“What’s sex and gender got to do with it?” A scoping review of sex and gender-based analysis in pharmacoepidemiologic studies of medication adherence


BACKGROUND: Medication taking is a complex multidimensional behaviour that may be impeded by a range of biological and psychosocial factors, including sex and gender. We aimed to synthesize how sex and gender have been reported and analyzed in pharmacoepidemiologic studies of medication. METHODS: We searched for English-language peer-reviewed articles of observational studies (e.g., cross-sectional, cohort, case-control) that examined medication adherence among adults and included sex and/or gender in their reporting. RESULTS: We included 937 studies among 530,537,287 participants published between 1979 and 2021. Most studies were cross-sectional (47%), lasted < 1 year (35%), examined self-reported adherence (53%), did not assess specific adherence problem(s) (40%), and included medications for cardiovascular conditions (24%) or systemic infections (24%). A quarter (25%) of studies used sex and gender interchangeably, over a third (36%) of studies that reported gender data likely collected data on sex, and less than 1% of studies described sex and gender as distinct variables. Studies of cisgender participants more often reported that females/women experienced greater adherence problems compared to often than males/men (31% vs 20%), particularly discontinuation and cost-related non-adherence. Only 21 studies (2%) reported on transgender individuals, and these predominantly examined antiretroviral medications for HIV. CONCLUSIONS: Our review revealed substantial conflation of sex and gender in studies of medication adherence as well as a paucity of research among transgender individuals. Moreover, our synthesis showed sex/gender disparities in medication taking with studies reporting greater medication adherence problems among cisgender women and transgender participants compared to cisgender men.


Rebić N, Law MR, Cragg J, Brotto LA, Ellis U, Garg R, Park JY, de Vera MA




  • Population(s)
    • General HIV+ population
  • Prevention, Engagement and Care Cascade
    • Engagement and Care Cascade
  • Engagement and Care Cascade
    • Treatment


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