Medical drugs are one of the most common treatment interventions in healthcare. Already in the late 1960s, gender differences in drug utilization were highlighted but no systematic analysis has yet been done.
In Sweden there are opportunities to study – one of the few countries in the world – all residents’ purchase of prescription drugs. This makes it possible to systematically analyze gender differences in drug utilization. An analysis carried out by Region Stockholm (then Stockholm County Council) and Karolinska Institutet (1, 2) showed that 6.2 million (67%) of Sweden’s population purchased at least one prescribed drug in the year 2009. Of these, 2.7 million purchases were by men and 3.5 million purchases were by women. Elderly purchased most prescription drugs. Of the population 65 years and older, 80 percent were treated with drugs. In all age groups – except for the youngest – women had the greatest drug utilization. Although the use of contraception pills was not counted in, women purchased more drugs. Seventy-five drug classes have been studied and in more than three quarters of these groups, the drug utilization was higher among women. Antibiotics are the most used drug class – 19 percent of men and 26 percent of women. It can be explained by a greater percentage of women are diagnosed with urinary tract infections, although there may be other causes for the symptoms. Women use more painkillers, probably because women are more likely than men to suffer from diseases that cause chronic pain. Of all patients diagnosed with depression, 70 percent are women. Sleeping pills are used more often by women even though sleep problems are reported to be equally common in both sexes. Vitamins and minerals are mostly used by women, usually of unknown cause. Adverse events are reported more often by women than men. Women receive higher doses relative to their body weight. Men dispense more drugs for alcohol dependence, opioid dependence, gout, diabetes and anti-arrhythmic drugs.
Healthcare seems to not adapt to women’s and men’s different conditions regarding drugs. Sometimes there is a lack of knowledge about the gender-specific needs. Men are at risk of being treated according to a female standard (e.g. osteoporosis) and women can receive treatment according to a male standard (e.g. acute myocardial infarction).
The politicians in Region Stockholm (then Stockholm County Council) and the Health and Medical Care Board urged in 2011 the Health and Medical Care Administration to initiate following with regard to drugs:
- To create a knowledge base about sex and gender differences in drug utilization in the county
- The Health and Medical Care Administration should continuously study and analyze drug utilization from a gender perspective and the factors that can explain the differences should be further analyzed
- The Health and Medical Care Administration should review the possibility of designing a knowledge support system for drug prescribing and dose recommendations where gender-specific needs are taken into account
This knowledge support service is an initiative to collect and systematize the knowledge and literature available in the area of drugs and sex/gender. Hopefully, this will stimulate more research and analysis as well as greater insight and understanding of these issues in medicine.
Stockholm, September 2013, Karin Schenck-Gustafsson
- Loikas D, Wettermark B, von Euler M, et al. Stora könsskillnader i användningen av läkemedel. Läkartidningen. 2011;108:40
- Loikas D, Wettermark B, von Euler M, et al. Differences in drug utilisation between men and women: a cross-sectional analysis of all dispensed drugs in Sweden. BMJ Open 2013;3(5) Pubmed 23645921