Sex-specific health phenotypes in a large qatari cohort: a cross-sectional analysis with implications for population health policy

Sex-specific differences in health are often overlooked in population health strategies in the Arabian Gulf. Characterising these differences is essential for targeted interventions and optimal healthcare resource allocation. This study aimed to quantify sex-specific health phenotypes across multiple domains in a large Qatari cohort, to distinguish normative physiological dimorphism from potentially modifiable health risk, and to assess the implications for health policy. Cross-sectional data from 2,389 Qatar Biobank participants, all Qatari nationals (1,192 males, 1,197 females) were analysed. Five composite scores were derived from standardised z-scores: muscular strength, blood pressure and adiposity, respiratory function, cognitive function, and a socio-environmental index. Respiratory function was quantified using reference-equation z-scores standardised for age, sex, height and ethnicity rather than raw volumes. Sex differences were assessed using MANOVA, followed by univariate models and effect size estimation (Cohen’s d ), with multivariable models adjusting for age, education, income and smoking. Prespecified sensitivity analyses addressed component overlap between composites, internal consistency, selection into the cognitive subsample, and effect modification by age. MANOVA indicated significant overall sex differences (Pillai’s Trace = 0.598, F (5,667) = 198.5, p < 0.001). Males had substantially higher muscular strength ( d = 2.41), a difference that persisted after adjustment ( d = 2.28) and is consistent with established structural dimorphism. In contrast, the large male advantage in respiratory function seen with raw volumes ( d = 2.05) attenuated to d = 0.30 when reference-equation z-scores were used, and to d = 0.17 after adjustment, indicating that the raw-volume difference reflected body size rather than respiratory health. Females showed a more favourable blood pressure and adiposity profile ( d = -0.58; adjusted d = -0.82), but this advantage was markedly larger below age 50 ( d = -0.78) than at age 50 and above ( d = -0.37; sex-by-age interaction p < 0.001), consistent with a menopause-related narrowing. Cognitive differences were small and did not persist after adjustment (adjusted d = 0.18, p = 0.068). The socio-environmental composite showed no net sex difference ( d = -0.01) because opposing component gradients cancelled: males had higher education and income but substantially greater tobacco and night-shift exposure. Sex-specific health phenotypes in this Qatari cohort are domain-specific, and only some represent actionable health inequity. Differences in muscular strength and raw lung volumes reflect normative physiological dimorphism and should not be interpreted as disparities requiring intervention. The narrowing female cardiometabolic advantage after midlife, and the divergent socio-environmental exposure profiles of men and women, are the findings with the clearest implications for prevention policy. Whether these patterns extend to other Middle Eastern populations requires comparative data.