Abstract
Background Despite growing recognition of sex and gender differences in disease presentation and treatment responses, clinical guidelines often fail to address these variables, risking patient safety.
Aim This study aimed to determine how many NICE clinical guidelines incorporate sex and/or gender considerations, and to analyse gender composition of guideline committees.
Method The study reviewed 197 non-sex-specific NICE guidelines, evaluating whether they mentioned sex or gender beyond pregnancy and childbirth. Secondary outcomes included whether sex and/or gender were considered in disease risk, presentation, and management and perceived gender of guideline committee chairs and members.
Results Of 223 guidelines, 197 assessed a non-sex-specific condition. 120 referenced sex or gender related terminology, of which only 81 deployed this terminology outside of pregnancy and childbearing. Only 4 (2%) of guidelines stated sex/gender differences related to disease pathophysiology, 18 guidelines (9%) related to disease presentation, 29 (15%) related to investigations, and 38 (19%) related to epidemiology.
Of 162 published committee chairs, 126 (76%) were men. Committees chaired by women produced clinical guidelines which better account for sex and gender.
Conclusion Recommendations related to sex and gender are underreported in NICE guidelines. Women are underrepresented as committee chairs, failing to reflect participation in the healthcare workforce. Meaningful change will require systematic, whole sector progress to integrate sex and/or gender disaggregated research into clinical guidelines. In the UK, the MESSAGE project has co-design a sex and gender policy framework for funding and regulatory organisations, supporting policy implementation across the UK research sector.
