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INTRODUCTION

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The clinical discipline of women’s health is well established. Indeed, its emphasis on greater attention to patient education and medical decision-making is a paradigm for what has become known as patient-centered health care. Moreover, the recognition of sex differences in disease processes and health outcomes is an important example of precision medicine. Sex difference refers to the biologic differences conferred by sex chromosomes and hormones. In contrast, gender differences are related to psychosocial roles and cultural expectations. The study of sex differences continues to grow as a scientific discipline. In 2016, the National Institutes of Health recognized its importance by implementing the expectation that sex should be considered as a biologic variable in study designs, analyses, and reporting in not only human but also vertebrate animal research. Strong scientific justification must be provided to limit research to only one sex.

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DISEASE RISK: REALITY AND PERCEPTION

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The leading causes of death are the same in women and men: (1) heart disease and (2) cancer (Fig. 391-1). The leading cause of cancer death, lung cancer, is the same in both sexes. Breast cancer is the second leading cause of cancer death in women, but it causes about 60% fewer deaths than does lung cancer. Men are more likely than women to die from suicide and accidents.

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FIGURE 391-1

Percent distribution of 10 leading causes of death in women compared to men in the United States in 2014. In both women and men, the first and second leading causes of death are the same, heart disease and cancer, respectively. Causes of death then diverge by sex. For example, accidents are the third leading cause of death in men but the sixth leading cause of death in women. Stroke, chronic lower respiratory disease (CLRD) and Alzheimer’s disease (AD) cause a larger percentage of deaths in women than in men. Suicide is among the 10 leading causes of death in men but not in women. (Data from https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_04.pdf.)

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Women’s risk for many diseases increases at menopause. The median age of menopause in Caucasian women from industrialized countries is between 50 and 52 years, where women spend one-third of their lives in the postmenopausal period. Menopause occurs at earlier ages in Hispanic and African-American women as well as in women of lower socioeconomic status. Estrogen levels fall abruptly at menopause, inducing a variety of physiologic and metabolic responses. Rates of cardiovascular disease (CVD) increase and bone density begins to decrease rapidly after menopause.

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In the United States, women live on average 4.8 years longer than men, with a life expectancy at birth in 2014 of 81.2 years in women compared with 76.4 years in men of all races. Life expectancy was lower in African Americans of both sexes and higher in Hispanics of both sexes than their Caucasian ...

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