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Sex-and age-based differences in the delivery and outcomes of critical care.
CMAJ 2007; 177(12):1513-9CMAJ

Abstract

BACKGROUND

Previous studies have suggested that a patient's sex may influence the provision and outcomes of critical care. Our objective was to determine whether sex and age are associated with differences in admission practices, processes of care and clinical outcomes for critically ill patients.

METHODS

We used a retrospective cohort of 466,792 patients, including 24,778 critically ill patients, admitted consecutively to adult hospitals in Ontario between Jan. 1, 2001, and Dec. 31, 2002. We measured associations between sex and age and admission to the intensive care unit (ICU); use of mechanical ventilation, dialysis or pulmonary artery catheterization; length of stay in the ICU and hospital; and death in the ICU, hospital and 1 year after admission.

RESULTS

Of the 466,792 patients admitted to hospital, more were women than men (57.0% v. 43.0% for all admissions, p < 0.001; 50.1% v. 49.9% for nonobstetric admissions, p < 0.001). However, fewer women than men were admitted to ICUs (39.9% v. 60.1%, p < 0.001); this difference was most pronounced among older patients (age > or = 50 years). After adjustment for admission diagnoses and comorbidities, older women were less likely than older men to receive care in an ICU setting (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.66-0.71). After adjustment for illness severity, older women were also less likely than older men to receive mechanical ventilation (OR 0.91, 95% CI 0.81-0.97) or pulmonary artery catheterization (OR 0.80, 95% CI 0.73-0.88). Despite older men and women having similar severity of illness on ICU admission, women received ICU care for a slightly shorter duration yet had a longer length of stay in hospital (mean 18.3 v. 16.9 days; p = 0.006). After adjustment for differences in comorbidities, source of admission, ICU admission diagnosis and illness severity, older women had a slightly greater risk of death in the ICU (hazard ratio 1.20, 95% CI 1.10-1.31) and in hospital (hazard ratio 1.08, 95% CI 1.00-1.16) than did older men.

INTERPRETATION

Among patients 50 years or older, women appear less likely than men to be admitted to an ICU and to receive selected life-supporting treatments and more likely than men to die after critical illness. Differences in presentation of critical illness, decision-making or unmeasured confounding factors may contribute to these findings.

Authors+Show Affiliations

Interdepartmental Division of Critical Care Medicine and Department of Medicine, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ont. rob.fowler@sunnybrook.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18003954

Citation

Fowler, Robert A., et al. "Sex-and Age-based Differences in the Delivery and Outcomes of Critical Care." CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, vol. 177, no. 12, 2007, pp. 1513-9.
Fowler RA, Sabur N, Li P, et al. Sex-and age-based differences in the delivery and outcomes of critical care. CMAJ. 2007;177(12):1513-9.
Fowler, R. A., Sabur, N., Li, P., Juurlink, D. N., Pinto, R., Hladunewich, M. A., ... Martin, C. M. (2007). Sex-and age-based differences in the delivery and outcomes of critical care. CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, 177(12), pp. 1513-9.
Fowler RA, et al. Sex-and Age-based Differences in the Delivery and Outcomes of Critical Care. CMAJ. 2007 Dec 4;177(12):1513-9. PubMed PMID: 18003954.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Sex-and age-based differences in the delivery and outcomes of critical care. AU - Fowler,Robert A, AU - Sabur,Natasha, AU - Li,Ping, AU - Juurlink,David N, AU - Pinto,Ruxandra, AU - Hladunewich,Michelle A, AU - Adhikari,Neill K J, AU - Sibbald,William J, AU - Martin,Claudio M, Y1 - 2007/11/14/ PY - 2007/11/16/pubmed PY - 2008/1/16/medline PY - 2007/11/16/entrez SP - 1513 EP - 9 JF - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne JO - CMAJ VL - 177 IS - 12 N2 - BACKGROUND: Previous studies have suggested that a patient's sex may influence the provision and outcomes of critical care. Our objective was to determine whether sex and age are associated with differences in admission practices, processes of care and clinical outcomes for critically ill patients. METHODS: We used a retrospective cohort of 466,792 patients, including 24,778 critically ill patients, admitted consecutively to adult hospitals in Ontario between Jan. 1, 2001, and Dec. 31, 2002. We measured associations between sex and age and admission to the intensive care unit (ICU); use of mechanical ventilation, dialysis or pulmonary artery catheterization; length of stay in the ICU and hospital; and death in the ICU, hospital and 1 year after admission. RESULTS: Of the 466,792 patients admitted to hospital, more were women than men (57.0% v. 43.0% for all admissions, p < 0.001; 50.1% v. 49.9% for nonobstetric admissions, p < 0.001). However, fewer women than men were admitted to ICUs (39.9% v. 60.1%, p < 0.001); this difference was most pronounced among older patients (age > or = 50 years). After adjustment for admission diagnoses and comorbidities, older women were less likely than older men to receive care in an ICU setting (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.66-0.71). After adjustment for illness severity, older women were also less likely than older men to receive mechanical ventilation (OR 0.91, 95% CI 0.81-0.97) or pulmonary artery catheterization (OR 0.80, 95% CI 0.73-0.88). Despite older men and women having similar severity of illness on ICU admission, women received ICU care for a slightly shorter duration yet had a longer length of stay in hospital (mean 18.3 v. 16.9 days; p = 0.006). After adjustment for differences in comorbidities, source of admission, ICU admission diagnosis and illness severity, older women had a slightly greater risk of death in the ICU (hazard ratio 1.20, 95% CI 1.10-1.31) and in hospital (hazard ratio 1.08, 95% CI 1.00-1.16) than did older men. INTERPRETATION: Among patients 50 years or older, women appear less likely than men to be admitted to an ICU and to receive selected life-supporting treatments and more likely than men to die after critical illness. Differences in presentation of critical illness, decision-making or unmeasured confounding factors may contribute to these findings. SN - 1488-2329 UR - https://www.unboundmedicine.com/medline/citation/18003954/Sex_and_age_based_differences_in_the_delivery_and_outcomes_of_critical_care_ L2 - http://www.cmaj.ca/cgi/pmidlookup?view=long&amp;pmid=18003954 DB - PRIME DP - Unbound Medicine ER -