McMaster University, Hamilton, Ontario, Canada.
St Michael's Hospital, Toronto, Ontario, Canada.
JAMA Health Forum. 2021 Jul 16;2(7):e211615. doi: 10.1001/jamahealthforum.2021.1615. eCollection 2021 Jul.
Hospitalized medical patients cared for by female physicians may have decreased mortality rates compared with patients of male physicians. However, this association has yet to be assessed outside of the US, and little is known about factors that may explain this difference.
To determine whether mortality, other hospital outcomes, and processes of care differed between the patients cared for by female and male physicians.
This retrospective cross-sectional study included patients admitted to general medical wards at 7 hospitals in Ontario, Canada, between April 1, 2010, and October 31, 2017. The association of physician gender with patient outcomes was examined while adjusting for hospital fixed effects, patient characteristics, physician characteristics, and processes of care. All patients were admitted to a general internal medicine service through the emergency department and were cared for by a general internist or family physician-hospitalist. Patients were excluded if length of stay was greater than 30 days or if the attending physician cared for less than 100 hospitalized general medicine patients over the study period. Statistical analyses were performed from October 15, 2020, to May 8, 2021.
In-hospital mortality, length of stay, intensive care unit admission, 30-day readmissions, and process-of-care measures (blood tests, medications, imaging, endoscopy, and interventional radiology services).
A total of 171 625 hospitalized patients with a median age of 73 years (interquartile range, 56-84 years) were included (84 221 men [49.1%], 87 402 women [50.9%], and 2 patients with unspecified sex). Patients were cared for by 172 attending physicians (54 female physicians [31.4%] and 118 male physicians [68.6%]). In fully adjusted models, female physicians ordered more imaging tests, including computed tomography (adjusted difference, -1.70%; 95% CI, -2.78% to -0.61%; = .002), magnetic resonance imaging (-0.88%; 95% CI, -1.37% to -0.38%; = .001), and ultrasonography (-1.90%; 95% CI, -3.21% to -0.59%; = .005). Patients treated by female physicians had lower in-hospital mortality (2256 of 46 772 patients [4.8%] vs 6452 of 124 853 patients [5.2%]). This difference persisted after adjustment for patient characteristics but was no longer statistically different after adjustment for other physician characteristics (adjusted difference, 0.29%; 95% CI, -0.08% to 0.65%; = .12). The difference was similar after further adjustment for processes of care.
In this cross-sectional study of patients admitted to general medical units in Canada, patients cared for by female physicians had lower mortality rates than those treated by male physicians, adjusting for patient characteristics. This finding was nonsignificant after adjustment for other physician characteristics.
与男医生治疗的患者相比，由女医生治疗的住院医疗患者的死亡率可能较低。然而，这种关联尚未在美国以外的地区进行评估，并且对于可能解释这种差异的因素知之甚少。
确定女性医生和男性医生治疗的患者在死亡率、其他医院结局和护理过程方面是否存在差异。
设计、设置和参与者：这是一项回顾性的横断面研究，纳入了 2010 年 4 月 1 日至 2017 年 10 月 31 日期间在加拿大安大略省 7 家医院普通内科病房住院的患者。在调整医院固定效应、患者特征、医生特征和护理过程后，研究了医生性别与患者结局的关联。所有患者均通过急诊科入住普通内科服务，并由普通内科医生或家庭医生-医院医生治疗。如果住院时间超过 30 天或在研究期间主治医生治疗的住院普通内科患者少于 100 人，则排除患者。统计分析于 2020 年 10 月 15 日至 2021 年 5 月 8 日进行。
住院死亡率、住院时间、重症监护病房入院、30 天内再入院和护理过程测量（血液检查、药物、影像学检查、内窥镜检查和介入放射学服务）。
共纳入 171625 名中位数年龄为 73 岁（四分位距，56-84 岁）的住院患者（84221 名男性[49.1%]，87402 名女性[50.9%]，2 名患者性别未指定）。由 172 名主治医生治疗（54 名女医生[31.4%]和 118 名男医生[68.6%]）。在完全调整的模型中，女性医生开具了更多的影像学检查，包括计算机断层扫描（调整差异，-1.70%；95%CI，-2.78%至-0.61%；.002）、磁共振成像（-0.88%；95%CI，-1.37%至-0.38%；.001）和超声检查（-1.90%；95%CI，-3.21%至-0.59%；.005）。由女医生治疗的患者院内死亡率较低（46772 名患者中有 2256 例[4.8%]，124853 名患者中有 6452 例[5.2%]）。在调整患者特征后，这种差异仍然存在，但在调整其他医生特征后，这种差异不再具有统计学意义（调整差异，0.29%；95%CI，-0.08%至 0.65%；.12）。在进一步调整护理过程后，差异仍然相似。
在这项对加拿大普通内科病房住院患者的横断面研究中，与男医生治疗的患者相比，由女医生治疗的患者死亡率较低，这与患者特征有关。在调整其他医生特征后，这种关联不再具有统计学意义。
