Brian Altonen, MPH, MS

Asymmetric Age Incidence-Prevalence Distribution, by Gender

Work in Progress

There are some ICDs or medical conditions that demonstrate both progression and significant age-related differences based on gender comparisons.  These conditions are not completely specific to males of females, but show a significant difference in age-related incidence/prevalence behaviors, often unexpected and of unknown cause.

Many fairly common mid-age peaking diseases of conditions with gender differences are reviewed elsewhere, such as Diabetes, Epilepsy, Hypertension and Heart Failure.

.

The following ICDs demonstrate this feature:

Male > Female

• Hyperkinesthesia 314.*
• Alcoholics’ Polyneuropathy 357.5
• Constrictive Pericarditis 423.2
• Adhesive Pericarditis 423.1
• Obscure African Cardiomyopathy 425.2 (reviewed elsewhere)
• Nutritional Cardiomyopathy 425.7
• Asbestosis 501.*
• Silicosis 502.*
• Intestinal Volvulus 560.2
• Inguinal Hernia 550.*

Female > Male

• Osteoporosis 733.*
• Varicose Veins
• Hyperthyroidism, 240-242
• Hypersenitivity Angiitis 446.2
• Lymphatic Drainage Problems 457
• Iron Deficiency Anemia 280.*

.

Examples

No asymmetry (except perhaps gangrene)

No age-related asymmetry, just prevalence demonstrates asymmetry

Asymmetry of age with total distributions for each gender essentially equal

Symmetry of one age group, asymmetry of another

Exercise

• Which of the follow demonstrates the greatest difference between genders?  the least?
• Which age group appears to demonstrate the smallest difference between genders for all of the demonstrated ICDs?
• Which ICD(s) is/are most related to behavior and psychology?
• Which ICD(s) is/are most related to physical, biological mechanisms?
• Which ICD is most related to just gender-age related differences and the association of gender-age to accidents?
• Which ICD(s) is/are closely realted to psychosomatic influences?
• Which ICD demonstrate the least gender-related difference?

.

The reasons for gender asymmetry for an ICD are numerous.  The most basic causes for assymmetry are:

• Type I.  Gender-specific ICDs or diseases due to gender specificity (of sex chromosome related somatic or physiological ontology)
• Type II.  Gender favoring ICDs or diseases with underlying somatic genetic cause(s) favoring but not requiring gender specific features
• Type III. Gender favoring ICDs or diseases with underlying gender specific, but not gender-requiring developmental causes
• Type IV.  Gender favoring ICDs or diseases with underlying bigender physiological and environmental causes
• Type V. Gender favoring ICDs or diseases with underlying bigender physiological and psychological or behavioral causes
• Type VI. Gender favoring ICDs or diseases with underlying bigender psychological or behavioral causes
• Type VII. Gender-favoring ICDs or diseases with underlying bigender sociological, socioeconomic, and/or cultural causes

.

 Type I 

The first two or three of these disease types are demonstrated quite clearly by their population pyramids.  There are (at least in theory) no entries for the opposing sex.  The reason for this lack of complete exclusion possibly pertains to patients who undergo gender change procedures.  Type I is biologically gender-specific, so we expect a result of 100% single gender assignment.

Type II

 Type II is mostly behavioral, but may at times be primarily biological due to specific anatomical features for just one gender, for example breast cancer (it also rarely occurs in men).   Gender assignments may vary between 90-95% focus upon one gender.

.

Type III

Development-related gender specificity implies two relationships underlying the differences.  First, gender impacts developmental changes due to biological or physiological differences between genders–for example a developmental delay or problem with male patients could be very different from female patients due to internal locus of control (ILOC) and external locus of control (ELOC) features.  These differences exist in younger age groups, ranging from 0 to maturation age.   Most of the time this pertains to changes occuring between 0 and 17 years of age, but can involve situations where maturation is delayed or the ICDs is a direct result of the maturation process.  Second, individual, personal behavior and physiological differences impact the development for any predominantly ILOC cases, versus the sociological and professional working environment (hospital,  long term care facility, etc.) differences responsible for gender asymmetry involving in ELOC cases.  For example, anorexia nervosa is a teen to twenty years old female behavior primarily.  Specific behavioral and learning and social integration disabilities involving affective disorders are see and documented primarily in in children, any many just for the youngest age group.  A third example of this early in life asymmetric behavior involves the Mental Retardation ICDS; there are often two ages when male patients undergo events related to a given condition, whereas female patients demonstrate a single, and somewhat belated age peak for notation of this ICD in the health medical records.  Moreover, for uncertain reasons this notation behavior recurs across various sub-categories of mental health ICDs.

.

Type IV

Type IV cases are those which favor one gender over the other, during the complete lifespan or just a specific part of life, due to any of several gender differences.   These ICDs relate more to the ILOC and the individual’s physiological and genetic make up than to any common ELOC features.  The asymmetric difstribution of cardiomyopathy is an example.

.

Type V

Type V cases add a little more ELOC to the Type IV disease development paradigm.  These ICDs are similar to Type III, with the exception that there is much more interaction of the individual and his/her social and natural environments resulting in the final age-gender distribution.  STDs for example demonstrate these features.  Some STDs favor female population documentation, others male documentation.  Due to the behavior of the patient, the STD may undergo a late diagnosis for example, demonstrate peaks during its later stages for male patients versus female patients.  Certain unhealthy behaviors that continue and worsen into midlife years are other other examples, such as unwillingness to conform to required disease prevention expectations for a contagious STD.

.

Type VI

Types VI and VII have the unique feature of demonstrate asymmetric age-gender relationships due to age-gender physical and behavior differences.  The distributions of cases are not as imbalanced as earlier disease types.  There are certain forms these diseases take on the tend to recur, appearing nearly identical often.  Even though these diseases may appear unrelated, the sum of the sociological, psychological and biological effects of the condition result in similar diagnostic rates and age-related incidence-prevalence rates.

These ICDs are primarily behavioral and psychological in origins, and emphasize individual psychology (ILOC) with little impact of physiological intervention or interactions.  Some scientists argue that these diseases do have an underlying physiological relationship due to the association of specific forms of neurochemistry (serotonin inhibitors, GABA, etc.) that may be related to these syndromes, but excluding this scientific hypothesis, these ICDs demonstrate their closest relationship to subjective, individual behaviors, not physiological, environmentally-targeted survival mechanisms.  Examples include GERD and IBS, and numerous other common diseases that have a history of psychosomatic consideration during the 1950s and 1960s.  ELOC has the effect of defining the peak ages for these events, due to a combination of cultural setting and the public perspective on ILOC.

Some of the best examples of these ICDs are those which show a direct relationship to retirement age (62-67 yo).  There are significant reductions in these syndromes of conditions that occur by 65 years of age.  These conditions impact work performance and “peak performance” for those engaged in such activities, and no longer impact life’s peak performance issues once retirement years approach.

.

Type VII

These ICDs are similar to Type VI, but tend to demonstrate behaviors that can be linked to sociocultural environmental causalities.  The severe psychiatric conditions lacking physiological mechanisms, possibly consisting of some genetic tendencies, are one example of these types of syndromes.  Schizophrenia for example has genetic, neurochemical, and ILOC-ELOC components, but is very much sociocultural dependent due to the ever-changing diagnostic process related to this and many other serious psychiatric conditions.  Individuals begin their life under the influences of their biological differences, but with time, are impacted as well by the environment’s (social environment’s) response to these states of being.  Biology and ILOC has the effect of defining the peak ages for these events, due to a combination of cultural setting and the public perspective on ELOC and ILOC.  These are typically related to the more deteriorating syndromes assocaited with aging and chronic diseases, such as chronic heart disease, hypertension, diabetes, all conditions that convert to a series of strong acting physiological and biological stressors on life.

.

Age-Related Asymmetries and Peak Age Differences

The above figures demonstrate peak age differences, with men activity engaged or related to the ICD reviewed much earlier than women.  The first two figures depict different stages in the life of an alcoholic.  Abuse begins early in life, and hte long term consequences much later, demonstrating a direct correlation between behavior and physical health.

Whiplash and psychogenic constipation demonstrate similarities between a condition with obvious physical medical history related to trauma, and another with a primarily psychgenic reason for onset and diagnosis.  Both also demonstrate childhood experience related peaks.  The important feature to note is the symmetry of childhood conditions versus the asymmetery of the same when it is experience during adulthood regarding gender related events.

This male peak age < female peak age recurs in the next set, with childhood events documented, but less prevalent, and again, equal across genders.   The first ICD is organic sleep apnea and the second sllep apnea diagnosed as a non-organic, non-physical body dependent state.  The two results are very similar.  This similarity could be a result of the subjective nature of these diagnoses and the lack of ability to truly differentiate between the two.  In theory, the organic syndrome is mostly biological in nature and the 780 series more behavioral and ‘humanistic’.  The biological demonstrate earlier peaking male counts/prevalence than the behavioral-psychosomatic ICD.

The final two examples demonstrate very biologically-pronounced disease conditions or patterns.  Sacroidosis and MS result in physical changes in the body, which can often become debilitating.  Again, the earlier onset for men is noticed for Sarcoidosis, with overall prevalence nearly equal if all age ranges are counted together.  Such is not the case for MS.   Woemn far outnumber men in a statistical manner, and demonstrate a much more pronounced peak age than men.   Men with MS who are of this peak age are much younger than women who are at their genders peak prevalence age.

Exercise

How might the following asymmetries be defined?  Define the ILOC and ELOC features for each.  Relate these to the Health Belief Model.

Assume gender distributions were expected be equal.   Take into account the following medical history items:

• the easiest to identify age peak(s) for each gender
• major age gender symmetry for very young/young, middle age/working class age, very old
• major age gender asymmetry
• overall gender age-prevalence plotted area difference
• gender, age peak and range
• age ranges for greatest gender differences
• reason for diagnosis/problem
• is ICD related to iatrogenics, accidents, age-linked deterioration, treatment protocols
• the ILOC and ELOC features for each

The ICDs illustrated are:

• 558.1 Radiation-induced Gastroenteritis
• 886.* Finger Amputation
• V46.2 Wheelchair Dependence
• V15.81 Non-compliance with Prescription/Care recommendations
• 560.2 Volvulus problem in GI