Effects of sex and gender on cardiovascular risk factors and mental disorders in a middle-aged population-based cohort
Description: Background: Women and men present major differences in prevalence and course of cardiometabolic diseases and mental disorders, two leading causes of disability in the world. Despite these important disparities, the effects of gender, a multidimensional sociocultural concept, and of sex, a set of biological characteristics, on health are largely understudied. Large epidemiological studies that include multidimensional gender measures and sex hormone blood levels are lacking. Objective: to conduct a fourth follow-up (FU4) of the population-based CoLaus|PsyCoLaus cohort, approximately 5 years after the last assessment, including a new multidimensional measure of gender in order to study the specific effects of sex (administrative sex and change in sex hormones across menopause/andropause) and gender (as a multidimensional construct) on health behaviors (smoking status, alcohol use, physical activity, diet patterns), as well as cardiovascular risk factors (CVRF; obesity, type 2 diabetes, dyslipidemia, hypertension), mental disorders (major depressive disorders and subtypes, anxiety disorders and alcohol use disorders) and their complex interplay. More specifically, our research questions are: 1: What are the roles of sex and gender in differences in health behaviors between women and men? 2: What are the roles of sex and gender in the differential vulnerability of women and men to CVRF and mental disorders? 3: What are the effects of sex and gender on the prospective association between mental disorders and the incidence of CVRF? Methods: FU4 will include the younger half of participants (year of birth 1956-1969; n=2853) of the population-based CoLaus|PsyCoLaus cohort, who were randomly selected from the population of Lausanne between 2003 and 2006. Almost 70% of the original cohort still participated in FU3. Participants underwent four thorough physical, biochemical evaluations of CVRF, and comprehensive psychiatric assessments including a semi-structured diagnostic interview. The study involves repetitive measures of health-related behaviors and psychological factors through validated questionnaires and assessment of physical activity through actigraphy. FU4 (expected n=2000 for the physical and n=1600 for the psychiatric evaluations) will include the measures of previous assessments as well as a new questionnaire on gender indicators using seven dimensions (caregiving strain, work strain, independence, risk taking, emotional intelligence, social support and discrimination) and measures of sex hormones (testosterone, estradiol, sex-hormone-binding globulin), which are also available from previous evaluations. We will cross-sectionally assess the associations of the multi-dimensional gender measure introduced at FU4 with health behaviors and health outcomes. Given the availability of psychosocial variables (socioeconomic status, social support, life events, weekly amount of professional activity, neuroticism and coping), which typically differ between women and men, and hormone measures from several data collection waves, we will prospectively test the moderating or mediating role of these psychosocial variables and hormone changes before age 45 and after age 55 in the associations of administrative sex and health behaviors or health outcomes as well as in the associations between mental disorders and CVRF using data across the FU. Data will be analyzed using multiple generalized linear regression, structural equation modelling and Cox’s proportional hazard regression models. Expected results and impact: Our population-based cohort study has a series of unique and novel features including 1) a new multi-dimensional gender measurement; 2) repetitive measures of sex hormones using liquid-chromatography with mass spectrometry before and after the age of menopause/andropause; 3) thorough data on CVRF, mental disorders and health related behaviors, and 4) objective measures of physical activity by actigraphy. This project will facilitate the implementation of adapted assessments of sex and gender in the Swiss context. Based on these sound methodological features, this project will extend current knowledge on the respective roles of sex and gender that underlie disparities in CVRF and mental health between women and men. A better insight into the causes of health disparities between women and men would be crucial because most of the gender norms that underlie gendered health-related behaviors are modifiable risk factors and thereby promising targets for preventive efforts in the perspective of improving healthcare and social justice.
Amount: CHF 1,064,000
Funding type: research
Funder scheme: Project funding
Start date: 2024-01-01
End date: 2027-12-31
Investigator: Clair, Carole
Institution: University of Lausanne – LA
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Funded outputs count: 11
Funder award ID: 220190
OpenAlex ID: G3627919663