Sex and gender aspects on intensive care. A cohort study

Zettersten, Erik; Jäderling, Gabriella; Bell, Max; Larsson, Emma

doi:10.1016/j.jcrc.2019.09.023

Cited by 22 publications

(28 citation statements)

References 37 publications

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“…Our findings are consistent with previous studies derived from smaller and more heterogenous populations demonstrating a male predominance in ICU hospital admissions [ 11 – 15 , 17 ]. We now extend the existing literature by showing that women hospitalized for neuro- and cardiovascular diseases were significantly older than men across all conditions.…”

Section: Discussionsupporting

confidence: 93%

“…The impact of gender on provision and outcomes of critical care treatment has been described in several smaller cohorts. Overall, women remain underrepresented amongst intensive care unit (ICU) patients, in particular amongst higher age groups [11][12][13][14], are less likely to receive life-supporting treatments, and have overall shorter ICU stays than men [15][16][17]. This contrasts with the fact that CVD prevalence is higher in older women than in older men with women having a higher burden of pre-existing disabilities [3,18,19].…”

Section: Introductionmentioning

confidence: 99%

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Gender differences in the provision of intensive care: a Bayesian approach

et al. 2021

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Purpose It is currently unclear whether management and outcomes of critically ill patients differ between men and women. We sought to assess the influence of age, sex and diagnoses on the probability of intensive care provision in critically ill cardio- and neurovascular patients in a large nationwide cohort in Switzerland. Methods Retrospective analysis of 450,948 adult patients with neuro- and cardiovascular disease admitted to all hospitals in Switzerland between 01/2012 and 12/2016 using Bayesian modeling. Results For all diagnoses and populations, median ages at admission were consistently higher for women than for men [75 (64;82) years in women vs. 68 (58;77) years in men, p < 0.001]. Overall, women had a lower likelihood to be admitted to an intensive care unit (ICU) than men, despite being more severely ill [odds ratio (OR) 0.78 (0.76–0.79)]. ICU admission probability was lowest in women aged > 65 years (OR women:men 0.94 (0.89–0.99), p < 0.001). Women < 45 years had a similar ICU admission probability as men in the same age category [OR women:men 1.03 (0.94–1.13)], in spite of more severe illness. The odds to die were significantly higher in women than in men per unit increase in Simplified Acute Physiology Score (SAPS) II (OR 1.008 [1.004–1.012]). Conclusion In the care of the critically ill, our study suggests that women are less likely to receive ICU treatment regardless of disease severity. Underuse of ICU care was most prominent in younger women < 45 years. Although our study has several limitations that are imposed by the limited data available from the registries, our findings suggest that current ICU triage algorithms could benefit from careful reassessment. Further, and ideally prospective, studies are needed to confirm our findings. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-021-06393-3.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Gender differences in the provision of intensive care: a Bayesian approach

et al. 2021

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“…Only 11 patients died after 90 days [4,12]. Several studies demonstrate a male dominance in general ICU populations, where men constitute approximately 60% of the patients [13,14]. This is lower compared to COVID-19 patients where men constitute an even larger proportion [15,16], as also seen in the current study with 73% males.…”

Section: Discussionsupporting

confidence: 57%

Long-term outcome after intensive care for COVID-19: differences between men and women—a nationwide cohort study

et al. 2021

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Background Questions remain about long-term outcome for COVID-19 patients in general, and differences between men and women in particular given the fact that men seem to suffer a more dramatic course of the disease. We therefore analysed outcome beyond 90 days in ICU patients with COVID-19, with special focus on differences between men and women. Methods We identified all patient ≥ 18 years with COVID-19 admitted between March 6 and June 30, 2020, in the Swedish Intensive Care Registry. Patients were followed until death or study end-point October 22, 2020. Association with patient sex and mortality, in addition to clinical variables, was estimated using Cox regression. We also performed a logistic regression model estimating factors associated with 90-day mortality. Results In total, 2354 patients with COVID-19 were included. Four patients were still in the ICU at study end-point. Median follow-up time was 183 days. Mortality at 90-days was 26.9%, 23.4% in women and 28.2% in men. After 90 days until end of follow-up, only 11 deaths occurred. On multivariable Cox regression analysis, male sex (HR 1.28, 95% CI 1.06–1.54) remained significantly associated with mortality even after adjustments. Additionally, age, COPD/asthma, immune deficiency, malignancy, SAPS3 and admission month were associated with mortality. The logistic regression model of 90-day mortality showed almost identical results. Conclusions In this nationwide study of ICU patients with COVID-19, men were at higher risk of poor long-term outcome compared to their female counterparts. The underlying mechanisms for these differences are not fully understood and warrant further studies.

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“…[1][2][3][4][5][6] In studies of sex differences in ICU admissions from North America, the United Kingdom and Europe, the percentage of female patients ranges from 35% to 45%. [1][2][3][5][6][7][8][9][10] This simple observation likely reflects complex sex differences in the incidence, presentation and management of critical illness.Previous studies focused on quantifying sex differences in illness severity and outcomes from ICU admission, with conflicting results. 1,3,[5][6][7][8][9] These studies highlight two important features of the sex imbalance in ICU admissions that warrant further investigation.First, the sex imbalance is not evenly distributed across diagnostic categories.…”

mentioning

confidence: 99%

“…5,8,9 Some critical illnesses have a marked male predominance; for example, trauma, cardiac surgery and aortic dissection. [10][11][12][13] Other critical illnesses, such as subarachnoid haemorrhage and asthma, are more common in women. 14,15 This raises a question: what is the relative contribution of different disease categories to the overall sex balance in ICU admissions?Second, there is a wide variation in the reported percentage of female ICU patients in studies performed at different times in different regions of the world.…”

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confidence: 99%

Sex differences in intensive care unit admissions in Australia and New Zealand

Modra¹,

Pilcher²,

Bailey³

et al. 2021

Critical Care and Resuscitation

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Introduction: Fewer women than men are admitted to intensive care units (ICUs) worldwide. Objectives: To quantify the relative contribution of each major diagnostic category to the overall sex balance in ICU admissions in Australia and New Zealand, and to describe changes in the sex balance over time and with patient age. Methods: Retrospective cross-sectional study of Australian and New Zealand ICU admissions recorded in the Australian and New Zealand Intensive Care Society Adult Patient Database between 2005 and 2018. Multivariate logistic regression for the likelihood of female admission considered key explanatory variables: diagnostic category, patient age, admission year, geographic region, hospital type, and planned versus unplanned ICU admission. Results: Overall, 42.3% of 1 616 856 Australian and New Zealand ICU patients were women (99% CI, 42.2–42.4%). 247 988 more men than women were admitted to an ICU during the 14-year study period. There was a sex imbalance in most diagnostic categories: less than 48% women in 15 of 23 diagnostic categories, and greater than 52% women in four diagnostic categories (P < 0.001). Admissions following cardiovascular surgery accounted for over half of the total sex imbalance. The percentage of ICU patients who are women increased linearly from 40.8% in 2005 to 43.6% in 2018 (R2 = 93.1%; P < 0.001). Compared with admission in 2005, the adjusted odds ratio for female admission in 2018 was 1.03 (99% CI, 1.01–1.06). Conclusion: There is a significant sex imbalance in ICU admissions in Australia and New Zealand, widespread across the diagnostic categories. Cardiovascular admissions contribute most to the observed preponderance of men. The proportion of female ICU patients is steadily increasing.

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Sex and gender aspects on intensive care. A cohort study

Cited by 22 publications

References 37 publications

Gender differences in the provision of intensive care: a Bayesian approach

Gender differences in the provision of intensive care: a Bayesian approach

Long-term outcome after intensive care for COVID-19: differences between men and women—a nationwide cohort study

Sex differences in intensive care unit admissions in Australia and New Zealand

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