Introduction
Materials and methods
Database
Study sample
Definition
Measurements
Statistics
Results
Variables | Men (n= 69,064) | Women (n= 59,263) |
---|---|---|
Age, years
| 54 (39-70) | 55 (41-71) |
≥ 65 | 34.1 | 35.3 |
Surgical condition
| 43.8 | 47.3 |
Comorbidity
| ||
Charlson Comorbidity Index
| 0 (0-1) | 0 (0-1) |
COPD | 4.7 | 2.1 |
Congestive heart failure | 2.8 | 3.1 |
Cerebrovascular disease | 7.3 | 6.2 |
Cancer | 8.2 | 7.7 |
Principal diagnoses
| ||
Respiratory | 10.8 | 8.5 |
Neurological | 3.3 | 4.1 |
Cardiovascular | 14.2 | 11.7 |
Digestive | 16.4 | 10.8 |
Genitourinary | 8.8 | 13.6 |
Metabolic/endocrine | 2.6 | 3.8 |
Injury/poisoning | 19.5 | 15.9 |
Others | 24.5 | 31.6 |
No. of organ dysfunction
| ||
0 | 90.4 | 92.6 |
1 | 8.1 | 6.3 |
2+ | 1.5 | 1.1 |
Mechanical ventilation
| 6.0 | 4.1 |
ICU admission
| 10.6 | 7.5 |
Hospital level
| ||
Medical center | 34.0 | 35.4 |
Regional hospital | 41.8 | 40.3 |
District hospital | 24.2 | 24.3 |
Variables | No | INV-only, % | NIV-only, % | NIV/INV, % | P Value |
---|---|---|---|---|---|
Total
| 6,621 | 84.6 | 6.8 | 8.6 | |
Sex
| < 0.001 | ||||
Men | 4,177 | 85.9 | 5.7 | 8.4 | |
Women | 2,444 | 82.4 | 8.6 | 9.0 | |
Age
| < 0.001 | ||||
< 65 years | 2,917 | 88.9 | 4.8 | 6.3 | |
≥ 65 years | 3,704 | 81.3 | 8.3 | 10.4 | |
Surgical condition
| < 0.001 | ||||
Yes | 3,594 | 87.5 | 3.5 | 9.0 | |
No | 3,027 | 81.2 | 10.6 | 8.1 | |
Charlson Comorbidity index
| < 0.001 | ||||
0 | 2,158 | 88.3 | 4.4 | 7.3 | |
1 | 2,076 | 83.9 | 7.0 | 9.1 | |
2 | 1,258 | 81.4 | 9.6 | 9.0 | |
3+ | 1,129 | 82.4 | 7.7 | 9.9 | |
Comorbid conditions
| |||||
COPD | < 0.001 | ||||
Yes | 533 | 66.2 | 16.7 | 17.1 | |
No | 6088 | 86.2 | 5.9 | 7.9 | |
Congestive heart failure
| < 0.001 | ||||
Yes | 573 | 74.9 | 12.2 | 12.9 | |
No | 6,048 | 85.5 | 6.3 | 8.2 | |
Cerebrovascular disease
| < 0.001 | ||||
Yes | 1,118 | 89.6 | 3.2 | 7.2 | |
No | 5,503 | 83.6 | 7.5 | 8.9 | |
Cancer
| 0.001 | ||||
Yes | 946 | 82.2 | 9.5 | 8.2 | |
No | 5,675 | 85.0 | 6.3 | 8.7 | |
Principal diagnoses
| < 0.001 | ||||
Respiratory | 1,395 | 76.3 | 12.4 | 11.3 | |
Non-respiratory | 5,220 | 86.9 | 5.2 | 7.9 | |
No. of organ dysfunction
| 0.011 | ||||
1 | 5,173 | 83.8 | 7.5 | 8.7 | |
2 | 1,198 | 86.9 | 4.5 | 8.6 | |
3+ | 250 | 90.4 | 2.4 | 7.2 | |
ICU admission
| < 0.001 | ||||
Yes | 5,882 | 87.5 | 3.1 | 9.5 | |
No | 739 | 61.8 | 36.3 | 1.9 | |
Hospital level
| < 0.001 | ||||
Medical center | 2,861 | 81.0 | 7.7 | 11.4 | |
Regional hospital | 2,802 | 86.3 | 6.2 | 7.5 | |
District hospital | 958 | 90.6 | 5.6 | 3.8 |
Variables | With intensive care | Without intensive care | ||||
---|---|---|---|---|---|---|
Men ( n = 3,713) | Women ( n = 2,169) | P Value | Men ( n = 464) | Women ( n = 275) | P Value | |
Age, years
| 65 (49-77) | 71 (56-80) | < 0.001 | 70 (52-79) | 72 (57-82) | 0.032 |
≥ 65 | 50.9 | 62.9 | < 0.001 | 59.9 | 62.2 | 0.542 |
Surgical condition
| 57.7 | 54.5 | 0.018 | 36.0 | 36.7 | 0.841 |
Cormorbidity
| ||||||
Charlson Comorbidity Index | 1 (0-2) | 1 (0-2) | 0.080 | 1 (0-2) | 1 (1-2) | 0.132 |
COPD | 8.9 | 4.4 | < 0.001 | 16.2 | 12.0 | 0.121 |
Congestive heart failure | 7.3 | 11.2 | < 0.001 | 7.3 | 9.1 | 0.393 |
Cerebrovascular disease | 17.1 | 19.3 | 0.034 | 8.0 | 10.5 | 0.236 |
Cancer
| 14.6 | 11.0 | < 0.001 | 22.2 | 23.3 | 0.736 |
Principal diagnoses | 0.664 | 0.734 | ||||
Respiratory | 19.8 | 19.3 | 33.3 | 32.1 | ||
Non-respiratory
| 80.2 | 80.7 | 66.7 | 67.9 | ||
Number of organ dysfunction
| 1 (1-1) | 1 (1-1) | 0.779 | 1 (1-1) | 1 (1-1) | 0.284 |
Hospital level
| 0.085 | 0.905 | ||||
Medical center | 41.4 | 41.4 | 58.0 | 56.7 | ||
Regional hospital | 45.2 | 43.2 | 24.4 | 25.8 | ||
District hospital | 13.4 | 15.4 | 17.7 | 17.5 | ||
Types of mechanical ventilation
| < 0.001 | 0.001 | ||||
NIV-only | 2.3 | 4.3 | 32.5 | 42.5 | ||
NIV/INV | 9.3 | 9.7 | 1.1 | 3.3 | ||
INV-only | 88.3 | 86.0 | 66.4 | 54.2 | ||
Resource use
| ||||||
Duration of MV | 3 (1-8) | 3 (1-8) | 0.831 | 1 (1-4) | 2 (1-4) | 0.954 |
ICU LOS, days | 4 (2-9) | 4 (2-9) | 0.860 | 0 | 0 | - |
Hospital LOS, days | 17 (8-30) | 16 (8-29) | 0.863 | 10 (5-19) | 11 (6-19) | 0.842 |
Hospital mortality
| 27.2 | 28.0 | 0.321 | 34.3 | 28.7 | 0.098 |
Types of MV | Conventional method
b
| Propensity score method
c
| |||
---|---|---|---|---|---|
All ARF patients (M/F = 4177/2444) | ARF patients (M/F = 2390/2390) | ARF patients with COPD (M/F = 126/126) | ARF patients with CHF (M/F = 217/217) | Other ARF patients
d
(M/F = 2037/2037) | |
aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | |
Without GEE modeling
a
| |||||
NIV-only
| 1.63 (1.30-2.05) | 1.50 (1.20-1.88) | 1.08 (0.56-2.09) | 2.76 (1.47-5.20) | 1.43 (1.10-1.85) |
NIV/INV
| 1.10 (0.91-1.32) | 1.05 (0.86-1.28) | 0.97 (0.50-1.86) | 1.06 (0.58-1.92) | 1.07 (0.85-1.35) |
INV-only
| 0.76 (0.66-0.89) | 0.80 (0.68-0.93) | 0.97 (0.58-1.62) | 0.55 (0.35-0.86) | 0.81 (0.68-0.97) |
With GEE modeling
a
| |||||
NIV-only
| 1.61 (1.32-1.96) | 1.58 (1.15-2.15) | 1.07 (0.55-2.11) | 2.76 (1.38-5.53) | 1.43 (0.97-2.11) |
NIV/INV
| 1.11 (0.96-1.29) | 1.07 (0.85-1.35) | 1.01 (0.48-2.14) | 1.08 (0.57-2.03) | 1.09 (0.82-1.45) |
INV-only
| 0.75 (0.64-0.88) | 0.77 (0.61-0.95) | 0.95 (0.54-1.66) | 0.55 (0.33-0.93) | 0.80 (0.60-1.06) |
ARF patients | ARF patients with COPD | ARF patients with CHF | Other ARF patients | |||||
---|---|---|---|---|---|---|---|---|
Women ( n = 2390) | Men ( n = 2390) | Women ( n = 126) | Men ( n = 126) | Women ( n = 217) | Men ( n = 217) | Women ( n = 2037) | Men ( n = 2037) | |
Age, years
| 70 (55-80) | 71 (56-79) | 78 (72-85) | 77 (70-83) | 76 (70-82) | 77 (68-82) | 69 (53-79) | 69 (53-78) |
Surgical condition
| 52.9 | 53.6 | 22.2 | 21.4 | 28.6 | 33.2 | 57.2 | 57.8 |
Comorbidity
| ||||||||
Charlson Comorbid Index | 1 (0-2) | 1 (0-2) | 2 (1-2) | 1 (1-2) | 2 (1-3) | 2 (1-3) | 1 (0-2) | 1 (0-2) |
COPD | 5.4 | 5.2 | - | - | 11.5 | 12.9 | - | - |
Congestive heart failure | 10.5 | 10.0 | 19.0 | 20.6 | - | - | - | - |
Cerebrovascular disease | 18.2 | 18.9 | 13.5 | 11.9 | 7.8 | 5.5 | 19.6 | 21.1 |
Cancer | 12.9 | 12.9 | 4.0 | 4.8 | 4.1 | 5.1 | 14.5 | 14.5 |
Principal diagnoses
| ||||||||
Respiratory | 20.9 | 20.3 | 65.1 | 65.9 | 32.3 | 30.9 | 17.4 | 18.0 |
Neurological | 1.7 | 1.6 | 8.7 | 10.3 | 0 | 0 | 1.8 | 1.9 |
Cardiovascular | 24.7 | 24.5 | 12.7 | 10.3 | 48.8 | 49.3 | 22.4 | 22.4 |
Digestive | 8.5 | 8.6 | 4.8 | 5.6 | 4.1 | 3.2 | 9.1 | 9.3 |
Genitourinary | 2.8 | 2.5 | 4.0 | 3.2 | 2.3 | 3.2 | 2.8 | 2.2 |
Metabolic/endocrine | 1.9 | 1.7 | 0 | 0 | 0 | 0 | 2.2. | 1.7 |
Injury/poisoning | 15.2 | 15.6 | 4.0 | 4.0 | 2.3 | 3.2 | 17.4 | 17.4 |
Others | 24.4 | 25.3 | 8.7 | 10.3 | 10.1 | 10.1 | 26.8 | 27.0 |
No. of organ dysfunction
| 1(1-1) | 1(1-1) | 1(1-1) | 1(1-1) | 1(1-1) | 1(1-1) | 1(0-1) | 1(0-1) |
Intensive care unit admission
| 88.7 | 88.7 | 74.6 | 73.8 | 90.8 | 89.4 | 89.4 | 89.7 |
Hospital level
| ||||||||
Medical center | 43.4 | 43.5 | 32.5 | 29.4 | 31.3 | 35.5 | 45.4 | 45.4 |
Regional hospital | 41.2 | 41.1 | 42.9 | 47.6 | 47.0 | 47.0 | 40.4 | 40.9 |
District hospital | 15.4 | 15.4 | 24.6 | 23.0 | 21.7 | 17.5 | 14.3 | 13.7 |
Discussion
Conclusions
Key messages
-
Studies in western countries have shown that gender differences exist in the process of care for critically ill patients.
-
Our findings confirm the reports from western countries that women were less likely than men to receive intensive care and mechanical ventilation.
-
Moreover, we found that women were more likely than men to receive NIV-only for acute respiratory failure, especially those with underlying heart failure.
-
The finding of a higher NIV use in women may reflect a higher perception for dyspnea and their lower tendency to receive invasive treatments than men as well as a lack of strict criteria for NIV use in clinical practices.
-
Further research is needed to understand why the gender difference occurs, especially whether and how gender-biased decision-making affects the use of NIV.