Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Department of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Health Serv Res. 2020 Feb;55(1):35-43. doi: 10.1111/1475-6773.13215. Epub 2019 Nov 10.
To evaluate whether the male predominance of older people admitted to intensive care units (ICUs) is due to gender differences in the presence of spouses, partners, or children; rates of gender-specific disease; or triage decisions made by health system personnel.
Three population-based datasets, 2004-2012, of Canadians ≥65 years: provincial health care data from Manitoba (n = 250 190) and national data of nursing home residents (n = 133 982) and community-based homecare recipients (n = 210 090).
Retrospective observational study, using multivariable Cox proportional hazards and logistic regression.
Males predominated in ICU admissions: from Manitoba (hazard ratio [HR] = 1.87, 95% CI = 1.80-1.95), nursing homes (HR = 1.47, 1.35-1.60), and homecare (odds ratio = 1.14, 1.11-1.17). Adjustment for spouses, partners, and children did not attenuate this effect. The HR for gender was lower by 13.5 percent, relative, after excluding ICU care for cardiac causes. Male predominance was not present during a second ICU admission among survivors of a first ICU-containing hospitalization (HR = 1.07, 0.96-1.20).
In three older cohorts, the male predominance of ICU admission was not explained by gender differences in the presence of a spouse, partner, or children, or cardiac disease rates. The third finding suggests that triage bias is unlikely to be responsible for the male predominance.
评估老年人入住重症监护病房（ICU）的男性比例偏高是否归因于配偶、伴侣或子女存在方面的性别差异、特定性别疾病的发病率，或是医疗保健系统人员做出的分诊决策。
2004 年至 2012 年，对加拿大≥65 岁的人群进行了三项基于人群的数据集研究：来自马尼托巴省的省级医疗保健数据（n=250190）、养老院居民的全国数据（n=133982）和基于社区的家庭护理接受者的全国数据（n=210090）。
采用多变量 Cox 比例风险和逻辑回归的回顾性观察性研究。
男性在 ICU 入院中占主导地位：来自马尼托巴省（危险比[HR] = 1.87，95%置信区间[CI] = 1.80-1.95）、养老院（HR = 1.47，1.35-1.60）和家庭护理（优势比[OR] = 1.14，1.11-1.17）。调整配偶、伴侣和子女的因素并没有减弱这种影响。在排除 ICU 因心脏原因引起的护理后，性别相关的 HR 降低了 13.5%。在首次 ICU 住院患者的第二次 ICU 入院中，男性比例没有增加（HR = 1.07，0.96-1.20）。
在三个较年长的队列中，ICU 入院的男性比例偏高不能用配偶、伴侣或子女的存在方面的性别差异、特定性别疾病的发病率来解释。第三个发现表明，分诊偏差不太可能是男性比例偏高的原因。
