A comprehensive review of international studies has found that women with the same medical conditions as men are less likely to be offered active medical interventions, including surgical procedures, stents and strong analgesics.
Researchers at the University of St Andrews analysed 38 studies addressing treatment patterns across a range of illnesses and reported that in 33 of those studies women were less likely to be offered active treatment than men with comparable clinical presentations. The discrepancy was observed across conditions such as cardiovascular disease, kidney failure and Parkinson’s disease.
Differences in types of care offered
The review identified consistent patterns in how men and women are treated for several common and serious conditions. Among people with cardiac conditions — including myocardial infarction, heart failure and arrhythmias — women were more often managed with medication, while men were more frequently offered invasive procedures such as coronary bypass surgery or stent insertion. Women with cardiovascular disease were also less likely to be prescribed statins.
Other disparities noted include:
- People with Parkinson’s: men were more likely to be referred for deep brain stimulation than women.
- Advanced liver disease: men were more likely to receive a liver transplant than women.
- Kidney failure: female patients requiring dialysis were less likely to receive permanent vascular access and spent longer on a catheter.
- Pain management: women were less likely to be prescribed opioid analgesics for pain.
Scope and limitations
The authors report that the treatment differences they identified do not appear to be based on clinical guidance that mandates different care by sex. None of the studies in the review cited guidelines recommending sex-specific treatment that would explain the observed disparities, prompting the researchers to question whether unequal care is a contributing factor.
| Measure | Finding |
|---|---|
| Studies analysed | 38 |
| Studies reporting women less likely to be offered active treatment | 33 |
The review did note exceptions: for stroke and diabetes there was no significant sex difference in treatment, and women were more likely to receive treatment for dementia.
Expert comment and implications for practice
“For clinicians, the findings are a prompt to check whether treatment is being offered on clinical grounds rather than assumption.”
The study co-lead, Dr. Andrew O’Malley, urged health-care professionals to reflect on whether unconscious assumptions might influence treatment offers. The authors emphasised that their findings should trigger closer scrutiny of decision-making processes to ensure care is determined by clinical need rather than gendered expectations.
The findings come amid heightened public concern about the so-called gender health gap. In the United Kingdom, that debate has featured political attention — including commentary from former health officials and the appointment of a women’s health ambassador — but the problem the review describes is likely relevant to health systems internationally, including Canada, where equitable access and standardised practice remain policy priorities.
What this means for patients and systems
The review’s conclusions have several consequences for clinicians, patients and health systems:
- Clinicians should review decision-making against evidence-based guidelines to ensure treatment offers are clinically justified.
- Health systems may need to audit care pathways and referral patterns to identify and address sex-based differences in access to procedures and advanced therapies.
- Researchers should explore drivers of disparity — such as referral bias, differences in symptom presentation or system-level barriers — to design interventions that promote equity.
For patients, the authors’ message is clear: if there is uncertainty about whether all appropriate options have been discussed, seeking a second opinion or asking specific questions about alternative treatments may help ensure a full range of clinically appropriate choices are considered.
While the review does not establish causation, its breadth — covering dozens of studies and multiple conditions — underscores a pattern that health professionals and policymakers will likely need to address to achieve equitable care across sexes.
Reporting for this article is based on the University of St Andrews analysis and associated commentary.
