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Sex and Gender Differences in Travel-Associated Disease

  1. Patricia Schlagenhauf1,
  2. Lin H. Chen4,5,
  3. Mary E. Wilson4,5,6,
  4. David O. Freedman7,
  5. David Tcheng8,
  6. Eli Schwartz9,
  7. Prativa Pandey10,
  8. Rainer Weber2,
  9. David Nadal3,
  10. Christoph Berger3,
  11. Frank von Sonnenburg11,
  12. Jay Keystone12,
  13. Karin Leder13,14, and
  14. GeoSentinel Surveillance Networka
  1. 1University of Z uml;rich Centre for Travel Medicine, World Health Organisation Collaborating Centre for Travellers' Health, University of Zörich, Zörich, Switzerland
  2. 2Division of Infectious Diseases, University Hospital of Zörich, Zörich, Switzerland
  3. 3Division of Infectious Diseases, University of Zurich Childrens' Hospital, Zörich, Switzerland
  4. 4Mount Auburn Hospital, Cambridge
  5. 5Harvard Medical School, Boston, Massachusetts
  6. 6Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts
  7. 7Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham
  8. 8National Center for Supercomputing Applications, University of Illinois at Urbana-Champaign, Urbana
  9. 9Chaim Sheba Medical Centre, University of Tel Aviv, Tel Hashomer, Israel
  10. 10CIWEC Clinic, Kathmandu, Nepal
  11. 11Department of Tropical and Infectious Diseases, University of Munich, Munich, Germany
  12. 12Division of Infectious Diseases, University of Toronto, Toronto, Canada
  13. 13Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne
  14. 14Department of Epidemiology and Preventive Medicine, Monash University, Monash, Victoria, Australia
  1. Dr Patricia Schlagenhauf, University of Z uml;rich Centre for Travel Medicine, World Health Organisation Collaborating Centre for Travellers' Health, University of Z uml;rich, Hirschengraben 84, CH-8001, Z uml;rich, Switzerland (pat{at}ifspm.unizh.ch).
 
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Abstract

Background. No systematic studies exist on sex and gender differences across a broad range of travel-associated diseases.

Methods. Travel and tropical medicine GeoSentinel clinics worldwide contributed prospective, standardized data on 58,908 patients with travel-associated illness to a central database from 1 March 1997 through 31 October 2007. We evaluated sex and gender differences in health outcomes and in demographic characteristics. Statistical significance for crude analysis of dichotomous variables was determined using hi; 2 tests with calculation of odds ratios (ORs) and 95% confidence intervals (CIs). The main outcome measure was proportionate morbidity of specific diagnoses in men and women. The analyses were adjusted for age, travel duration, pretravel encounter, reason for travel, and geographical region visited.

Results. We found statistically significant (Pµ.001) differences in morbidity by sex. Women are proportionately more likely than men to present with acute diarrhea (OR, 1.13; 95% CI, 1.09–1.38), chronic diarrhea (OR, 1.28; 95% CI, 1.19–1.37), irritable bowel syndrome (OR, 1.39; 95% CI, 1.24–1.57), upper respiratory tract infection (OR, 1.23; 95% CI, 1.14–1.33); urinary tract infection (OR, 4.01; 95% CI, 3.34–4.71), psychological stressors (OR, 1.3; 95% CI, 1.14–1.48), oral and dental conditions, or adverse reactions to medication. Women are proportionately less likely to have febrile illnesses (OR, 0.15; 95% CI, 0.10–0.21); vector-borne diseases, such as malaria (OR, 0.46; 95% CI, 0.41–0.51), leishmaniasis, or rickettsioses (OR, 0.57; 95% CI, 0.43–0.74); sexually transmitted infections (OR, 0.68; 95% CI 0.58–0.81); viral hepatitis (OR, 0.34; 95% CI, 0.21–0.54); or noninfectious problems, including cardiovascular disease, acute mountain sickness, and frostbite. Women are statistically significantly more likely to obtain pretravel advice (OR, 1.28; 95% CI, 1.23–1.32), and ill female travelers are less likely than ill male travelers to be hospitalized (OR, 0.45; 95% CI, 0.42–0.49).

Conclusions. Men and women present with different profiles of travel-related morbidity. Preventive travel medicine and future travel medicine research need to address gender-specific intervention strategies and differential susceptibility to disease.

Conclusions. Men and women present with different profiles of travel-related morbidity. Preventive travel medicine and future travel medicine research need to address gender-specific intervention strategies and differential susceptibility to disease.

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Figures and Tables

Figure 1
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Figure 1

Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for diagnoses profiles for female and male travelers. ORs (for female versus male travelers) are squares (filled squares show illnesses more likely to occur in men, and open squares show illnesses more likely to occur in women), and 95% CIs are lines; diagnoses profiles in female and male travelers are adjusted for age, travel duration, region of travel, reason for travel, pretravel encounter, and whether the individual was seen at a GeoSentinel site during or after travel. Delusional, delusional parasitosis; HIV, human immunodeficiency virus infection.

Table 1
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Table 1

Demographic Characteristics of Ill Travelers Presenting During and After Travel at GeoSentinel Clinics Worldwide

Table 2
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Table 2

Comparison of Diagnoses in Ill Female and Male Travelers Who Presented to GeoSentinel Clinics Worldwide

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Acknowledgments

P.S. and K.L. had access to all data. We thank Adam Plier and Hanspeter Jauss for their help with formatting the figures and the article.

Financial support.; GeoSentinel is supported by a cooperative agreement (U50/CCU412347) from the Centers for Disease Control and Prevention and by an initial pilot grant from the International Society of Travel Medicine.

Potential conflicts of interest.; P.S. has received research funding, honoraria for speaking at conferences and consultancy fees from F. Hoffmann- La Roche and GlaxoSmithKline. R.W. has received travel grants from Abbott, Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Merck, Pfizer, F. Hoffmann– La Roche, and TRB Chemedica. L.H.C. has received honoraria for serving on editorial board from AHC Media. D.N. has received research and travel grants from AstraZeneca, Abbott, and Pfizer. All other authors: no conflicts.

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Footnotes

  • ↵Members of the GeoSentinel Surveillance Network who contributed data are listed at the end of the text.

  • Received August 12, 2009.
  • Revision received October 28, 2009.
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  1. Clin Infect Dis. (2010) 50 (6): 826-832. doi: 10.1086/650575
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