{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T18:27:36Z","timestamp":1787855256877,"version":"build-2784847793"},"reference-count":412,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T00:00:00Z","timestamp":1745971200000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["917.17.308"],"award-info":[{"award-number":["917.17.308"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["918.196.27"],"award-info":[{"award-number":["918.196.27"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001711","name":"Schweizerischer Nationalfonds zur F\u00f6rderung der Wissenschaftlichen Forschung","doi-asserted-by":"publisher","award":["206639"],"award-info":[{"award-number":["206639"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000781","name":"European Research Council","doi-asserted-by":"publisher","award":["101001237"],"award-info":[{"award-number":["101001237"]}],"id":[{"id":"10.13039\/501100000781","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2025,4,13]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"\n Introduction<\/jats:title>\n We aimed to describe global sex-specific proportions and case fatality ratios of bacterial meningitis and to explore their associations with the Human Development Index (HDI) and Gender Inequality Index (GII).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Google Scholar and MEDLINE (via PubMed.gov) were searched in January 2022 using the terms \u201cbacterial meningitis\u201d and \u201cmortality\u201d. Studies with a mean observation period after the year 1940 and reporting \u226510 patients with community-acquired bacterial meningitis and their survival status were included, irrespective of the participants\u2019 age. Studies that selected participants by specific risk factors, reported specific pathogens only, or had >10% missing outcomes were disregarded. Data were extracted by one researcher and validated by a second researcher. The main outcomes, sex-specific proportions and case fatality ratios, were analysed using random-effects models. Associations with HDI and GII were explored using metaregression.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n In this meta-analysis with metaregression, from 371 studies with 157\u2009656 meningitis episodes, 217 (58%) reported the patients\u2019 sex and 41 (11%) reported sex-specific outcomes. Proportion of males was 58% (95% CI 57%\u201359%, prediction interval (PI) 45%\u201371%). Case fatality ratios were slightly higher in females (male-to-female fatality ratio, 0.89, 95%\u2009CI 0.78 to 1.01, PI 0.53\u20131.49). The size of the male proportion was strongly associated with HDI (per index point, \u22120.64, 95%\u2009CI \u22120.88 to \u22120.40; R2<\/jats:sup> 16%; p<0.001) and GII (per index point, 0.61, 95%\u2009CI 0.39 to 0.83; R2<\/jats:sup> 19%; p<0.001). Sex-specific case fatality ratios were weakly associated with HDI (per index point, 0.53, 95%\u2009CI \u22120.19 to 1.25; R2<\/jats:sup> 2%; p=0.15) and GII (per index point, \u22120.58, 95%\u2009CI \u22121.55 to 0.39; R2<\/jats:sup> 7%; p=0.24).<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Based on worldwide reporting from the last 80 years, we show that indicators of human development and gender inequality are associated with sex-based disparities and case fatality ratios in bacterial meningitis.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjgh-2024-016802","type":"journal-article","created":{"date-parts":[[2025,4,30]],"date-time":"2025-04-30T23:23:47Z","timestamp":1746055427000},"page":"e016802","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Sex differences in bacterial meningitis and associations with socioeconomic indicators: a systematic review and meta-analysis with 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