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.

Research Results

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.

Project Team

Principal Investigators:

Allan Garland, MD, MA, BSc — University of Manitoba

Clare Ramsey, MD, MSc, FRCPSC — University of Manitoba

Co-Investigators:

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 — agarland@hsc.mb.ca

CORE 2012-19

Key words: sex; social supports; ICU admission; ICU mortality; widowhood; elderly

Publications

This study addressed issues of equity related to access to critical care.

Principal Investigators

Allan Garland, MD, MA, BSc — University of Manitoba

Clare Ramsey, MD, MSc, FRCPSC — University of Manitoba

Publications

Ramsey, C., Fowler, R., Dodek, P., Fransoo, R., Doupe, M., Wong, H., Kozak, J., Hill, A., Chen, H., Yogendran, M., Garland, A. (May 2015). The Effects of Widowhood on Sex Differences in Admission to Intensive Care Units. Presented at 2015 American Thoracic Society International Conference, Denver, CO. American Journal of Respiratory and Critical Care Medicine 191:A1393.

Ramsey, C.D., Hill, A., Dodek, P., Fowler, R., Kozak, J., Wong, H., Fransoo, R., Doupe, M., Yogendran, M., Garland, A. (May 2016). Male Predominance in Admission to Intensive Care Units (ICU) Disappears After Surviving One ICU Admission. Presented at 2016 American Thoracic Society International Conference, San Francisco, CA. American Journal of Respiratory and Critical Care Medicine 193:A2957.

Hill, A, Ramsey, C.D., Dodek, P., Kozak, J., Doupe, M., Fowler, R., Wong, H., Fransoo, R., Scales, D.C., Garland, A. (May 2016). Marital Status Does Not Explain the Male Predominance of ICU Admission Among Home Care Clients. Presented at 2016 American Thoracic Society International Conference, San Francisco, CA. American Journal of Respiratory and Critical Care Medicine. 193:A3642. 

Webinars

Sex differences in ICU admission: role of social support factors — Allan Garland

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Rationale

This study addressed issues of equity related to access to critical care.

Principal Investigators

Allan Garland, MD, MA, BSc — University of Manitoba

Clare Ramsey, MD, MSc, FRCPSC — University of Manitoba

Rationale: The rationale behind the current study begins with the assumption that among the elderly, the willingness to undergo aggressive care will be higher if ones’ spouse/partner is still alive.

Hypothesis: Based on the fact that women generally outlive men, the current study tests the hypothesis that the male predominance of ICU admission is mediated by a lower desire of unmarried/widowed individuals to undergo ICU care.

Research Plan: For this retrospective study, we studied three cohorts of individuals 65 years and older: (1) all Manitobans during the interval 2004-2012; and all Canadians [excepting Québec] during the interval 2007-2012, (2) living in nursing homes or (3) living at home and enrolled in homecare. These administrative datasets, which include information about marital status, were obtained from the Manitoba Centre for Health Policy, or from the Canadian Insitute for Health Information.

Objectives: For cohorts (1) and (2) we assessed the impact of marital status on ICU admission using multivariable Cox regression of time from cohort entry to ICU admission, or multivariable logistic regression of ICU admission during acute care hospitalization, adjusted for covariates. For cohort (3) we used logistic regression to evaluate admission to ICU among those admitted to hospital. Our primary analyses randomly selected one record for each subject included.

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