{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T07:10:30Z","timestamp":1778224230257,"version":"3.51.4"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":39,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Schweizerischer Nationalfonds zur F\u00f6rderung der Wissenschaftlichen Forschung","doi-asserted-by":"publisher","award":["196140"],"award-info":[{"award-number":["196140"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001711","name":"Schweizerischer Nationalfonds zur F\u00f6rderung der Wissenschaftlichen Forschung","doi-asserted-by":"publisher","award":["211422"],"award-info":[{"award-number":["211422"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Intensive Care Unit (ICU) Research Foundation, University Hospital Basel"},{"name":"University of Zurich CRPP Precision Medicine","award":["Bacterial Infections"],"award-info":[{"award-number":["Bacterial Infections"]}]},{"name":"University Hospital Zurich foundation","award":["USZF270808"],"award-info":[{"award-number":["USZF270808"]}]},{"name":"the LOOP Zurich"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Biol Sex Differ"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Validated tools to assess gender are essential for clinical and population research but remain scarce and unstandardized. Understanding how sociocultural gender interacts with biological sex in shaping disease risk is critical for precision medicine. We aimed to investigate the association of sex and gender with cardiovascular risk factors and common comorbidities, and to refine an existing composite Gender score in a Swiss cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter prospective study conducted in three tertiary and one regional hospital included outpatients and inpatients with PCR-confirmed SARS-CoV-2 infection (n\u2009=\u20092,690; estimation and internal validation sets) and outpatients with periodontitis (n\u2009=\u2009337; external validation set). Gender-related variables were acquired via questionnaire. Logistic regression models and propensity score matching were used to assess associations between sex, gender, and the prevalence of cardiometabolic and chronic health conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 3,027 individuals (46.3% women; mean age 45\u2009\u00b1\u200917\u00a0years) were included. The composite Gender Score predicted biological sex with good accuracy (ROC 0.776\u20130.809). Biological sex was more strongly associated with most cardiometabolic risk factors, stroke, immune disorders, and bone diseases, whereas gender showed limited independent associations. For diabetes, female sex was inversely associated with diabetes prevalence, while a more feminine gender profile was positively associated. These opposing associations persisted after accounting for gender in matched analyses, illustrating that sex and gender may contribute differently to specific metabolic outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Sociocultural variables can accurately approximate biological sex and are differentially associated with health outcomes. In this cohort, biological sex explained most associations with cardiometabolic and chronic conditions, while gender effects were modest and condition-specific. The divergent associations observed for diabetes highlight that sex and gender are related but distinct constructs that should be considered jointly. Integrating both dimensions may improve future approaches to risk stratification, although these findings require confirmation in prospective and diverse populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13293-026-00888-8","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T07:25:00Z","timestamp":1774855500000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Decoding sex and gender effects on health: evidence from a nationwide cohort"],"prefix":"10.1186","volume":"17","author":[{"given":"Caroline E.","family":"Gebhard","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bianca","family":"Gysi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pimrapat","family":"Gebert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nidaa","family":"Mikail","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Livia","family":"Liechti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick R.","family":"Schmidlin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriana","family":"Vinzens","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Achi","family":"Haider","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan","family":"Bengs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerie","family":"Treyer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp K.","family":"Buehler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reto A.","family":"Schuepbach","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annelies S.","family":"Zinkernagel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvio D.","family":"Brugger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitri","family":"Patriki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedikt","family":"Wiggli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00fcrg H.","family":"Beer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andr\u00e9e","family":"Friedl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raphael","family":"Twerenbold","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriela M.","family":"Kuster","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joerg C.","family":"Schefold","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thibaud","family":"Spinetti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pedro D.","family":"Wendel-Garcia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel A.","family":"Hofmaenner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Scheier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Siegemund","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vera","family":"Regitz-Zagrosek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Gebhard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"issue":"4","key":"888_CR1","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1038\/s41569-022-00797-4","volume":"20","author":"V Regitz-Zagrosek","year":"2023","unstructured":"Regitz-Zagrosek V, Gebhard C. 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Written informed consent was obtained from all patients or their legally authorized representative, as appropriate.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"CG has received research grants and speakers\u2019 fees from the Novartis Foundation, from Sanofi Genzyme, Switzerland, and Bayer Pharmaceuticals outside of the submitted work. JCS and TS reports (full departmental disclosure) have received grants from Orion Pharma, Abbott Nutrition International, B. Braun Medical AG, CSEM AG, Edwards Lifesciences Services GmbH, Kenta Biotech Ltd, Maquet Critical Care AB, Omnicare Clinical Research AG, Nestle, Pierre Fabre Pharma AG, Pfizer, Bard Medica S.A., Abbott AG, Anandic Medical Systems, Pan Gas AG Healthcare, Bracco, Hamilton Medical AG, Fresenius Kabi, Getinge Group Maquet AG, Dr\u00e4ger AG, Teleflex Medical GmbH, Glaxo Smith Kline, Merck Sharp and Dohme AG, Eli Lilly and Company, Baxter, Astellas, Astra Zeneca, CSL Behring, Novartis, Covidien, Nycomed, and Phagenesis, outside of the submitted work. The money went into departmental funds, no personal financial gain applies. RT reports research support from the German Center for Cardiovascular Research (DZHK), the K\u00fchne Foundation, the Joachim Herz Foundation, the Swiss National Science Foundation (Grant No P300PB_167803) and the Swiss Heart Foundation as well as speaker honoraria\/consulting honoraria from Abbott, Amgen, Astra Zeneca, Psyros, Roche, Siemens, Singulex and Thermo Scientific BRAHMS. RT is co-founder and shareholder of the ART-EMIS Hamburg GmbH, which holds an international patent application on a computing device for estimating the probability of myocardial infarction (International Publication Numbers WO2022043229A1, TW202219980A). All authors declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"100"}}