Sex and age affect access to critical care
Reported November 15, 2007
Women are less likely than men to be treated in intensive care units and to receive the life-supporting treatments provided there, and as a result are more likely to die during a critical illness, according to a new Canadian study.
The research, published online yesterday by the Canadian Medical Association Journal, shows the problem is even more pronounced among older women, shedding light on disparities in care based on gender and age.
“For a long time, we’ve recognized anecdotally that there are more men than women in critical care units, so we decided to investigate,” said Robert Fowler, a critical-care physician at Sunnybrook Health Sciences Centre in Toronto, in an interview.
The study, conducted in 14 Ontario hospitals and involving almost half a million patient records, found that 57 per cent of patients admitted to hospital are women, but only 40 per cent of admissions to ICU are women.
All told, severely ill women are about one-third less likely to be treated in ICU than men with comparable conditions.
Women are also less likely to undergo mechanical ventilation to help with breathing, as well as pulmonary artery catheterization, a technique for detecting life-threatening conditions such as heart failure or blood poisoning.
Further, when women do spend time in ICU, they are discharged earlier, but end up spending more time in hospital over all.
And women are about 20 per cent more likely to die while in ICU than men, according to the research.
Dr. Fowler said that while there are definite differences in treatment, it is not clear if this is due to the preferences of families (many ICU patients are so ill they cannot make health-care decisions themselves), the biases of health-care professionals, or a mixture of the two.
Dr. Fowler said that one of the most important messages the public can take from the research is that it’s important for families to have discussions about care and how aggressive it should be before a crisis occurs.
“You really need to have the dialogue ahead of time. Clear direction makes it much easier for families and health-care providers,” he said.
Arlene Bierman, the chair in women’s health in the faculty of nursing at the University of Toronto, said in a commentary also published by the CMAJ that the research is the latest in a long line of studies showing that women get “suboptimal care” for serious illnesses.
To help redress the situation, she said, gender-based analyses should be routine in all health research, and more research should be conducted on the reasons for these disparities and how to overcome them.
Nancy Baxter of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto said that beyond documenting disparities, addressing them must become a priority, particularly for health-care providers.
“We like to think that our care is not influenced by gender, race or socio-economic status, but we all have our unconscious biases,” she said. “We need to do a lot more work to figure out how that can change.”
Dr. Baxter stressed that the differences in care – and their underlying reasons – are much more subtle than the numbers might suggest.
“I don’t want people reading this material to think that physicians are all sexist pigs,” she said.
“We all want to ensure that women and men have equal access to care, but our subconscious biases are an impediment.”