Sex and Gender Play Role in Critical Care Access and Treatment

A highly influential study out of Sunnybrook Health Sciences Centre, released today in the Canadian Medical Association Journal, identifies differences in the way men and women have access to and receive intensive care treatment.

Says Dr. Robert Fowler, Critical Care physician at Sunnybrook and lead on the study, “It has often been noted that in most Critical Care Units there are always more men than women. We wanted to know why.”

The study ‘Sex-and age-based differences in the delivery and outcomes of critical care’ looked at a retrospective cohort of 466,792 patients consecutively admitted to adult hospitals in Ontario, 24 778 of which were critically ill, between Jan.1, 2001, and Dec.31, 2002. Associations were made between sex, 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 one year after discharge.

Of the 466 792 patients admitted to hospital, there were more women than men (57.0% vs. 43.0%.) However, fewer women than men were admitted to ICUs (39.9% vs. 60.1%). This difference was most notable among female patients age 50 and older, who were 32% less likely than men to be admitted to ICU. After adjusting for severity of illness, they were also 9% less likely than men to receive mechanical ventilation and 20% less likely to receive pulmonary artery catheterization. Despite a similar severity of illness upon ICU admission, older women received ICU care for a shorter period of time than men, yet had longer lengths of stay in hospital (mean 18.3 v. 16.9 days). Overall, women aged 50 years and older were 1.2 times more likely to die while in ICU than men.

“We found that there is indeed a difference in the way men and women receive care,” says Dr. Fowler, “but the reason for that difference remains unclear and requires further study.”

Dr. Fowler indicates that there could be a variety of factors that contribute to the difference. For example, do men get sicker than women and need more intensive care? Do men and women have different ideas about care and therefore make different choices? Do the decision makers for older women view aggressive treatment as too much to handle? These are the kinds of questions that need to be asked to get a better understanding of what might be at the root of this difference.

“Ultimately, the results should challenge our perceptions of age and gender among patients admitted to hospitals,” says Dr. Fowler. “It should stimulate further research, as well as discussion amongst healthcare providers, patients and their decision-makers.”