title: Gender Bias in U.S. Pediatric Growth Hormone Treatment.
abstract: Growth hormone (GH) treatment of idiopathic short stature (ISS), defined as height <-2.25 standard deviations (SD), is approved by U.S. FDA. This study determined the gender-specific prevalence of height <-2.25 SD in a pediatric primary care population, and compared it to demographics of U.S. pediatric GH recipients. Data were extracted from health records of all patients age 0.5-20 years with ≥ 1 recorded height measurement in 28 regional primary care practices and from the four U.S. GH registries. Height <-2.25 SD was modeled by multivariable logistic regression against gender and other characteristics. Of the 189,280 subjects, 2073 (1.1%) had height <-2.25 SD. No gender differences in prevalence of height <-2.25 SD or distribution of height Z-scores were found. In contrast, males comprised 74% of GH recipients for ISS and 66% for all indications. Short stature was associated (P < 0.0001) with history of prematurity, race/ethnicity, age and Medicaid insurance, and inversely related (P < 0.0001) with BMI Z-score. In conclusion, males outnumbered females almost 3:1 for ISS and 2:1 for all indications in U.S. pediatric GH registries despite no gender difference in height <-2.25 SD in a large primary care population. Treatment and/or referral bias was the likely cause of male predominance among GH recipients.
authors.affiliation: 1] Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA [2] Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA [3] Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
authors.forename: Adda
authors.initials: A
authors.lastname: Grimberg
authors.affiliation: Department of Pediatrics, Albert Einstein Medical Center, Philadelphia, PA.
authors.forename: Lina
authors.initials: L
authors.lastname: Huerta-Saenz
authors.affiliation: 1] Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA [2] Center for Biomedical Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Robert
authors.initials: R
authors.lastname: Grundmeier
authors.affiliation: Center for Biomedical Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Mark Jason
authors.initials: MJ
authors.lastname: Ramos
authors.affiliation: Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Susmita
authors.initials: S
authors.lastname: Pati
authors.affiliation: Clinical and Translational Research Center and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Cucchiara
authors.affiliation: 1] Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA [2] Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia.
authors.forename: Virginia A
authors.initials: VA
authors.lastname: Stallings
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D013006:Growth Hormone / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D063507:Sexism; D014481:United States
chemical_list: D013006:Growth Hormone