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Table 1 Typology of sex S and gender G effects on a health outcome Y

From: Considering sex and gender in Epidemiology: a challenge beyond terminology. From conceptual analysis to methodological strategies

Name Definitions Examples of counterfactual formulation
Total effect of sex (TES) The difference in the value of Y had the whole population been born female “S = f” versus the whole population been born male “S = m
Corresponds to the total effect of being born male (versus being born female) on Y value, whatever the mechanisms explaining these differences
\(E\left({Y}_{S=m}\right)-E\left({Y}_{S=f}\right)\)
Socially mediated indirect effect of sex (SMIES) The difference in the value of Y, had the sex been set to a constant level (for example “S = m”), and gender been change from Gf to Gm in the whole population
Corresponds to the indirect effect of sex which is explained/ mediated by social mechanisms G
\(E\left({Y}_{S=m;G={G}_{m}}\right)-E\left({Y}_{S=m;G={G}_{f}}\right)\)
Direct or residual effect of sex (RES) The difference in the value of Y had the sex been changed from female “S = f” to male “S = m” in the whole population, while the gender variable been set constant to \({G}_{f}\)
Corresponds to the direct effect of sex which does not pass through G
\(E\left({Y}_{S=m;G={G}_{f}}\right)-E\left({Y}_{S=f;G={G}_{f}}\right)\)
Sex-controlled gender effect (SCGE) The difference in the value of Y had the whole population been gendered in some way “G = f versus the other way “G = m”. Correspond to the total effect G → Y. In this case, the sex and the environment are confounding factors, it will therefore be necessary to adjust for them
Corresponds to the effect on G of Y “whatever the sex”
\(E\left({Y}_{G=f}\right)-E\left({Y}_{G=m}\right)\)
  1. With: S for Sex, G for Gender, Y for outcome