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Sex matters when it comes to survival rates in ICU

The wage gap between men and women has been front of mind for decades, but research shows that women are not just disadvantaged when it comes to pay packets, they are also the ‘losers’ when it comes to surviving in intensive care units.

According to a newly published study in the American Journal of Respiratory and Critical Care Medicine, women are about 50 per cent more likely to die in an intensive care unit following heart surgery than men. The same study reveals that women are also more likely to die in ICU following a cardiac arrest compared to men.

The Australasian-based study looked at ICU patients in the Australian and New Zealand Intensive Care Society’s Adult Patient Database for the period spanning 2011 to 2020. According to the researchers, it is the first study to investigate the relationship between sex balance and sex differences in outcomes.

Read: Women’s income won’t catch men for ‘more than 200 years’

Dr Lucy Modra, Austin Health intensivist and the study’s lead researcher, said: “The big question we set out to answer was, ‘Does sex or gender matter when you’re critically ill?’ And what we found is that sex absolutely matters. It has an impact on whether you live or die and your illness severity.”

A deeper dive into the data also revealed some more nuanced findings. Women’s chances of survival in ICU were lower if they were admitted with what is seen as a typically male condition, such as cardiac surgery and burns. Only 25 per cent of cardiac surgery patients are women and the proportion of women admitted with burn injuries is lower still, at just 25 per cent.

Surprisingly, though, the researchers found that the opposite was also true – men admitted with conditions normally associated with women also had a lower survival rate.

Read: Intensive care during COVID like a ‘delirium factory’, study finds

So what is going on?

The study refers to the phenomenon as the “minority effect”, and its results showed that it clearly cuts both ways. “This sex-based minority effect was bidirectional: women were more likely to die if admitted with a diagnosis relatively less common in women (e.g. cardiac surgery), and men were relatively more likely to die if admitted with a diagnosis less common in men (e.g. metabolic disorders).”

Why it happens, though, is still a matter of conjecture. One possibility, says Dr Modra, is cognitive bias. She says it’s “possible that clinicians or ICU teams get used to treating either male or female patients … recognising or responding to subtle deterioration for patients in the familiar, majority group.”

Read: How heart surgery gave Bob Mortimer a new lease on life

But biological differences between genders may also play a part. Heart bypass grafts provide a case in point, says Dr Modra. “Women can actually have blood vessels that are more difficult to graft, for example. So there’s technical and biological factors that make it harder to do the surgery.”

The next step for researchers is to try to untangle that web of possible factors, teasing out cognitive and gender biases, and biological factors. “Awareness of this minority effect,” the study concludes, “may allow clinicians to modify their management of patients presenting with illnesses uncommon in their sex”.

In the meantime, having a condition that is more typical of your own gender might just give you a better chance of survival in an intensive care unit.

Have you been admitted to intensive care? What was your experience? Why not share your thoughts in the comments section below?

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