed and how conditions are additive, differs by sex and gender.11 In women with multimorbidity, the interactions among conditions are poorly understood and often inadequately treated.4 Chronic debilitating conditions were last defined by the US Department of Health and Human Services (HHS) in 2010 as “conditions that last a year or more and require ongoing medical attention and/or limit activities of daily living.”12 However, this and other existing definitions of chronic debilitating conditions do not incorporate sex or gender considerations. Sex and gender influence health; and yet, significant knowledge gaps exist in the evidence base for prevention, diagnosis, and treatment of chronic debilitating diseases amongst women. Task Description: • Review existing literature on chronic conditions specific to women. o Specifically review literature on how the development and accumulation of chronic conditions in women are influenced by factors such as menopause, aging-related skeletal muscle dysfunction (loss of muscle mass, muscle strength, and muscle function), and frailty including the epidemiology and social and economic impact. o Gender, racial, and ethnic differences in clinical presentation and outcomes should be considered. o Prevention, diagnosis, and treatment of female-specific gynecologic conditions should be reviewed and considered • Convene workshop[s] of identified experts. • Assemble evidence-based findings on chronic debilitating conditions in women. o The findings should incorporate the influence of social determinants of health, including but not limited to gender, race and/or ethnicity, socioeconomic status, sexual and gender minorities and underserved rural populations Produce a workshop report that describes current gaps in evidence and provides a suggested research agenda for the future.

背景/概述： 随着人口老龄化和预期寿命比男性更长，慢性衰弱性疾病对女性的健康造成越来越大的负担，慢性病包括一生中发生的各种疾病和失调，其中许多是性病。具体而言。1 尽管目前临床研究中已常规纳入女性，但研究很少旨在获取有关女性的数据，纳入标准和研究终点通常不以女性的需求为中心。2 患病率和临床表现方面的性别和性别差异。的慢性病已按性别分类的 CMS 数据（按服务收费的受益人，不包括 Medicare Advantage 参保者）指出了女性更常见的六种疾病：高血压、关节炎、抑郁症、痴呆、哮喘和骨质疏松症。3 社会经济地位较低，受教育程度较低是多发病的额外风险因素，多发病的定义是同时发生两种或多种疾病，这些疾病可能有也可能没有因果关系，这进一步使妇女处于不利地位，而额外的不利因素影响了历史上代表性不足的妇女的健康人口.4, 5 我们对女性慢性衰弱性疾病的理解存在一些证据差距，这是由于临床研究历史上对男性的过度依赖造成的。女性经历的慢性病症状通常与男性不同；女性对许多一线治疗的反应率较低。更年期等荷尔蒙转变对慢性疾病自然史的影响尚未得到充分描述。此外，妇女健康与生殖健康密切相关的广泛假设限制了针对女性的研究。痛经、子宫内膜异位症和多囊卵巢综合征等慢性疾病青春期后先天性和适应性免疫系统的性别差异可能会影响疾病（例如哮喘）、自身免疫以及对疫苗接种和癌症治疗的反应。6 慢性病风险。 — 包括冠心病、癌症、肌肉骨骼疾病、慢性疼痛、肥胖、糖尿病和认知障碍 — 随着年龄的增长而累积，并且通常在绝经后、生殖激素水平升高时增加7, 8 迫切需要了解与衰老相关的骨骼肌功能障碍、虚弱和骨质流失如何影响女性的慢性病或受其影响。包括肌肉质量的损失（肌肉减少症）、肌肉力量和肌肉功能——可能会对女性的慢性病或慢性衰弱病产生负面影响或受其影响。 女性比男性更常见地患有多种疾病。9 女性的发病“网络”有所不同，与男性相比，多种疾病更有可能跨越多个器官系统。10 此外，发病率累积的模式，即最初诊断出的慢性疾病以及疾病如何累加、因性别而异。11 在患有多种疾病的女性中，人们对疾病之间的相互作用知之甚少，而且常常得不到充分的治疗。4 美国卫生与公众服务部 (HHS) 在 2010 年将慢性衰弱性疾病定义为“持续一年或更长时间并需要持续医疗护理和/或限制日常生活活动的疾病”。12 然而，这种情况和其他情况慢性衰弱性疾病的现有定义并未纳入性别因素；然而，女性慢性衰弱性疾病的预防、诊断和治疗的证据基础存在重大知识差距。 任务描述： • 回顾有关女性慢性病的现有文献。 o 回顾有关女性慢性病的发展和积累如何受到多种因素影响的文献，例如更年期、与衰老相关的骨骼肌功能障碍（肌肉质量、具体肌肉力量和肌肉功能的丧失）以及虚弱，包括流行病学和社会学和经济影响。 o 应考虑临床表现和结果中的性别、种族和民族差异。 o 应审查和考虑女性特有的妇科疾病的预防、诊断和治疗 • 召开指定专家的研讨会。 • 收集关于女性慢性衰弱状况的循证研究结果。 o 研究结果应纳入健康问题社会决定因素的影响，包括但不限于性别、种族和/或族裔、社会经济地位、性少数群体和服务不足的农村人口 制作一份研讨会报告，描述当前的证据差距并提供未来的建议研究议程。