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Published on: October 29, 2014
Sex differences in bacterial meningitis and associations with socioeconomic indicators: a systematic review and
Fabian D Liechti1,2, Cornelis N van Ettekoven2,3, Matthijs C Brouwer2
1Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Introduction:
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).
Methods:
Google Scholar and MEDLINE (via PubMed.gov) were searched in January 2022 using the terms "bacterial meningitis" and "mortality". Studies with a mean observation period after the year 1940 and reporting ≥10 patients with community-acquired bacterial meningitis and their survival status were included, irrespective of the participants' 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.
Results:
In this meta-analysis with metaregression, from 371 studies with 157 656 meningitis episodes, 217 (58%) reported the patients' sex and 41 (11%) reported sex-specific outcomes. Proportion of males was 58% (95% CI 57%-59%, prediction interval (PI) 45%-71%). Case fatality ratios were slightly higher in females (male-to-female fatality ratio, 0.89, 95% CI 0.78 to 1.01, PI 0.53-1.49). The size of the male proportion was strongly associated with HDI (per index point, -0.64, 95% CI -0.88 to -0.40; R2 16%; p<0.001) and GII (per index point, 0.61, 95% CI 0.39 to 0.83; R2 19%; p<0.001). Sex-specific case fatality ratios were weakly associated with HDI (per index point, 0.53, 95% CI -0.19 to 1.25; R2 2%; p=0.15) and GII (per index point, -0.58, 95% CI -1.55 to 0.39; R2 7%; p=0.24).
Conclusion:
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.
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