When gender bias is a prejudice!
Notice also this is an international study with less than 7000 participants (of which 91% were female), and it is based on self reporting.
"... Diagnosis can be challenging because many autoimmune diseases initially cause symptoms such as fatigue, pain, sleep disturbance or low mood, which are common in the general population. Symptoms can also affect multiple parts of the body and change over time. ..."
From the abstract:
"Background
Females have higher rates of autoimmune disease and reported misdiagnoses. Our study uses patient-reported diagnostic data to capture, and compare between sexes and diseases, elements of the diagnostic journey not routinely documented in medical records.
Methods
In this international cross-sectional study, an online survey was used to capture data on the time from symptom onset and number of clinician consultations before achieving the autoimmune diagnosis, and rates and types of reported misdiagnoses. These were then compared between males and females (self-reported biological sex). The survey was co-designed, pre-tested, and approved by patients, charities and clinicians. It was made available internationally through an online survey platform between Dec 7, 2024, and March 7, 2025.
Any individual aged 18 years or older reporting any autoimmune or rheumatic disease of likely inflammatory origin (e.g., polymyalgia rheumatica) confirmed in a clinical correspondence was eligible to participate.
Patient-reported measures included: time to diagnosis and number of healthcare visits from symptom onset, and types of perceived misdiagnoses. Pearson Chi-squared tests and Bayesian regression models were used to compare males and females. Results were adjusted for potential confounders. Firth’s penalised logistic regression model was used for disease group due to small numbers of males in some categories of misdiagnosis. ...
Findings
Of the 6607 participants with autoimmune diseases, most were female (91.2%), White (87.8%), and resided in the UK (69.7%).
Females were significantly more likely than males to report longer delays to diagnosis from symptom onset, more visits to healthcare providers, and a higher proportion reported that their autoimmune disease had been attributed to psychiatric (43.3% vs. 32.7%; p < 0.001) and psychosomatic causes (33.9% vs. 21.5%; p < 0.001). While more males than females reported being misdiagnosed with another physical disease (47.6% vs. 43.5%), this difference was not statistically significant (p = 0.131). Disease group was a significant predictor of perceived psychiatric and psychosomatic misdiagnoses with diseases with visible physical symptoms and/or more definitive biomarkers (e.g., Type 1 diabetes and rheumatoid arthritis) having lower rates of psychiatric/psychosomatic misdiagnoses. After adjusting for just disease group, females had significantly higher odds of reporting receiving mental health misdiagnoses (1.56, 95% CI 1.25–1.96; p < 0.001), and psychosomatic misdiagnoses (OR = 1.87, 95% CI 1.45–2.43; p < 0.001) than males. Following adjustment for age, disease group, continent, and household financial situation, females had significantly higher odds than males of psychiatric misdiagnoses (OR = 1.46, 95% CI 1.14–1.87; p = 0.003) and psychosomatic misdiagnoses (OR = 1.74, 95% CI 1.31–2.32; p < 0.001).
Interpretation
In our survey sample, females with autoimmune diseases reported more challenging diagnostic journeys than males.
Awareness of sex and disease differences in diagnostic experiences is essential for improving equality in care. The high number of reported psychiatric and psychosomatic misdiagnoses in both sexes may also reflect the challenges of interpreting presenting and evolving symptoms of autoimmunity. This is particularly relevant for primary care where most patients will initially present. This work is exploratory in nature and our findings should be interpreted cautiously. Future research is warranted into patients’ and clinicians’ perspectives on the causes of sex differences in diagnostic journeys and to design interventions to reduce diagnostic delays and psychiatric/psychosomatic misdiagnoses in autoimmune disease."
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