Sex differences in patient journeys to diagnosis, referral, and surgical treatment of trigeminal neuralgia: implications for equitable care.

Autor:	Hung PS; 1Institute of Medical Science, University of Toronto, Ontario, Canada., Byeon AG; 1Institute of Medical Science, University of Toronto, Ontario, Canada., Noorani A; 1Institute of Medical Science, University of Toronto, Ontario, Canada.; 2MD Program, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada., Walker MR; 3Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada., Lorello GR; 4Department of Anesthesia and Pain Management, University Health Network-Toronto Western Hospital, Toronto, Ontario, Canada.; 5Department of Anesthesiology and Pain Medicine, University of Toronto, Ontario, Canada.; 6The Wilson Centre, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada.; 7Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada., Hodaie M; 1Institute of Medical Science, University of Toronto, Ontario, Canada.; 3Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada.; 8Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada; and.; 9Division of Neurosurgery, Krembil Brain Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery [J Neurosurg] 2022 Dec 30; Vol. 139 (2), pp. 463-471. Date of Electronic Publication: 2022 Dec 30 (Print Publication: 2023).
DOI:	10.3171/2022.11.JNS221191
Abstrakt:	Objective: Trigeminal neuralgia (TN) is an orofacial pain disorder that is more prevalent in females than males. Although an increasing number of studies point to sex differences in chronic pain, how sex impacts TN patients' journeys to care has not been previously addressed. This study sought to investigate sex differences in patients' journeys to diagnosis, referral, and treatment of TN within a large national context. Methods: Patients with classic TN (n = 100; 50 females and 50 males) were randomly selected through chart reviews at the largest surgical treatment center for TN in Canada for a cross-sectional study. Statistical tests, including Welch's t-test, the chi-square test, Pearson's correlations, and analyses of covariance, were conducted with Python. Results: Key discrepancies between sexes in access to care were identified. Females had a significantly longer referral time interval (average 53.2 months vs 20.4 months, median 27.5 months vs 11.0 months, p = 0.018) and total time interval (average 121.1 months vs 67.8 months, median 78.0 months vs 45.2 months, p = 0.018) than males, despite reporting higher pain intensity at referral. Although medically intolerant patients had a significantly shorter referral time interval than medically tolerant patients (average 13.0 months vs 41.0 months, median 6.0 months vs 17.0 months, p < 0.001), medically tolerant females had a significantly longer referral time interval than medically tolerant males (average 59.9 months vs 21.7 months, median 30.0 months vs 12.0 months, p = 0.017). No statistically significant differences were detected between the sexes for diagnostic time interval (average 63.3 months vs 43.0 months, median 24.0 months vs 24.0 months, p = 0.263) or treatment time interval (average 4.6 months vs 4.7 months, median 4.0 months vs 3.0 months, p = 0.986). Conclusions: Critical sex differences in patients' journeys to TN surgical treatment were identified, with females enduring considerably longer referral timelines and expressing significantly greater pain intensity than males at referral. Taken together, our findings suggest the presence of unconscious bias and discrimination against females and highlight the need for expediting TN treatment referral for female TN patients.
Databáze:	MEDLINE
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