A comprehensive new study published in PLOS Medicine reveals startling sex-based disparities in the prevalence, diagnosis, treatment, and outcomes of three widespread health conditions: hypertension, diabetes, and HIV/AIDS. Spearheaded by Angela Chang at the University of Southern Denmark, this large-scale global analysis exposes the critical gaps that exist in how males and females experience these diseases and how health systems respond to their needs differently. The findings underscore the urgent necessity to rethink health policy to ensure it truly addresses the divergent health journeys shaped by both biological sex and socially constructed gender norms.
The investigation examined datasets from nearly 200 countries worldwide, parsing out sex-disaggregated data across multiple stages of what the researchers call the “health pathway.” This pathway traces the trajectory from exposure to risk factors, through disease development to diagnosis, treatment initiation, and eventual health outcomes, including mortality. The comprehensive approach illuminated profound differences not only in disease prevalence but also in patterns of healthcare access and treatment adherence between males and females, shaping an often-overlooked dimension of global health inequity.
One of the most disturbing revelations of the study is that males generally show higher prevalence and mortality rates for all three conditions, yet paradoxically are less likely to seek medical care or adhere to prescribed treatments. This trend was particularly pronounced in many low- and middle-income countries, where cultural norms often discourage men from engaging with healthcare systems. For example, in more than 200 countries studied for hypertension, men not only were more vulnerable to developing high blood pressure but also consistently lagged in diagnosis and management, translating to poorer health outcomes compared to women.
In the case of diabetes, disparities manifest with slightly different nuances. Although the disease is prevalent in both sexes, women disproportionately face risks linked to obesity—a well-known contributor to type 2 diabetes—while men again show higher rates of undiagnosed disease and lower treatment persistence. This phenomenon highlights how biological factors intersect with gendered behaviors and societal expectations, reinforcing vulnerabilities from multiple angles. The researchers emphasize that these patterns cannot be adequately addressed without sex-sensitive data informing clinical guidelines and public health initiatives.
HIV/AIDS presented a complex and multifaceted landscape in the investigation. The study found striking differences in exposure risk factors, particularly in unsafe sexual practices, where women were more likely to encounter certain risks, yet men had higher mortality rates. Additionally, males were less engaged in treatment programs, with significantly lower rates of antiretroviral therapy initiation and viral suppression. Such findings underscore the need for gender-responsive health programs that not only facilitate access but also dismantle barriers rooted in stigma and gender norms.
Crucially, the study directs attention to behavioral risk factors that vary by sex and significantly influence disease trajectories. For instance, men were consistently more likely to smoke tobacco, an established risk factor exacerbating hypertension and diabetes outcomes. Conversely, women showed higher obesity prevalence, a condition intricately linked to metabolic disorders and cardiovascular health. These contrasting risk profiles reflect how underlying societal gender structures shape daily behaviors that, in aggregate, result in dramatically different health burdens by sex.
This research challenges the prevailing “one size fits all” model of healthcare delivery. Despite mounting evidence for sex and gender influences on health, many clinical protocols and public health policies remain inadequately tailored. Males, in particular, fall through the cracks at numerous points in the health pathway, from delayed or absent diagnosis to insufficient treatment engagement. The researchers advocate for comprehensive data collection efforts that disaggregate results by sex and gender at every step, enabling targeted interventions designed with these disparities in mind.
Global health experts Kent Buse and Sarah Hawkes, co-founders of Global Health 50/50, emphasize that these disparities are rarely attributable to biology alone but are deeply rooted in social constructs of gender. They assert that achieving health equity requires integrating gender analysis into the design and delivery of healthcare systems. Such an approach would recognize the nuances of masculinity and femininity in health behaviors and experiences, seeking to dismantle harmful norms that deter males from seeking timely care.
Angela Chang underscores the problems caused by insufficient sex-specific data, describing the current state as "flying blind." Without disaggregated data on diagnosis, treatment uptake, and completeness of care cascades, public health professionals remain incapable of identifying which groups—particularly men—are most likely to be missed by preventive and therapeutic programs. This opacity hinders the design of interventions that could prevent avoidable deaths and improve health outcomes on a massive scale.
The implications of this study are far-reaching. Changing entrenched health inequities requires not only the availability of sex-disaggregated data but also an intentional commitment from global institutions, governments, clinicians, and researchers to incorporate these insights into policy. Tailoring health communication, outreach, diagnostic criteria, and treatment protocols can optimize efficacy and foster equity, especially in diseases like hypertension, diabetes, and HIV/AIDS that contribute heavily to the global burden of disease.
While the research draws principally on observational data, its scope and depth provide robust evidence of sex and gender differentials in health pathways worldwide. Undertaking this analysis across multiple diseases simultaneously is innovative and furnishes a template for future studies aiming to integrate sex and gender perspectives systematically. The study also signals a need for improved health information systems capable of capturing relevant demographic nuances, empowering decision-makers with clear metrics on vulnerable populations.
Finally, the study highlights that addressing health inequities is inseparable from broader social changes. Combating stigma, transforming gender norms, and creating supportive environments where men are encouraged and enabled to seek care must accompany biomedical and systemic reforms. These intertwined strategies offer the best hope for minimizing disparities in disease burden, improving quality of life, and closing gender gaps that have persisted for decades in global health.
In conclusion, Chang and colleagues provide an urgently needed lens through which to view the divergent but intertwined health trajectories of men and women globally. Their work not only draws attention to the disparities themselves but also charts a way forward via the routine collection and application of sex and gender-specific data. As health systems evolve to meet these challenges, adopting a gender justice approach will be paramount to delivering equitable care and achieving better health outcomes for all.
Subject of Research: People
Article Title: Sex-disaggregated data along the gendered health pathways: A review and analysis of global data on hypertension, diabetes, HIV, and AIDS
News Publication Date: May 1, 2025
Web References: http://dx.doi.org/10.1371/journal.pmed.1004592
References: Feraldi A, Zarulli V, Buse K, Hawkes S, Chang AY (2025) Sex-disaggregated data along the gendered health pathways: A review and analysis of global data on hypertension, diabetes, HIV, and AIDS. PLoS Med 22(5): e1004592.
Image Credits: Nnebuifé Kwubéi (CC-BY 4.0)
Keywords: Sex-disaggregated data, gendered health pathways, hypertension, diabetes, HIV/AIDS, health inequities, global health, sex differences, gender norms, treatment adherence, diagnosis disparities, public health policy
