Gender inequalities across ethnicities in primary care cancer referrals: scoping review protocol.

BACKGROUND: Early cancer diagnosis is associated with improved mortality and morbidity; however, studies indicate that women and individuals from ethnic minorities experience longer times to diagnosis and worse prognosis compared to their counterparts for various cancers. In countries with a gatekeeper healthcare system, such as UK, most suspected cancer referrals are initiated in primary care. AIM: To understand the extent of evidence available on the relationship between primary care cancer referral pathways and cancer outcomes in relation to gender across different ethnic groups. This will identify research gaps and enable development of strategies to ease potential inequalities in cancer diagnosis. DESIGN & SETTING: A scoping review based on the Joanna Briggs Institute methodology. PRISMA-ScR will be used. METHOD: Electronic databases and private collections of the team members will be searched for studies. Two independent reviewers will carry out the study selection and data extraction. Based on participants, concept and context framework, this review will consider studies after year 2000 that explored the relationship between gender, across various ethnic groups, and cancer outcomes following primary care cancer referral in countries with gatekeeper healthcare systems (UK, New Zealand, Sweden, Australia, Canada, Denmark, Ireland and Norway). Results will be presented as a narrative analysis. CONCLUSION: The results are expected to provide an overview of the discrepancies in primary care cancer referrals based on gender across ethnic groups, which will be crucial to define an appropriate range of strategies to ease any inequalities in primary healthcare cancer diagnosis. OPEN SCIENCE FRAMEWORK PROTOCOL REGISTRATION: https://osf.io/jvtxb.

[Gender Inequalities of the COVID-19 Pandemic: A Synthesis of Systematic Reviews with a Focus on Sexual and Gender Minorities]. / Geschlechtsspezifische Unterschiede und Ungleichheiten der COVID-19 Pandemie: Eine Synthese systematischer Reviews unter Einbeziehung sexueller und geschlechtlicher Minderheiten.

OBJECTIVE: From the very beginning of the COVID-19 pandemic, gender was shown to play a significant role in how people were affected by it, while aspects related to sexual and gender minorities (SGM) have been rather understudied. The aim of this review was to synthesize systematic reviews and meta-analyses that explicitly addressed the impact of gender within the context of the pandemic, with a focus on SGM. METHODS: We based the narrative synthesis of results on a literature search of PubMed. We included systematic reviews and meta-analyses as of 2019 with an identifiable gender comparison or SGM reference and a specified clinical outcome. RESULTS: The search yielded 2 658 hits; 29 systematic reviews were included for content synthesis. Of these, we identified 23 systematic reviews with gender comparisons and 8 related to SGM. Men showed higher prevalence, severity, and mortality of COVID-19 compared with women, but the psychological consequences of the COVID-19 pandemic affected women more compared with men. Evidence suggests that women are at higher risk for Long-COVID-19. SGM experienced increased mental health problems during the COVID-19 pandemic compared to the general population. DISCUSSION: It appears that biological and social risks led to differential susceptibility to infection and manifestation of COVID-19 disease and also accounted for differences in mortality between men and women. Insights on prevalence, disease burden, and mortality among SGM during the COVID-19 pandemic are lacking. This suggests an underrepresentation of SGM in COVID-19-related research. Despite the abundance of COVID-19 publications, gender effects have not often been explicitly and adequately studied. CONCLUSION: Future studies should examine gender differences and needs and concerns of SGM in mental disorders and further understudied entities like Long-COVID-19, to gain insights and help to provide preventive measures and adequate treatments for all, for potential future pandemics as well.

A Systematic Review and New Analyses of the Gender-Equality Paradox.

Some studies show that living conditions, such as economy, gender equality, and education, are associated with the magnitude of psychological sex differences. We systematically and quantitatively reviewed 54 articles and conducted new analyses on 27 meta-analyses and large-scale studies to investigate the association between living conditions and psychological sex differences. We found that sex differences in personality, verbal abilities, episodic memory, and negative emotions are more pronounced in countries with higher living conditions. In contrast, sex differences in sexual behavior, partner preferences, and math are smaller in countries with higher living conditions. We also observed that economic indicators of living conditions, such as gross domestic product, are most sensitive in predicting the magnitude of sex differences. Taken together, results indicate that more sex differences are larger, rather than smaller, in countries with higher living conditions. It should therefore be expected that the magnitude of most psychological sex differences will remain unchanged or become more pronounced with improvements in living conditions, such as economy, gender equality, and education.

Meta-Analysis of Demographic Disparities in Monkeypox Infections among Diverse Populations.

This meta-analysis aims to investigate demographic disparities in monkeypox (mpox) infections among various groups based on ethnicity, sexual partners, and gender. The study includes data from 2,646 to 4,002 patients across various outcomes. Among racial demographics, black populations show a lower odds ratio for mpox compared to white populations (OR=0.08 [0.01, 0.45], 95% CI, p=0.004). However, no statistically significant difference is found when comparing black populations with Hispanic or Asian populations (OR=0.72 [0.46, 1.11], p=0.13). There was a substantial disparity between gay, bisexual and other men-who-have-sex-with-men (GBMSM) and heterosexual populations, with significantly higher odds of mpox among the former (OR=393.80, 95% CI: [82.45, 180.85], p<0.00001). Analysis of sexual partners indicates a significant difference in infection risk between individuals with zero to one sexual partner and those with more than two partners (OR=0.06 [0.01, 0.28], p=0.0005). Additionally, there is a substantial difference in infection risk between male and female populations (OR=3868.02, p<0.00001). These findings emphasize the importance of considering demographic factors in understanding mpox transmission and risk profiles. Targeted research and intervention strategies are required to address the identified disparities and mitigate the spread of mpox.

Intersectional race and gender disparities in kidney transplant access in the United States: a scoping review.

BACKGROUND: Gender and racial disparities in kidney transplant access are well established, however how gender and race interact to shape access to kidney transplant is less clear. Therefore, we examined existing literature to assess what is known about the potential interaction of gender and race and the impact on access to kidney transplantation in the US. METHODS: Following PRISMA guidelines, we conducted a scoping review and included quantitative and qualitative studies published in English between 1990 and May 31, 2023 among adult end-stage kidney disease patients in the US. All studies reported on access to specific transplant steps or perceived barriers to transplant access in gender and race subgroups, and the intersection between the two. We narratively synthesized findings across studies. RESULTS: Fourteen studies met inclusion criteria and included outcomes of referral (n = 4, 29%), evaluation (n = 2, 14%), waitlisting (n = 4, 29%), transplantation (n = 5, 36%), provider perceptions of patient transplant candidacy (n = 3, 21%), and patient preferences and requests for a living donor (n = 5, 36%). Overall, we found that White men have the greatest access at all steps of the transplant process, from referral to eventual living or deceased donor transplantation. In contrast, women from racial or ethnic minorities tend to have the lowest access to kidney transplant, in particular living donor transplant, though this was not consistent across all studies. CONCLUSIONS: Examining how racism and sexism interact to shape kidney transplant access should be investigated in future research, in order to ultimately shape policies and interventions to improve equity.

Improving equity of services for sexually transmitted infections through community pharmacies: A scoping review.

BACKGROUND: Pharmacists have the potential to improve care for marginalized populations. Stigmatized and racialized groups may not find traditional health services accessible in other settings. Research focused on health care access for these populations is fundamental in understanding how to improve health equity. OBJECTIVES: This scoping review aimed to determine how health equity is addressed within services offered through community pharmacies for sexually transmitted infections (STIs). METHODS: This scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist. A comprehensive search strategy was developed with an academic librarian to capture studies containing search terms related to each of the following 3 topics: STIs, pharmacy, and underserved groups. PubMed and Embase were both searched up to July 2023 and search results were uploaded to the screening software Covidence. Two researchers independently screened titles, abstracts, and full texts. Articles were included if they reported evaluation of a pharmacy-based sexual health service and addressed health equity in service design or implementation. RESULTS: A total of 8 articles were identified that described services implemented for underserved groups. Four populations were identified: injection drug users, men who have sex with men, racial minorities, and those with low socioeconomic status. Equity was addressed through 2 mechanisms: location-based implementation of services in areas of high target population density or through specific targeting of marginalized populations in recruitment and promotion. All studies involved interventions for the prevention or testing services rather than assessment and treatment. CONCLUSIONS: Equity is not being readily addressed in pharmacy-based services for STIs yet evidence exists that considering equity in the design and implementation of services may improve reach to underserved populations.

Does education moderate gender disparities in later-life memory function? A cross-national comparison of harmonized cognitive assessment protocols in the United States and India.

INTRODUCTION: We compared gender disparities in later-life memory, overall and by education, in India and the United States (US). METHODS: Data (N = 7443) were from harmonized cognitive assessment protocols (HCAPs) in the Longitudinal Aging Study of India-Diagnostic Assessment of Dementia (LASI-DAD; N = 4096; 2017-19) and US Health and Retirement Study HCAP (HRS-HCAP; N = 3347; 2016-17). We derived harmonized memory factors from each study using confirmatory factor analysis. We used multivariable-adjusted linear regression to compare gender disparities in memory function between countries, overall and by education. RESULTS: In the United States, older women had better memory than older men (0.28 SD-unit difference; 95% CI: 0.22, 0.35). In India, older women had worse memory than older men (-0.15 SD-unit difference; 95% CI: -0.20, -0.10), which attenuated with increasing education and literacy. CONCLUSION: We observed gender disparities in memory in India that were not present in the United States, and which dissipated with education and literacy.

Health Disparities Among Lesbian, Gay, Bisexual, Transgender, and Queer Older Adults: A Structural Competency Approach.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) older adults experience significant health disparities. Examining these disparities has become an international research priority, but gaps remain. In this review article, we summarize major contributions of and ongoing gaps in health disparities research among LGBTQ+ older adults, while focusing on four major content areas: (a) social determinants of health disparities, (b) mental, cognitive, and physical health disparities, (c) reproductive and sexual health disparities, and (d) seeking LGBTQ+-affirming and age-friendly care. Using a structural competency approach, we develop a four-part agenda for this research area that enhances our understanding of how macro-level systems, institutions, and structures drive health disparities among aging LGBTQ+ communities. We also outline future research on structural competency in LGBTQ+ older adult health, while providing recommendations for researchers and clinicians. These recommendations illuminate potential best practices for bettering the health and quality of life of LGBTQ+ older populations.

Temporal trends of gender disparities in oral anticoagulant use in patients with atrial fibrillation.

AIMS: To investigate sex-specific temporal trends in the initiation of oral anticoagulant (OAC) therapy among patients diagnosed with atrial fibrillation (AF) in Finland between 2007 and 2018. METHODS: The registry-linkage Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) Study included all patients with incident AF in Finland from 2007 to 2018. The primary outcome was the initiation of any OAC therapy. RESULTS: We identified 229,565 patients with new-onset AF (50.0% women; mean age 72.7 years). The initiation of OAC therapy increased continuously during the observation period. While women were more likely to receive OAC therapy overall, after adjusting for age, stroke risk factors and other confounding factors, female sex was associated with a marginally lower initiation of OACs (unadjusted and adjusted hazard ratios comparing women to men: 1.08 (1.07-1.10) and 0.97 (0.96-0.98), respectively). Importantly, the gender disparities in OAC use attenuated and reached parity by the end of the observation period. Furthermore, when only patients eligible for OAC therapy according to the contemporary guidelines were included in the analyses, the gender inequalities in OAC initiation appeared minimal. Implementation of direct OACs for stroke prevention was slightly slower among women. CONCLUSION: This nationwide retrospective cohort study covering all patients with incident AF in Finland from 2007 to 2018 observed that although female sex was initially associated with a lower initiation of OAC therapy, the sex-related disparities resolved over the course of the study period.

Gender disparities in postoperative outcomes following elective spine surgery: a systematic review and meta-analysis.

OBJECTIVE: Several studies have described disparities between male and female patients following spine surgery, but no pooled analyses have performed a robust review characterizing differences in postoperative outcomes based on gender. The purpose of this study was to broadly assess the effects of gender on postoperative outcomes following elective spine surgery. METHODS: Between November 2022 and March 2023, PubMed, MEDLINE, ERIC, and Embase were queried using artificial intelligence-assisted software for relevant cohort studies. Cohort studies with a minimum sample of 100 patients conducted in the United States since 2010 were eligible. Studies related to trauma, tumors, infections, and spinal cord pathology were excluded. Independent extraction by multiple reviewers was performed using Nested Knowledge software. A fixed- or random-effects model was used if heterogeneity among included studies in a meta-analysis was < 50% or ≥ 50%, respectively. Risk of bias was assessed independently by multiple reviewers using the Newcastle-Ottawa Scale. Pooled effect sizes were calculated for readmission, nonroutine discharge (NRD), length of stay (LOS), extended LOS, reoperation, mortality, all medical complications (individual analyses for cardiovascular, deep venous thrombosis/pulmonary embolism, genitourinary, neurological, respiratory, and systemic infection complications), and wound-related complications. For each outcome, two subanalyses were performed with studies that used either center-based (single- or multi-institution) or high-volume (national or state-wide) databases. RESULTS: Across 124 included studies, male patients had an increased incidence of mortality (OR 0.54, p < 0.0001) and all medical complications (OR 0.80, p = 0.0114), specifically cardiovascular (OR 0.68, p < 0.0001) and respiratory (OR 0.76, p = 0.0008) complications. Female patients were more likely to experience a wound-related surgical complication (OR 1.16, p = 0.0183). These findings persisted in the high-volume database subanalyses. Only center-based subanalyses showed that female patients were at greater odds of experiencing an NRD (OR 1.18, p = 0.0476), longer LOS (SMD 0.23, p = 0.0036), and extended LOS (OR 1.28, p < 0.0001). CONCLUSIONS: Males are more likely to experience death and medical complications, whereas females were more likely to face wound-related surgical complications. At the institution level, females more often experience NRD and longer hospital stays. These findings may better inform preoperative expectation management and provide more detailed postoperative risk assessments based on the patient's gender.

Participatory approaches and methods in gender equality and gender-based violence research with refugees and internally displaced populations: a scoping review.

Using participatory approaches or methods are often positioned as a strategy to tackle power hierarchies in research. Despite momentum on decolonising aid, humanitarian actors have struggled to describe what 'participation' of refugees and internally displaced persons (IDPs) means in practice. Efforts to promote refugee and IDP participation can be tokenistic. However, it is not clear if and how these critiques apply to gender-based violence (GBV) and gender equality-topics that often innately include power analysis and seek to tackle inequalities. This scoping review sought to explore how refugee and IDP participation is conceptualised within research on GBV and gender equality. We found that participatory methods and approaches are not always clearly described. We suggest that future research should articulate more clearly what constitutes participation, consider incorporating feminist research methods which have been used outside humanitarian settings, take more intentional steps to engage refugees and IDPs, ensure compensation for their participation, and include more explicit reflection and strategies to address power imbalances.

Health disparities in one of the world's most progressive countries: a scoping review of mental health and substance use among sexual and gender minority people in the Netherlands.

BACKGROUND: Evidence from many parts of the world shows that sexual and gender minority (SGM) people have poorer health than their cisgender heterosexual counterparts. Minority stressors, particularly stigma and discrimination, have been identified as major contributors to sexual orientation- and gender identity-related health disparities, particularly negative mental health and behavioral health outcomes. To better understand factors that contribute to these disparities, we conducted a scoping review of SGM mental health and substance use research in the Netherlands-a country with a long-standing reputation as a pioneer in SGM equality. METHODS: Using Joanna Briggs Institute guidelines and the PRISMA-ScR protocol, we searched seven databases to identify studies published between 2010 and 2022 that focused on substance use and/or mental health of SGM youth and adults in the Netherlands. RESULTS: Although there was some evidence that SGM people in the Netherlands report fewer substance use and mental health concerns than those in less progressive countries, with very few exceptions studies found poorer outcomes among SGM participants than cisgender, heterosexual participants. However, this observation must be considered cautiously given major gaps in the literature. For example, only one study focused exclusively on adult sexual minority women, two focused on older SGM adults, and very little attention was given to nonbinary individuals. Most studies used non-probability samples that were quite homogenous. Many studies, especially those with youth, assessed sexual orientation based on sexual attraction; some studies of adults operationalized SGM status as having a same-sex partner. Importantly, we found no studies that directly assessed associations between structural-level stigma and health outcomes. Studies were mostly focused at the individual level and on health problems; very little attention was given to strengths or resilience. CONCLUSIONS: Findings of persistent health disparities-despite the relatively long history of SGM supportive policies in the Netherlands-highlight the need for more research and greater attention to population groups that have been underrepresented. Such research would not only provide guidance on strategies to improve the health of SGM people in the Netherlands, but also in other countries that are seeking to reduce health inequities. Addressing SGM health disparities in the Netherlands and elsewhere is complex and requires a multifaceted approach that addresses individual, interpersonal and structural factors.

A Tutorial for Propensity Score Weighting for Moderation Analysis With Categorical Variables: An Application Examining Smoking Disparities Among Sexual Minority Adults.

OBJECTIVE: To provide step-by-step guidance and STATA and R code for using propensity score (PS) weighting to estimate moderation effects with categorical variables. RESEARCH DESIGN: Tutorial illustrating the key steps for estimating and testing moderation using observational data. Steps include: (1) examining covariate overlap across treatment groups within levels of the moderator; (2) estimating the PS weights; (3) evaluating whether PS weights improved covariate balance; (4) estimating moderated treatment effects; and (5) assessing the sensitivity of findings to unobserved confounding. Our illustrative case study uses data from 41,832 adults from the 2019 National Survey on Drug Use and Health to examine if gender moderates the association between sexual minority status (eg, lesbian, gay, or bisexual [LGB] identity) and adult smoking prevalence. RESULTS: For our case study, there were no noted concerns about covariate overlap, and we were able to successfully estimate the PS weights within each level of the moderator. Moreover, balance criteria indicated that PS weights successfully achieved covariate balance for both moderator groups. PS-weighted results indicated there was significant evidence of moderation for the case study, and sensitivity analyses demonstrated that results were highly robust for one level of the moderator but not the other. CONCLUSIONS: When conducting moderation analyses, covariate imbalances across levels of the moderator can cause biased estimates. As demonstrated in this tutorial, PS weighting within each level of the moderator can improve the estimated moderation effects by minimizing bias from imbalance within the moderator subgroups.

Cultural interventions addressing disparities in the HIV prevention and treatment cascade among Black/African Americans: a scoping review.

Culture is an important determinant of HIV risk and protective behaviors; yet, we know little about how it is integrated in HIV interventions. This scoping review characterizes the integration of culture in HIV prevention and treatment interventions focused on Black/African Americans. We searched MEDLINE, PsycINFO, CINAHL, and Google Scholar for peer-reviewed manuscripts published between July 1, 2011, and June 28, 2021. Twenty-five interventions were identified, with 96% focused on prevention. Most (40%) targeted men who have sex with men or transgender women. Only three were grounded in cultural theory. Although all interventions were labeled "culturally based," only two explicitly defined culture. Moreover, there was much diversity regarding the ways in which interventions integrated cultural elements, with some conflating race/ethnicity with culture. To improve uptake and HIV-related outcomes, interventions integrating culture are greatly needed. Additionally, HIV interventions purporting to be "culturally based" must include basic information to support rigor and reproducibility.

Analysis of Gender-Based Inequality in Cardiovascular Health: An Umbrella Review.

This umbrella review aims to investigate possible gender-based inequality in cardiovascular health and improve understanding surrounding differing presentations seen in women. Searches of current literature were conducted using Medline; Cochrane; Cumulative Index of Nursing and Allied Health Literature (CINAHL Plus); and PubMed databases. Focusing on systematic reviews and meta-analyses from the last decade, searches were expanded to the publication year of 2000 onwards, to enable a broader review of current practices. Current clinical guidelines were also reviewed. 17 articles were deemed to satisfy the desired criteria and were therefore carried forward to be critically appraised. The articles reviewed were multifactorial; however, they can be grouped into four categories of common focus: risk factors, presentation, treatment, and current research. On critical analysis, 13 reoccurring themes were noted throughout the reviewed articles with each discussed in detail within this review. There is a need to prioritize women in cardiovascular health, through raising awareness, improving prevention (both primary and secondary), reducing delays in presentation, and increasing understanding and recognition of sex differences in symptom presentation, to enable improved diagnosis and treatment along with the standardization of gender-specific clinical guidance. The results are unanimous regarding an undeniable gender-based inequality in cardiovascular health to the detriment of women. With such damning evidence that women are under-represented and indeed undertreated, the time has come now to question whether women should be considered as their own specialty within cardiology and to ultimately raise awareness and ensure women are given the same consideration regarding cardiovascular disease (CVD) risk assessment and treatment, in order to finally remove gender inequality in cardiovascular (CV) health. In order to reverse this disparity, it is clear from the included studies that further research is required to understand the sex differences seen in both the presentation and symptoms of CVD as well as to enable improved treatment of women and the development of sex-specific strategies and clinical guidance to empower clinicians moving forward.

Gender Equality Training for Students in Higher Education: Protocol for a Scoping Review.

BACKGROUND: The principles of gender equality are integral to the goals, targets, and indicators of all sustainable development goals. Higher education institutes can be powerful agents for promoting gender equality, diversity, and inclusion not only in the higher education context but also in society as a whole. To address and overcome gender inequality in the higher education environment, experts posit that change needs to occur from day 1 of the student's academic experience. To this end, training is required. A preliminary review of the literature indicates that multiple gender equality-based training programs or initiatives for students have been designed and evaluated in second and third-level education settings. Examples of educational activities undertaken include delivery of didactic teaching, participation in a face-to-face collaboration project, site visits, case studies, and coaching. Yet, our initial search indicated that, to date, a comprehensive review collating the available evidence on gender equality training for third-level students has not yet been carried out. OBJECTIVE: Our review seeks to identify and explore the existing literature on gender equality training interventions for third-level students, with a particular emphasis on training content, methodology, and outcome evaluation. METHODS: This scoping review will be structured using the Arskey and O'Malley's 5-stage framework and will consider empirical research and other relevant published works that address gender equality training. Systematic searches will be carried out in 6 research databases and the gray literature using key search terms. Inclusion and exclusion criteria have been defined, and a data charting tool created to methodically extract information from selected literature. The free web software Rayyan will be used for primary screening where each reference will be screened in duplicate first by title, then abstract, and finally by full text. RESULTS: This review forms part of the LIBRA (Balance) study and has received peer-reviewed grant funding from the Irish Higher Education Authority. LIBRA aims to use simulation-based education to develop a gender equality leadership training program for student leaders in higher education. The findings will be summarized in tabular form, and a narrative synthesis produced to inform curriculum development. CONCLUSIONS: This review seeks to inform curriculum design by reporting on the gender equality-enabling skills and leadership skills necessary to foster gender equality. This paper should inform recommendations for training and catalyze future research in this rapidly evolving area. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44584.

Importance of Public and Private Partnership Supporting Data Disaggregation to Measure Racial, Sexual Orientation, and Gender Identity Disparities in COVID-19.

The COVID-19 pandemic has exposed shortcomings in the US public health data system infrastructure, including incomplete or disparate processes related to data collection, management, sharing, and analysis. Public health data modernization is critical to ensure health equity is at the core of preparedness and response efforts and policies that prioritize equitable responses to health emergencies. To address the inequitable uptake and distribution of COVID-19 vaccinations in communities most disproportionately impacted by the pandemic, the CDC Foundation's Response Crisis and Preparedness Unit began partnering with community-based organizations in March 2021 to provide education and outreach and facilitate access to vaccines. These organizations engaged with partners and communities to address vaccine-related concerns, develop innovative and culturally appropriate communication strategies, and promote timely vaccination. Two grantees, Out Boulder County in Colorado and the Coalition of Asian American Leaders in Minnesota, experienced issues related to public health data collection standards and practices for COVID-19. Data collection tools often lack the appropriate or necessary demographic variables or level of disaggregation needed to be able to assess prioritization and disparities within racial and ethnic groups and across sexual orientation and gender identity categories. In this case study, both grantee organizations document their experiences, challenges, and strategies to overcome barriers to implementing their projects resulting from a lack of meaningful data. These examples identify inequities and systems-level changes related to data collection and surveillance, and they provide recommendations and lessons learned to improve data surveillance for more equitable public health responses.

Sex and Gender Disparities in Living Kidney Donation: A Scoping Review.

Background: Women are more likely than men to be living kidney donors. We summarized the evidence concerning the reasons behind sex and gender disparities in living kidney donation (LKD). Methods: A scoping review of quantitative and qualitative evidence on reasons for sex and gender disparities in LKD was conducted from inception to March 2023. Results: Of 1123 studies screened, 45 were eligible for inclusion. Most studies were from North America, Europe, and Central Asia (n = 33, 73%). A predominance of women as living donors (55%-65%) was observed in 15 out of 18 (83%) studies. Reasons for sex and gender disparities in LKD included socioeconomic, biological, and cognitive or emotional factors. A gendered division of roles within the families was observed in most studies, with men being the primary income earner and women being the main caregiver. Fear of loss of income was a barrier to male donation. Human leukocyte antigen sensitization through pregnancy in female recipients precluded male partner donation, whereas female donation was supported by altruism and a positive attitude toward LKD. Conclusions: Sex imbalance in LKD is prevalent, with a predominance of women as living donors. Such disparities are driven by societal and cultural perceptions of gender roles, pregnancy-induced sensitization, and attitudes toward donation and at least some of these factors are modifiable. Donor compensation to support predonation assessments and income loss, implementation of innovative desensitization treatments, promotion of paired kidney exchange program, and targeted educational initiatives to promote equitable living donation may help to close the gender gap in LKD.