The online version of this article (doi:10.1186/cc10323) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
HNS designed the study, obtained funding, performed data mining and processing, did statistical analyses, drafted the initial manuscript, and revised important content. CLL contributed to the study design, data mining and processing, analyses and interpretation of results, and revision for important content. HHY participated in the interpretation of results and revision for important content. All authors read and approved the final manuscript.
Previous studies in western countries have observed that women are less likely than men to receive intensive care and mechanical ventilation (MV). We aimed to investigate whether the gender difference also exists in Asian populations and in the provision of different types of MV including invasive (INV) and noninvasive ventilation (NIV).
We analyzed all adult hospital patients between 2005 and 2007 in the claims data from 1,000,000 randomly selected people in the Taiwan National Health Insurance Research Database. NIV-only was defined as patients receiving NIV as the only ventilator treatment during hospitalization. Gender difference was assessed using multivariable analyses with/without considering a hospital cluster effect by generalized estimating equations models. Subgroup analyses for gender difference in NIV use were performed using propensity score matching method.
Of the 128,327 patients enrolled, 53.8% were men, 9.2% received intensive care and 5.2% used MV. After adjusting for potential confounders, women were less likely than men to receive intensive care (adjusted odds ratio [aOR] 0.77, 95% confidence interval [CI] 0.73-0.82) and MV (aOR 0.84, 95% CI 0.78-0.91). Among MV patients, 6.8% received NIV-only; the proportion of which was higher in women than in men (8.6% vs. 5.7%, P < 0.001). After controlling for confounders and a cluster effect, women remained more likely to receive NIV-only (aOR 1.61, 95% CI 1.32-1.96). Subgroup analyses showed that patients with underlying congestive heart failure (CHF) had the highest difference in the provision of NIV-only (female-to-male aOR 2.76, 95% CI 1.38-5.53). A hospital cluster effect on the gender difference in NIV use was found in patients with diseases other than chronic obstructive pulmonary disease and CHF.
Gender differences existed not only in the provision but also in the types of MV. Further studies are needed to understand why gender differences occur.
International Consensus Conferences in Intensive Care Medicine: noninvasive positive pressure ventilation in acute respiratory failure Am J Respir Crit Care Med 2001, 163: 283-291.
Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J, Global Initiative for Chronic Obstructive Lung Disease: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007, 176: 532-555. 10.1164/rccm.200703-456SO PubMedCrossRef
Keenan SP, Mehta S: Noninvasive ventilation for patients presenting with acute respiratory failure: the randomized controlled trials. Respir Care 2009, 54: 116-126. PubMed
Chiumello D: Is noninvasive ventilation still underused by physicians? Respir Care 2009, 54: 1302-1303. PubMed
Esteban A, Ferguson ND, Meade MO, Frutos-Vivar F, Apezteguia C, Brochard L, Raymondos K, Nin N, Hurtado J, Tomicic V, González M, Elizalde J, Nightingale P, Abroug F, Pelosi P, Arabi Y, Moreno R, Jibaja M, D'Empaire G, Sandi F, Matamis D, Montañez AM, Anzueto A, VENTILA Group: Evolution of mechanical ventilation in response to clinical research. Am J Respir Crit Care Med 2008, 177: 170-177. PubMedCrossRef
Carlucci A, Delmastro M, Rubini F, Fracchia C, Nava S: Changes in the practice of non-invasive ventilation in treating COPD patients over 8 years. Intensive Care Med 2003, 29: 419-425. PubMed
National Health Insurance Research Database[ http://w3.nhri.org.tw/nhird//en/index.htm]
Rosenbaum PR, Rubin DB: The central role of the propensity score in observational studies for causal effects. Biometrika 1983, 70: 41-55. 10.1093/biomet/70.1.41 CrossRef
Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguía C, Nightingale P, Arroliga AC, Tobin MJ, Mechanical Ventilation International Study Group: Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. JAMA 2002, 287: 345-355. 10.1001/jama.287.3.345 PubMedCrossRef
Francois B, Bellissant E, Gissot V, Desachy A, Normand S, Boulain T, Brenet O, Preux PM, Vignon P, Association des Réanimateurs du Centre-Ouest (ARCO): 12-h pretreatment with methylprednisolone versus placebo for prevention of postextubation laryngeal oedema: a randomised double-blind trial. Lancet 2007, 369: 1083-1089. 10.1016/S0140-6736(07)60526-1 PubMedCrossRef
Gutierrez F, Masia M, Mirete C, Soldán B, Rodríguez JC, Padilla S, Hernández I, Royo G, Martin-Hidalgo A: The influence of age and gender on the population-based incidence of community-acquired pneumonia caused by different microbial pathogens. J Infect 2006, 53: 166-174. 10.1016/j.jinf.2005.11.006 PubMedCrossRef
Hess DR, Pang JM, Camargo CA Jr: A survey of the use of noninvasive ventilation in academic emergency departments in the United States. Respir Care 2009, 54: 1306-1312. PubMed
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