Sex and gender differences in primary care help-seeking for common somatic symptoms: a longitudinal study

Abstract

Objective

Women are reported to consult general practitioners (GPs) more frequently than men. However, previous studies on sex differences in help-seeking behavior for somatic symptoms do not distinguish between sex and gender, do not account for sex differences in presented symptoms, and are frequently conducted in clinical settings, automatically excluding non-help seekers. Therefore, we aim to assess the independent associations of sex and gender with primary care help-seeking for somatic symptoms in the general population.

Design and setting

Records from the longitudinal population-based Lifelines Cohort Study were linked to routine electronic health records from GPs.

Subjects

Participants reporting new-onset common somatic symptoms.

Main outcome measures

Associations between sex and gender, operationalized via a novel gender-index, with primary care help-seeking for somatic symptoms and differences in the strength of the association between gender and help-seeking for somatic symptoms between women and men.

Results

Of 20,187 individuals with linked data, 8325 participants (67.5% female; mean age = 44.5 years [SD = 12.9]) reported at least one new-onset somatic symptom. Hereof, 255 (3.1%) consulted the GP within 6 weeks of symptom onset. Female sex was positively associated with consulting the GP (OR = 1.78; 95%CI = 1.13–2.80), whereas feminine gender was not (OR = 0.67; 95%CI = 0.39–1.16). The latter association did not differ in strength between men and women. More paid working days are negatively associated with help-seeking (OR = 0.95; 95%CI = 0.91–0.98).

Conclusions

The results suggest that female sex rather than feminine gender is associated with primary care help-seeking behavior for somatic symptoms. Nevertheless, clinicians should be aware that gender-related variables, such as mean paid working days, may be associated with help-seeking behavior.

Keywords:

• Gender roles
• general practice
• help-seeking behavior
• medically unexplained symptoms
• sex differences
• primary health care

Acknowledgements

The Lifelines initiative has been made possible by subsidy from the Dutch Ministry of Health, Welfare and Sport, the Dutch Ministry of Economic Affairs, the University Medical Center Groningen (UMCG), Groningen University and the Provinces in the North of the Netherlands (Drenthe, Friesland, Groningen). The authors wish to acknowledge the services of the Lifelines Cohort Study, the contributing research centers delivering data to Lifelines, and all the study participants.

Ethical approval

The Lifelines Cohort Study is performed according to the principles of the Declaration of Helsinki and in accordance with UMCG’s research code. It is approved by the Medical Ethical Committee of the University Medical Center Groningen, The Netherlands (number: 2007/152) and all participants have provided written consent. The use of electronic health records, including those provided by the NPCD, for research purposes is allowed under certain conditions. When these conditions are fulfilled, neither obtaining informed consent from patients nor approval by a medical ethics committee is obligatory for this type of observational studies containing no directly identifiable data (art. 24 GDPR Implementation Act jo art. 9.2. sub j GDPR).

Consent form

Informed consent was obtained from all individual participants included in the study.

Disclosure statement

The authors have no competing interests to declare that are relevant to the content of this article.

Data availability statement

Given the privacy of participants included in Lifelines and NPCD, the authors cannot publicly share the databases used in this study. Access to data can be requested by contacting Lifelines and NIVEL.

Additional information

Funding

This work was supported by the ZonMw Gender and Health Program (849200013).