Atanas Todorov1,2,3, Fabian Kaufmann1, Ketina Arslani4, Ahmed Haider2,3, Susan Bengs2,3, Georg Goliasch5, Núria Zellweger1, Janna Tontsch1, Raoul Sutter1,6,7, Bigna Buddeberg8, Alexa Hollinger1,7, Elisabeth Zemp7,9, Mark Kaufmann8, Martin Siegemund1,6,7, Cathérine Gebhard2,3, Caroline E Gebhard10. 1. Intensive Care Unit, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. 2. Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland. 3. Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland. 4. Department of Cardiology, University Hospital Basel, Basel, Switzerland. 5. Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria. 6. Department of Clinical Research, University Hospital Basel, Basel, Switzerland. 7. University of Basel, Basel, Switzerland. 8. Department of Anesthesiology, University Hospital Basel, Basel, Switzerland. 9. Swiss Tropical and Public Health Institute, Basel, Switzerland. 10. Intensive Care Unit, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. evacaroline.gebhard@usb.ch.
Abstract
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.
PURPOSE: It is currently unclear whether management and outcomes of critically illpatients 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 neurovascularpatients 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.
Entities:
Keywords:
Cardiovascular disease; Critical illness; Gender bias; Survival; Women
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