Gender differences in tuberculosis diagnosis and treatment in an industrialised low-incidence setting: Victoria, Australia, 2002-2015

      Background: Gender has a significant impact on tuberculosis (TB) diagnosis and outcomes in a variety of contexts worldwide. We explored gender disparities in TB management in Victoria, Australia.
      Methods & Materials: We performed a retrospective cohort study of all TB notifications in Victoria between 2002-2015. Gender was included as an independent variable in statistical analyses to assess TB presentations, management and outcomes, including both patient-related and healthcare system related factors, and a particular focus on diagnostic delays.
      Results: There were 2,782 (54.5%) males and 2,324 (45.5%) females notified; a male to female ratio of 1.2:1. Compared to females, males were more likely to have pulmonary involvement and pleural TB, and less likely to have lymph node TB (p < 0.001). Overall, there was no significant gender disparity in patient, health system or diagnostic delays. Among cases with pulmonary involvement, males received a CXR (HR 1.1, 95%CI 1.05-1.28, p = 0.029) and began treatment sooner (HR 1.2, 95%CI1.07-1.33, p = 0.002) after presentation, and were more likely to have a sputum smear sample taken (OR 1.3, 95%CI 1.02-1.54, p = 0.030). Males were less likely to receive <4 first-line medications (OR 0.8, 95%CI 0.60-0.99, p = 0.044) and were more likely to die during treatment (OR 1.5, 95%CI 1.01-2.14, p = 0.043).
      Conclusion: The impact of gender disparities appeared to be small in our setting. Women experienced small but statistically significant delays in management compared to men, with no obvious detriment in their assessment results or treatment outcomes. Observed differences were consistent with the hypothesis that males exhibited more severe TB disease at presentation in our setting, which could relate to a range of biological and sociological factors.