Sex differences in pain expressed by patients across diverse disease states: individual patient data meta-analysis of 33,957 participants in 10 randomized controlled trials

The experience of pain is determined by many factors and has a significant impact on quality of life. This study aimed to determine sex differences in pain prevalence and intensity reported by participants with diverse disease states in several large international clinical trials. Individual participant data meta-analysis was conducted using EuroQol-5 Dimension (EQ-5D) questionnaire pain data from randomised controlled trials published between January 2000 and January 2020 and undertaken by investigators at the George Institute for Global Health. Proportional odds logistic regression models, comparing pain scores between females and males and fitted with adjustments for age and randomized treatment, were pooled in a random-effects meta-analysis. In 10 trials involving 33,957 participants (38% females) with EQ-5D pain score data, the mean age ranged between 50 and 74. Pain was reported more frequently by females than males (47% vs 37%; P < 0.001). Females also reported greater levels of pain than males (adjusted odds ratio 1.41, 95% CI 1.24-1.61; P < 0.001). In stratified analyses, there were differences in pain by disease group (P for heterogeneity <0.001), but not by age group or region of recruitment. Females were more likely to report pain, and at a higher level, compared with males across diverse diseases, all ages, and geographical regions. This study reinforces the importance of reporting sex-disaggregated analysis to identify similarities and differences between females and males that reflect variable biology and may affect disease profiles and have implications for management

Attribution of observed surface humidity changes to human influence

Water vapour is the most important contributor to the natural greenhouse effect, and the amount of water vapour in the atmosphere is expected to increase under conditions of greenhouse-gas-induced warming, leading to a significant feedback on anthropogenic climate change1, 2, 3. Theoretical and modelling studies predict that relative humidity will remain approximately constant at the global scale as the climate warms, leading to an increase in specific humidity1, 4, 5. Although significant increases in surface specific humidity have been identified in several regions6, 7, 8, 9, and on the global scale in non-homogenized data10, it has not been shown whether these changes are due to natural or human influences on climate. Here we use a new quality-controlled and homogenized gridded observational data set of surface humidity, with output from a coupled climate model, to identify and explore the causes of changes in surface specific humidity over the late twentieth century. We identify a significant global-scale increase in surface specific humidity that is attributable mainly to human influence. Specific humidity is found to have increased in response to rising temperatures, with relative humidity remaining approximately constant. These changes may have important implications, because atmospheric humidity is a key variable in determining the geographical distribution11, 12, 13 and maximum intensity14 of precipitation, the potential maximum intensity of tropical cyclones15, and human heat stress16, and has important effects on the biosphere17 and surface hydrology17, 18