Gender influences ICU care

Older women with heart failure and other critical conditions receive less life support and die more than men in intensive care units, according to a disturbing new Canadian study.
 
This difference was most pronounced among women over age 50, who were 32 per cent less likely than men to be admitted to intensive care units. They were also nine per cent less likely than men to receive mechanical ventilation to assist breathing and 20 per cent less likely to receive pulmonary artery catheters to monitor failing hearts. They were also more likely to die.
 
"Among older patients, being female was associated with a 20 per cent increased risk of death in ICU, an eight per cent increased risk of death in hospital and six per cent increased risk of death over one year," reports a medical team that looked at almost 500,000 patients admitted to 13 Ontario hospitals over two years.

"You can't deny there are differences," says Dr. Robert Fowler, a critical care physician at Sunnybrook Health Sciences Centre and researcher at the University of Toronto who headed the study.
 
The report, to be published in the Dec. 4 issue of the Canadian Medical Association Journal, is being held up as clear evidence of gender disparities in the quality and provision of health care.
 
Dr. Arlene Bierman, of the University of Toronto, describes the differences in death rates between older men and women in ICU as "particularly troubling."
 
Dr. Nancy Baxter of Toronto's St. Michael's Hospital notes that the study focuses on critically ill patients who had already been admitted to hospital, "where it is assumed that care is delivered strictly on the basis of need." But the study, she says, "demonstrates that the sex of the patient influences not only the care he or she receives in ICU, but also whether he or she is admitted to ICU in the first place."
 
Bierman and Baxter say the findings are just the latest evidence of gender-related differences in Canada's health care. Other studies have found women are not as likely as men to be admitted to hospital after arriving at emergency departments with heart problems, are less likely than men to receive implantable cardiac defibrillators, and are at increased risk of receiving potentially inappropriate medications.
 
Baxter also points to disparities in the provision of health care based on age, socio-economic status, race and geographic location.
 
Addressing the issue "must become a national priority," she writes in a commentary accompanying the study, which reveals a marked gender difference in critical care that showed up in patients at age 50 and became more pronounced the older the patients got, with men in their 60s, 70s and 80s far outnumbering older women in ICU.
 
"So far, we haven't been able to explain the differences away," Fowler said in an interview.
 
He suspects some of the disparities may be rooted in the way men and women are viewed differently as they age in terms of using aggressive measures to treat failing lungs and hearts.
 
He says health-care teams and family members frequently describe older female patients as "frail elderly women."