Abstract
Background: Sex-related treatment disparities are well-documented across various medical conditions, yet their impact on the management of inflammatory bowel disease (IBD) remains underexplored. This study aims to investigate sex-based differences in the management of ulcerative colitis (UC), focusing on both medical and surgical approaches and examining whether biological sex correlates with variations in healthcare utilization. Methods: A systematic search was conducted across multiple databases, including MEDLINE (via PubMed), Google Scholar, the Cochrane Library, and ScienceDirect, to identify studies on sex differences in ulcerative colitis (UC) management up to April 2024. Statistical analysis was performed using RevMan 5.4, with a random-effects model to combine odds ratios (OR) for both primary and secondary outcomes. The study is registered with PROSPERO (CRD42024537750). Results: The meta-analysis included eight observational studies involving 47,089 patients (51.9% females). There were no statistically significant sex differences in biologic therapy use (OR 0.89, 95% CI: 0.69 to 1.15, p = 0.36) or corticosteroid use (OR 1.17, 95% CI: 0.89 to 1.54, p = 0.27). However, females were less likely to use immunomodulators compared to males (OR 0.89, 95% CI: 0.85 to 0.94, p < 0.0001). There were no significant differences in surgical interventions, including total abdominal colectomy. Females had higher annual UC-related hospitalizations compared to males (OR 1.41, 95% CI: 1.22 to 1.64, p < 0.00001). Conclusions: In conclusion, while biologic and surgical treatments showed no significant sex differences, disparities were noted in immunomodulator use and hospitalization rates, underscoring the need for sex-specific UC management strategies.