Sex differences in admission to intensive care units: the role of social support factors
This study addressed issues of equity related to access to critical care.
Findings: Contrary to our hypothesis, we found that the male predominance of admission to an intensive care unit (ICU) is not explained by widowhood, or other differences in social supports of men versus women towards the end-of-life. Indeed among elderly individuals, being married was associated with a lower likelihood of being admitted to an ICU. Our data also provides an indirect clue to the actual explanation for the male predominance of ICU admission in the elderly. Specifically, we found evidence highly consistent with the idea that older women, in general, are less willing than older men to undergo ICU care. This evidence does not suggest that there is a disparity between men and women in access to ICU care.
Impact of findings: This indicates that there is not a need for urgent efforts to remediate bias in ICU access for women. But it would be interesting and valuable to understand the motivation(s) behind a generally lower desire of woman for aggressive medical care. Do older women have an overly pessimistic view of the outcomes of such care, or do older men have an overly optimistic view? Unrealistic understanding of the range and likelihood of outcomes of treating critical illness could result in some individuals denying themselves a chance to survive with good functional outcomes, and other individuals going through futile and uncomfortable healthcare interventions.
Publications, presentations and webinars
About the Project
Researchers have found that for certain illnesses patients may be more likely to receive certain kinds of care depending on whether they are men or women. Previous studies by this team have suggested: that men receive more critical care treatments for almost all kinds of conditions; this male predominance of critical care is accentuated in elderly people; and that women are less likely to survive their critical illness, despite being about as sick as men when they are admitted to the hospital or ICU.
The investigators assessed whether the differences in admission to ICUs for men and women over the age of 65 years are due to differences in social supports (marital status, number of children), and prior personal or family member experience with critical care.
A better understanding of the factors that influence health care decisions and outcomes for critically ill older people and differences by gender is needed to develop action plans to ensure equitable delivery of care to these individuals.
For more details on the project rationale, hypothesis, research plan and objectives, click here.
Allan Garland, MD, MA, BSc -- University of Manitoba
Clare Ramsey, MD, MSc, FRCPSC -- University of Manitoba
Peter Dodek, MD, MHSc -- St. Paul’s Hospital
Malcolm Doupe, PhD, MSc, BPEd -- University of Manitoba
Robert Fowler, MD, MSc -- Sunnybrook Research Institute
Randy Fransoo, PhD -- University of Manitoba
George Heckman, MD, MSc, FRCP(C) -- University of Waterloo
Jean-François Kozak, PhD, MA -- Providence Health Care, Vancouver
Hubert Wong, PhD -- Providence Health Care, Vancouver
Project Contact: Dr. Allan Garland -- firstname.lastname@example.org
Key words: sex; social supports; ICU admission; ICU mortality; widowhood; elderly