title: The Contribution of Gender to Apparent Sex Differences in Health Status Among Patients with Coronary Artery Disease.
abstract: While it has been identified that gender (socially manufactured roles, behaviors, expressions, and identities) plays a central role in men's and women's health, the distinction between gender and sex (biological attributes) has largely been ignored in health science research. The purpose of this study was to look at the unique contributions of sex, age, and the Gender Index (GI) to baseline health status in a cohort of patients with coronary artery disease (CAD).
  
  
  
  Questions that comprised the GI were included in the follow-up questionnaire sent to patients in the APPROACH registry. To examine the relationship between sex, gender, and health status, a sequential linear regression modeling approach was used.
  
  
  
  A total of 632 patients completed the GI between July and August 2015. The women were significantly older (68 years vs. 66 years, p = 0.02) and significantly more likely to have hypertension (50.8% vs. 38.8%, p = 0.02) compared to the men. Women reported significantly lower mean Seattle Angina Questionnaire (SAQ) scores compared to men. The inclusion of age into the models did not change the relationship between sex and the SAQ scales. However, the inclusion of the GI attenuated the relationship between sex and the SAQ scale scores.
  
  
  
  Our results support the concept that sex differences in health status outcomes may be better explained by patient's gender-related characteristics, than biological sex characteristics. More importantly, the GI offers a pragmatic composite score to assess the effects of psychosocial factors that researchers interested in measuring gender could use in studies of subjects with CAD.
authors.affiliation: 1 Faculty of Nursing, University of Alberta , Edmonton, Alberta.|2 Heart Health and Stroke Strategic Clinical Network, Alberta Health Services , Edmonton, Alberta.|3 Division of CV Surgery, Faculty of Medicine, University of Alberta , Edmonton, Alberta.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Norris
authors.affiliation: 1 Faculty of Nursing, University of Alberta , Edmonton, Alberta.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Johnson
authors.affiliation: 4 University of Calgary , Calgary, Alberta.
authors.forename: Emeleigh
authors.initials: E
authors.lastname: Hardwicke-Brown
authors.affiliation: 2 Heart Health and Stroke Strategic Clinical Network, Alberta Health Services , Edmonton, Alberta.
authors.forename: Matthew
authors.initials: M
authors.lastname: McEwan
authors.affiliation: 5 Division of Clinical Epidemiology, Research Institute of the McGill University , Montreal, Québec.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Pelletier
authors.affiliation: 5 Division of Clinical Epidemiology, Research Institute of the McGill University , Montreal, Québec.|6 Division of General Internal Medicine, McGill University , Montreal, Québec.
authors.forename: Louise
authors.initials: L
authors.lastname: Pilote
mesh_terms: D000368:Aged; D000416:Alberta; D003324:Coronary Artery Disease / Q000503:physiopathology*; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D011788:Quality of Life; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016387:Women's Health
keywords: gender; gender index; outcomes research; sex; women's cardiovascular disease