Introduction

This concept provides definitions for the words "sex" and "gender", describes the current state of sex and gender related variables available in the Manitoba Population Research Data Repository (Repository), identifies additional data in the Repository related to gender identity and gender expression, and provides links to information containing guidelines, resources and tools that describe approaches to using sex and/or gender in health research.

Definitions of Sex and Gender

The words sex and gender are often used interchangeably, but the definitions for these words are quite different.

According to the Canadian Institutes of Health Research (CIHR) website:

"Sex refers to a set of biological attributes in humans and animals ... primarily associated with physical and physiological features including chromosomes, gene expression, hormone levels and function, and reproductive/sexual anatomy. Sex is usually categorized as female or male but there is variation in the biological attributes that comprise sex and how those attributes are expressed.

Gender refers to the socially constructed roles, behaviours, expressions and identities of girls, women, boys, men, and gender diverse people. It influences how people perceive themselves and each other, how they act and interact, and the distribution of power and resources in society. Gender identity is not confined to a binary (girl/woman, boy/man) nor is it static; it exists along a continuum and can change over time."

(Source: Canadian Institutes of Health Research (CIHR) website: What is gender? What is sex? . Accessed December 8, 2023)

Sex and Gender Related Variables in the Repository

In the Manitoba Population Research Data Repository, the variables labelled SEX and/or GENDER are available in many of the datasets. These variables are often used interchangeably in our research and most values are recorded as either female or male, although some additional values are available in some datasets.

The values recorded for female and male can be represented in different ways depending on the dataset being used. For example, females can be identified by the values: Female, F, or 2 and males can be identified by the values: Male, M or 1, depending on the dataset being used.

In some datasets, a small number of additional values may be recorded, such as:


• "X", "U", "O", "3", "4", or "A" - these values carry the meaning of undefined, undifferentiated, unspecified, unknown, other, or ambiguous, depending on which dataset they are recorded in.
  
• In some cases, the value for either of these variables can be missing; meaning that no value is recorded in the data.

The collection and reporting of sex and gender data is largely limited to values of female or male, or other sex-related terminology. When GENDER is available as a variable, it is unclear whether these values are intended to describe social / cultural perspective or biological aspects.

When using these variables, it is important to note sex is not a placeholder for gender (or vice-versa) and data users should attempt to avoid conflating these terms and / or acknowledge limitations in the data.

Gender Identity and Gender Expression Related Data

The Repository currently contains very limited data available to investigate gender identity or gender expression in your research.

The datasets in the Manitoba Data Repository that do contain a limited amount of gender-related information are:


• 2021 Canada Census data - see the Statistics Canada web page titled Filling the gaps: Information on gender in the 2021 Census for more information on what gender-related information is available from the 2021 Census.
  
  
• Youth Health Survey (YHS) data (2012-2013) - includes a question on IDENTITY with response values that include: different sex, same sex, transgender, and missing. However, the limited range of values available seem to conflate identity and orientation.

Additional gender-related data may be found:


• in the Hospital Abstracts data and / or the Medical Services / Medical Claims data that may contain specific ICD / CCI diagnoses and intervention codes that identify gender-related medical conditions and procedures.

Approaches to Using Sex and/or Gender in Health Research

The following links provide some suggestions and ideas on how to approach using sex and / or gender in health research.

The Canadian Institutes of Health Research (CIHR) website provides some guidelines, resources, and tools to assist researchers in using sex and/or gender in their research. Two of these resources are:


• Sex and Gender in Health Research
  
• How to integrate sex and gender into research

In the article Integrating and evaluating sex and gender in health research by Day, S, Mason, R, Lagosky, S, and Rochon, PA (Health Research Policy and Systems 2016;14(1):75) they examine some of the challenges of using and investigating sex and gender in research, and offer some strategies in dealing with these challenges.