Cultural Biases and Clinical Variation
Gasulla Ó. Sarría-Santamera A. Mazaira-Font F.A. García-Montero C. Fraile-Martinez O. Cantalapiedra D. Carrillo-Rodríguez M.F. Gómez-Valcárcel B. Ortega M.Á. Álvarez-Mon M. Asúnsolo A.
December 2025Multidisciplinary Digital Publishing Institute (MDPI)
Clinics and Practice
2025#15Issue 12
Background: This study investigates the possible role of cultural biases in clinical variation. Methods: An observational, analytical, and retrospective cohort design, using a Spanish primary care database, was used, on which a cross-sectional analysis was performed. Diseases were classified into the following: generic conditions with established protocols (control group), specialist-diagnosed diseases, women’s diseases, and psychiatric diseases. Diagnostic incidence was calculated across 25 geographical clusters, and variability was measured using the coefficient of variation (CV). To test systematic differences, multivariate linear regression models were adjusted for socio-demographics and healthcare system proxies. Results: The final sample for analysis consisted of 617,222 women aged 15 to 65, with a mean age of 43. The results did not reveal significant variability between generic and specialized diseases, but women’s and psychiatric diseases showed consistently higher CVs in all models (p < 0.05), indicating that approximately 20% to 30% of the clinical variation observed in these groups was unexplained. Conclusions: Although we cannot establish causality, these findings may suggest that cultural taboos and gender biases likely contribute to unjustified clinical variation, highlighting cultural bias as a plausible explanatory factor.
clinical biases , clinical variation , healthcare quality , social stigma
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Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, L’Hospitalet de Llobregat, 08907, Spain
Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, 28801, Spain
Department of Biomedical Sciences, Nazarbayev University School of Medicine, Astana, 010000, Kazakhstan
Departament d’Econometria, Estadística i Economia Aplicada, Universitat de Barcelona, Barcelona, 08907, Spain
Department of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcala de Henares, 28801, Spain
Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, 28034, Spain
Faculty of Medicine, Universidad Europea of Madrid, Madrid, 28670, Spain
Networking Research Center on for Liver and Digestive Diseases (CIBEREHD), Immune System Diseases-Rheumatology and Internal Medicine Service, University Hospital Prince of Asturias, Alcala de Henares, 28806, Spain
Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, University of New York, New York, 10027, NY, United States
Hospital Universitari de Bellvitge
Department of Surgery
Department of Biomedical Sciences
Departament d’Econometria
Department of Medicine and Medical Specialities
Ramón y Cajal Institute of Sanitary Research (IRYCIS)
Faculty of Medicine
Networking Research Center on for Liver and Digestive Diseases (CIBEREHD)
Department of Epidemiology and Biostatistics
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