title: The importance of study design strategies in gender bias research: the case of respiratory disease management in primary care.
abstract: BACKGROUND
  Most research on gender bias has been carried out in hospitals and focuses mainly on severe diseases. Consequently, little is known about gender bias in relation to other illnesses and healthcare settings.
  
  
  OBJECTIVE
  To explore the existence of gender bias in the management of patients seeking primary care for respiratory complaints.
  
  
  METHODS
  An observational, prospective blind follow-up study was performed in a primary care centre in Alicante, Spain. 830 patients were monitored from first visit to their general practitioner with a respiratory complaint until final diagnosis. Information was obtained about the diagnostic process (anamnesis, clinical examination and diagnostic tests) and therapeutic procedures (concession of unfit to work status and the patient's destination following the visit). Logistic regression was used to compare the diagnostic/therapeutic procedures in men and women.
  
  
  RESULTS
  Although men (318) and women (512) had similar respiratory complaints, after adjustment by age, marital status, employment, education, comorbidity and severity, men were more likely to be asked about smoking habits: RRa: 2.41 (95% CI: 1.57 to 3.70), auscultated: RRa: 1.30 (0.90 to 1.75), provided with a defined diagnosis: RRa: 1.77 (0.98 to 3.32) and considered unfit to work: RRa: 5.43 (1.64 to 9.96). Women were more likely to receive a pharyngotonsillar exploration: RRa: 0.63 (0.41 to 0.97).
  
  
  CONCLUSIONS
  Despite having the same respiratory symptoms, women were less likely to undergo diagnostic procedures and doctors tended to classify women in the category of undefined diagnosis more often. It should be considered that gender bias in the diagnosis could contribute to an erroneous estimation of respiratory disease prevalence, which could lead to unequal management of one sex related to the other.
authors.affiliation: Public Health Department, Apdo 99, University of Alicante, 03080 Alicante, Spain. cantero@ua.es
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Ruiz-Cantero
authors.forename: Elena
authors.initials: E
authors.lastname: Ronda
authors.forename: Carlos
authors.initials: C
authors.lastname: Alvarez-Dardet
mesh_terms: D000328:Adult; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D005194:Family Practice / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D011287:Prejudice; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies; D012107:Research Design; D012120:Respiration Disorders / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D012959:Socioeconomic Factors; D013030:Spain