Are we moving the dial? Sex- and gender-based analysis trends in Canadian health research funding from 2009-2020

Sex and gender impacts health outcomes and disease risk throughout life. Women and Two-Spirit, Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Intersex, and Asexual (2S/LGBTQIA+) health is often compromised as they experience delays in diagnosis. Distinct knowledge gaps in the health of these populations has prompted funding agencies to mandate incorporation of sex and gender into reearch. Sex- and gender-informed research perspectives and methodology increases rigor, promotes discovery, and expands the relevance of health research. The Canadian Institutes of Health Research (CIHR) implemented a Sex and Gender-based Analysis (SGBA) framework reccommending the inclusion of SGBA in project proposals in 2010 and in 2019, CIHR mandated the incorporation of SGBA into grant proposals. To examine whether these mandates resulted in increased SGBA uptake in research proposals, we searched the publicly available database of proposals funded by CIHR to analyze the amount of research that focused on sex and gender differences in health, as well as the 2S/LGBTQIA+ community. We categorized a total of 8,964 Project and Operating grant abstracts awarded from 2009-2020. Overall, under 10% of research funded by CIHR explicitly examined SGBA, with 1.94% of grants examining sex differences, 0.66% examining gender differences, 5.92% investigating female-specific outcomes, and 0.35% focusing on the 2S/LGBTQIA+ community. Although there was an increased number of grants funded for sex and 2S/LGBTQIA+ health across time, these increases were less than 2% between 2009 to 2020. The percentage of grants investigating female-specific health or gender differences did not change significantly. The percentage of funding dollars allocated to proposals analyzing SGBA also did not change substantially from 2009-2020, with grants examining sex differences or females increasing by 1.26% and 3.47% respectively, gender differences research funding decreasing by 0.49% and no change for 2S/LGBTQIA+-specific health. Our findings suggest more work needs to be done to increase researcher uptake in SGBA to advance health equity in research. Highlights Funded grants focusing on sex or gender differences in health research have largely remained unchanged from 2009 to 2020 with the largest increase of 1.57% for sex differences research. Total funding amounts for sex or gender differences in health research have stagnated or declined across 2009 to 2020. Grants focusing on female-specific health did not change across 2009-2020, but the percentage of funding dollars increased by 3.47%. The percentage of grants focused on, and funding allocated to, 2S/LGBTQIA+-specific health more than tripled across 2009-2020 but remained less than 1% of all funded grants.