We know sickle cell disease (SCD) is most prevalent in people of African descent. However, a limited number of studies have evaluated whether sex-based differences occur with SCD. These studies have found that females with SCD are more likely to outlive males with SCD.
One case series found that a handful of women with SCD lived past 80 years old with a healthy lifestyle, familial support, and proper adherence to medication and medical care. Still, the small sample size of that study proved to be a limitation in making definitive claims .
A larger, more recent study collected data from the Sickle Cell Disease Implementation Consortium patient registry, a consortium funded by the National Heart Lung and Blood Institute. The registry includes data from eight comprehensive SCD centers across the United States.
The researchers conducted a cross-sectional study that included 2,124 participants and compared differences in disease complications between males and females with SCD. Their study also looked at differences in sociodemographics and disease and treatment characteristics.
Ultimately, the study found that women used more opioids for pain management than men. Women also experienced higher pain severity scores and more hospitalizations than men. In contrast, men experienced more life-threatening complications than women. Men also experienced less anxiety and depression than women.
The higher incidence of pain events in women may be attributed to menstruation in some women. Other notable differences that may be specific to women include a higher incidence of autoimmune diseases in women with SCD.
As with the high incidence of pain events, the incidence of autoimmune disease could be attributed to female-specific hormones and the reproductive cycle. Because hydroxyurea treatment can be teratogenic, women were found to take less hydroxyurea than their male counterparts.
The differences in pain severity and income among men and women could also partly explain the higher incidence of anxiety and depression in women than in men. Pain and stress are associated with depression and anxiety. Although women were found to have a higher education level than men, a lower household income was more common in women than in men. Income inequality has also been associated with higher rates of depression and anxiety.
The researchers concluded that more research is needed to determine the exact effects of sex-based characteristics on SCD outcomes. Although the study included a large sample size, it was limited by its cross-sectional design. Nevertheless, the findings from this study could help accelerate the discussion on sex-based differences in SCD. By understanding sex-based differences, we can consider specific factors when individualizing the most effective therapies for SCD .
 Masese, R. V., Bulgin, D., Knisely, M. R., Preiss, L., Stevenson, E., Hankins, J. S., Treadwell, M. J., King, A. A., Gordeuk, V. R., Kanter, J., Gibson, R., Glassberg, J. A., Tanabe, P., & Shah, N. (2021). Sex-based differences in the manifestations and complications of sickle cell disease: report from the Sickle Cell Disease Implementation Consortium. PLOS ONE, 16(10), e0258638. https://doi.org/10.1371/journal.pone.0258638