Umemura Yutaka, Katayama Yusuke, Kitamura Tetsuhisa, Kiyohara Kosuke, Hirose Tomoya, Kiguchi Takeyuki, Tachino Jotaro, Nakao Shunichiro, Nakagawa Yuko, Shimazu Takeshi
Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2‑15 Yamada‑oka, Suita, Osaka, 565-0871, Japan.
Department of Emergency and Critical Care, Osaka General Medical Center, 3‑1‑56 Bandai‑Higashi, Sumiyoshi‑ku, Osaka, Japan.
Eur J Trauma Emerg Surg. 2022 Aug;48(4):2731-2740. doi: 10.1007/s00068-021-01840-8. Epub 2021 Dec 3.
Sex-based differences in post-traumatic mortality have been widely discussed for quite some time. We hypothesized that age-related pathophysiologic changes would affect sex-based differences in post-traumatic mortality and aimed to verify the hypothesis using a nationwide trauma registry in Japan.
This was a retrospective analysis of trauma patients registered in The Japanese Trauma Data Bank. We stratified the study population into the following three subsets based on age: (1) pediatric subset (age ≤ 14), (2) adult subset (age 15-50) and (3) senior adult subset (age ≥ 51). We evaluated both sex-based differences in mortality in each subset separately using multivariate logistic regression analysis and the two-way interaction effect for predicted survival between the continuous increase of age and the sexes using a nonlinear multivariate regression model.
We included 122,819 trauma patients who fulfilled the inclusion criteria and classified them into the 3 subsets according to age. Male patients were more likely to die compared to female patients only in the senior adult subset (adjusted odds ratio: 1.26; 95% confidence interval: 1.18-1.36), whereas there were no statistically significant differences in the other two subsets. Furthermore, non-linear logistic regression analysis revealed that predicted survival probability in male patients decreased more sharply in accordance with the increase of age compared to that in female patients (p for interaction: 0.051).
Age-related change in post-traumatic mortality was significantly different between males and females, and male patients had a relatively higher risk of death in the older population.
创伤后死亡率的性别差异已经被广泛讨论了相当长一段时间。我们假设与年龄相关的病理生理变化会影响创伤后死亡率的性别差异，并旨在使用日本的全国创伤登记系统来验证这一假设。
这是一项对日本创伤数据库中登记的创伤患者的回顾性分析。我们根据年龄将研究人群分为以下三个亚组：（1）儿童亚组（年龄≤14岁），（2）成人亚组（年龄15 - 50岁）和（3）老年成人亚组（年龄≥51岁）。我们分别使用多因素逻辑回归分析评估每个亚组中死亡率的性别差异，并使用非线性多因素回归模型评估年龄持续增加与性别之间预测生存的双向交互作用。
我们纳入了122,819名符合纳入标准的创伤患者，并根据年龄将他们分为3个亚组。仅在老年成人亚组中，男性患者比女性患者更易死亡（调整后的优势比：1.26；95%置信区间：1.18 - 1.36），而在其他两个亚组中没有统计学上的显著差异。此外，非线性逻辑回归分析显示，与女性患者相比，男性患者的预测生存概率随着年龄的增加下降得更急剧（交互作用p值：0.051）。
创伤后死亡率的年龄相关变化在男性和女性之间存在显著差异，并且男性患者在老年人群中的死亡风险相对较高。
