June 23, 2022
Precision health builds on the principle that a person’s health depends on the interaction of many biological, environmental and behavioral factors. Sex, which encompasses biologically defined traits related to anatomy, and gender, which encompasses socially defined traits related to self-concept and identity, are important characteristics that affect this interaction. As research datasets and participant groups are diversified according to sex, gender and other factors, we will understand more about how this interaction affects health outcomes. June is Men’s Health Month, so the time is right to think about how healthcare providers can apply precision health principles to optimize care for men.
Providers who practice preventive healthcare must evaluate a variety of data to assess an individual patient’s level of health risk. Choosing the right screening tests according to a man’s age, family health history, personal medical history, lifestyle, social determinants and other personal characteristics is important to mitigate those risks without causing undue harm or expense. Once a man has a health problem, continuing appropriate testing is important for diagnosing and monitoring the development of disease and evaluating the effectiveness of treatment.
Age and Disease Risk
As men age, their risk for developing certain diseases increases. Family medical history or genetic testing results may add to that level of risk. A higher risk of disease typically warrants testing at a younger age and more often.
With younger men, the first obstacle to addressing health risks is getting them to establish a regular preventative healthcare routine. According to the National Center for Health Statistics’ National Health Interview Survey, U. S. men between the ages of 18 and 44 are much less likely than women of the same age, children or adults aged 45 and older to have a usual place to go for healthcare. This means they are likely to miss out on these recommended screenings:
- Blood pressure check: Any reading higher than 120 (systolic) over 80 (diastolic) is cause for concern. Under current guidelines, the American College of Cardiology and the American Heart Association classify high blood pressure (hypertension) as starting at 130/80. Hypertension puts people at higher risk for developing cardiovascular disease, stroke, dementia and kidney disease.
Younger men are much more likely than younger women to have high blood pressure, according to the American Heart Association. For ages 20 to 34, the prevalence of hypertension is 25.7% of men compared to 13% of women; for ages 35 to 44, it’s 42.5% versus 31.6%. Men are also less likely than women to be aware that they have hypertension, to be getting treatment for it, and to have it under control.
When race and ethnicity are considered, the risks can be even higher. Black men have the highest prevalence of high blood pressure across all age groups at 58.6 % of the population. Compare that to 48.2% of white men, 47.4% of Hispanic men, and 46.4 % of Asian men.
- Lipoprotein panel: These test results show the levels of HDL cholesterol, LDL cholesterol, and triglycerides in the patient’s blood. This data is important to better assess the patient’s risk of cardiovascular disease. The National, Heart, Lung, and Blood Institute recommends this testing first at age 9 to 11, next at 14 to 16, and then every 5 years from age 20 to 45. Because men tend to experience cardiovascular disease at a younger age than women, men should start being screened every 1 or 2 years beginning at age 45.
- Colorectal cancer screening: In response to data showing that the number of younger people getting colorectal cancer is increasing, the American Cancer Society and others have recently lowered the recommended age of a first colorectal cancer screening from 50 to 45. The risk of developing colorectal cancer is nearly the same for men and women. Colonoscopies are the preferred test because they are thorough, and any precancerous polyps that are found can be removed during the procedure. However, if patients do not want to undergo sedation or do bowel preparation, they have other options, such as stool tests.
Just as important as choosing the appropriate age to begin screening for cancers and other serious diseases is recognizing when to stop this testing. Such tests are not likely to improve patient outcomes if the patient is older than 75 or has an estimated life expectancy of less than 10 years.
According to the Centers for Disease Control, men are more likely to smoke and drink alcohol, habits that increase their health risks. Men are also less likely to take certain actions to reduce health risks, such as getting a flu vaccine. On the plus side, men are more likely to exercise than women.
As Lauren Vogel points out in the Canadian Medical Association Journal article titled “Why do patients often lie to their doctors?,” patients may not give accurate information when asked about behavior that is likely to negatively affect their health. If the behavior progresses to the point of physical symptoms, providers may need to use testing or other measures to get a full picture of their patients’ health. Providers can increase the odds of getting honest answers to lifestyle questions by taking the time to establish trust with their patients.
- Weight: An unhealthy diet and lack of exercise can cause obesity. According to data from the National Health and Nutrition Examination Survey, 34.1% of men are overweight; 43% are obese. Obesity prevalence is lowest among Asian men at 17.5%, compared with 41.1% for Black men, 44.7% for white men, and 45.7% for Hispanic men. Being overweight or obese increases a man’s risk of heart disease; stroke; type 2 diabetes; cancer in the esophagus, gallbladder, stomach, kidneys, liver, pancreas, and thyroid; depression; sleep apnea; and erectile dysfunction.
The U.S Preventive Services Task Force recommends prediabetes and type 2 diabetes screening for all overweight adults between 35 and 70. The A1C or HbA1c blood sugar test is typically used for this screening, with a result of 5.7% to 6.4% indicating prediabetes and a result of 6.5% or above indicating diabetes.
- Mental health: Although mental illness as a whole is more prevelant in women than men, men are less likely to have received mental health treatment in the past year and are more likely to die from drug overdoses and suicide. Symptoms of mental illness can include insomnia or excessive sleeping; anger and aggressiveness; behavior that interferes with work or relationships; and unexplained headaches, pain or digestive issues.
Screening for mental health issues involves asking questions about thoughts and behavior instead of testing specimens. The U.S. Preventive Services Task Force recommends screening all adults for unhealthy drug use, suicide risk and depression. Treatment through medication and talk therapy requires a personalized approach and consistent follow-up to be effective.
Providers are constantly under pressure to provide better care in less time and for less money. They need clinical decision support in order to be able to apply LIS and EHR information, population data, professional society recommendations, and healthcare organization initiatives to the individual men they are treating. With this support, they have the best chance of personalizing testing and treatments to deliver the best possible patient outcome.
For providers and healthcare organizations that are working to deliver precision care, hc1 offers hc1 PrecisonDx Advisor™ to help optimize lab test ordering. This solution analyzes data against a set of customizable rules based on the latest recommendations from government, medical professional societies and advocacy groups for laboratory stewardship. These rules include demographic criteria, such as gender and age, as well as diagnosis, medication and test result criteria. Request a demo to learn more.