Gender Disparities In Mortality Research Articles

Worse outcomes in young women compared to men presenting with ST-elevation myocardial infarction: a 15-year statewide population-linkage cohort study

Abstract Background Gender disparity in outcomes among patients presenting with acute ST-elevation myocardial infarction (STEMI) is well recognised. It is unclear whether the gap has improved with contemporary management and therapies over time. This study compared the 30-day mortality between women and men admitted with STEMI from 2003-2017. Purpose To examine whether the gender disparity in 30-day mortality following STEMI is consistent across patient age groups and whether it has changed over time with contemporary management. Methods We used the NSW Admission-Patient-Data-Collection (APDC) database which maintains the admission records of more than 97% of the state’s healthcare facilities to identify consecutive STEMI patients admitted from 1-Jan-2003 to 31-Dec-2017. Cause-specific mortality (classified as cardiac, non-cardiac) was identified from death certificates. Multivariable logistic regression analysis was performed to examine the impact of gender on mortality adjusted for comorbidities, admission year-groups, PCI during STEMI, and stratified by age groups of ≤60, 61-70 and >70yo. Results The study cohort comprised 65033 STEMI patients: 32% women (n=20825; median age 76.1yrs); 68% men (n=44208; median age 63.8yrs). The overall 30-day all-cause and cardiac mortality was 11.5% and 8.3% respectively, with women having worse outcomes compared to men (all-cause: 17.0% vs 8.9%; cardiac: 12.2% vs 6.5% respectively, both p<0.0001). Following adjustment, higher mortality among women persisted: adjusted odds ratio [aOR]=1.65 (95% confidence interval [CI]=1.40-1.94) and 1.55 (95%CI=1.28-1.87) for total and cardiac mortality respectively. The gender disparity in mortality did not change during the study period. There was an interaction between age and gender so that differences in gender specific mortality were greater in younger than in older patients: total mortality women vs men ≤60yrs aOR=1.65 (95%CI=1.40-1.94), >70yrs aOR=1.19 (95%CI=1.12-1.27), p(interaction)=0.0011; cardiac mortality women vs men ≤60yrs aOR=1.55 (95%CI=1.28-1.87), >70yrs aOR=1.17 (95%CI=1.09-1.25), p(interaction)=0.026. Unexpectedly, a similar age-gender interaction was observed for non-cardiac mortality: women vs men ≤60yrs aOR=1.88 (95%CI=1.41-2.51), >70yrs aOR=1.15 (95%CI=1.03-1.28), p(interaction)=0.0063. Conclusion Women admitted with STEMI have significantly higher 30-day mortality than their male counterparts, with no improvement in gender disparity during the study period. The gender-bias is most pronounced in the younger age-group across and is observed for both cardiac and non-cardiac mortality. Further efforts are needed to identify the drivers of worse outcomes following STEMI in younger women.

Gender differences in estimated excess mortality during the COVID-19 pandemic in Thailand

BackgroundThere is a limited body of research specifically examining gender inequality in excess mortality and its variations across age groups and geographical locations during the COVID-19 pandemic. This study aims to fill this gap by analyzing the patterns of gender inequality in excess all-cause mortality in Thailand during the COVID-19 pandemic.MethodsData pertaining to all-cause deaths and population between January 1, 2010, and December 31, 2021, were obtained from Thailand’s Bureau of Registration Administration. A seasonal autoregressive integrated moving average (SARIMA) technique was used to estimate excess mortality during the pandemic between January 2020 to December 2021. Gender differential excess mortality was measured as the difference in age-standardized mortality rates between men and women.ResultsOur SARIMA-based estimate of all-cause mortality in Thailand during the COVID-19 pandemic amounted to 1,032,921 deaths, with COVID-19-related fatalities surpassing official figures by 1.64 times. The analysis revealed fluctuating patterns of excess and deficit in all-cause mortality rates across different phases of the pandemic, as well as among various age groups and regions. In 2020, the most pronounced gender disparity in excess all-cause mortality emerged in April, with 4.28 additional female deaths per 100,000, whereas in 2021, the peak gender gap transpired in August, with 7.52 more male deaths per 100,000. Individuals in the 80 + age group exhibited the largest gender gap for most of the observed period. Gender differences in excess mortality were uniform across regions and over the period observed. Bangkok showed the highest gender disparity during the peak of the fourth wave, with 24.18 more male deaths per 100,000.ConclusionThe findings indicate an overall presence of gender inequality in excess mortality during the COVID-19 pandemic in Thailand, observed across age groups and regions. These findings highlight the need for further attention to be paid to gender disparities in mortality and call for targeted interventions to address these disparities.

Global Disparities in Burn Outcomes: Does Gender Predict Mortality in the Global Burn Registry?

IntroductionGlobal burn injury burden disproportionately impacts low- and middle-income countries. Surgery is a mainstay of burn treatment, yet access to surgical care appears to be inequitably distributed for women. This study sought to identify gender disparities in mortality and access to surgery for burn patients in the World Health Organization Global Burn Registry (GBR). MethodsWe queried the World Health Organization GBR for a retrospective cohort (2016-2021). Patients were stratified by sex. Outcomes of interest were in-hospital mortality and surgical treatment. Patient demographics, injury characteristics, outcomes, and health facility resources were compared between sexes with Wilcoxon rank sum test for nonparametric medians, and chi-squared or Fisher’s exact test for nonparametric proportions. Multivariable logistic regressions were performed to assess the relationships between sex and mortality, and sex and surgery. ResultsOf 8445 patients in the GBR from 20 countries (10 low resource), 40% of patients were female, with 51% of all patients receiving surgical treatment during their hospitalization. Female patients had a higher incidence of mortality (24% versus 15%, P < 0.001) and a higher median total body surface area (20% versus 15%, P < 0.001), yet a lower incidence of surgery (47% versus 53%, P < 0.001) following burn injury when compared to males. In multivariable analysis, female sex was independently associated with mortality after controlling for age, time to presentation, smoke injury, percent total body surface area, surgery, and country income status. Female sex was independently associated with surgical care (odds ratio 0.86, P = 0.001). ConclusionsFemale burn patients suffer higher mortality compared to males and are less likely to receive surgery. Further study into this gender disparity in burns is warranted.

175-LB: Patient Determinants of Mortality with Severe DKA and/or HHS during the COVID Pandemic Differ from the Prepandemic

Background: SARS CoV-2 has been linked to higher mortality rate among DM patients who present with diabetic ketoacidosis (DKA) and/or hyperosmolar hyperglycemic state (HHS) . The Riverside University Health System Medical Center (RUHS-MC) -DKA Outcomes Group initiated a study to determine outcomes and risk factors before and during the pandemic in patients hospitalized at RUHS-MC with DKA and/or HHS. Methods: This was a retrospective cohort study reviewing medical records of non-pregnant adults age 18 or older admitted to the RUHS-MC for DKA and/or HHS from 03/2020 to 02/2021 (“pandemic”) compared to 3 years before the pandemic (“pre-pandemic”) . Descriptive statistics were used to determine the clinical characteristics. Logistic regression was used to assess the impact of the parameters on the death rate. Results: The mortality rate of DKA and/or HHS was 9% (30/335) during pandemic vs. 1.8% (15/855) during pre-pandemic. Six out of 30 patients died without COVID-19 infection, consistent with the pre-pandemic mortality rate. Pre-existing myocardial infarction and lower beta-hydroxybutyrate level were associated with increased mortality (Table 1) . Discussion: At our institution, the mortality rate of DKA and/or HHS during pandemic was significantly higher, specifically associated with COVID-19 infection. Our study suggests concomitant COVID-19 is a highly lethal and independent factor in patients that develop DKA. The gender disparity in mortality is unexplained and requires additional studies. Disclosure A. J. Yang: None. M. A. Firek: n/a. I. Munir: None. A. Tran: None. A. Firek: None.

Abstract 11362: Revisiting Gender Equality in Mortality After MitraClip Implantation: A Systematic Review and Meta-Analysis

Introduction: The presence of gender disparities in outcomes after non-coronary cardiac interventions is well-recognized, but conflicting data have been reported regarding the impact of gender on mortality after MitraClip (MC) implantation. Identification of sex differences in outcomes is important for effective risk stratification in patients with severe mitral regurgitation, who are at high risk for surgery. Hypothesis: We hypothesized that there are no gender-based differences in all-cause mortality after MC procedure. Methods: We searched electronic databases PubMed, Embase, and Web of Science from inception up to May 2021 for studies evaluating patient outcomes after MC implantation. The primary outcome of interest was late all-cause mortality ≥ 1 year after MC procedure. Secondary outcome of interest was in-hospital mortality. A random-effects model meta-analysis was conducted, and heterogeneity was assessed using I-squared test. Results: Seventeen studies comprising 21,549 patients were included. Women constituted 45.2% of the cohort. Male and female genders were not found to be independent predictors of late all-cause mortality ≥ 1 year after MC procedure (male, Hazard Ratio: 1.08; 95% CI: 0.92-1.26; I 2 = 15% and female, Odds Ratio (OR): 0.91; 95% CI: 0.73-1.14; I 2 = 0%, respectively) (Figure 1). There were no differences in in-hospital mortality between women and men after the index procedure (female, OR: 1.06; 95% CI: 0.61-1.85; I 2 = 29%) (Figure 2). Conclusions: There is no gender disparity in mortality with MitraClip implantation, both in-hospital and during long-term follow-up.

Analysis of Race and Gender Disparities in Mortality Trends from Patients Diagnosed with Nasopharyngeal, Oropharyngeal and Hypopharyngeal Cancer from 2000 to 2017.

BackgroundSquamous cell carcinoma of the nasopharynx, oropharynx and hypopharynx constitutes a majority of head neck malignancies. The incidence-based mortality across different races has been noted to be divergent. This study analyzes the trend in incidence-based mortality from the years 2000 to 2017 amongst both the genders in Caucasian/White and African American/Black patients.MethodsThe Surveillance, Epidemiology, and End Results (SEER) Database was queried to conduct a nation-wide analysis for the years 2000 to 2017. Incidence-based mortality for all stages of nasopharyngeal, oropharyngeal and hypopharyngeal cancer was queried and the results were grouped by race (Caucasian/White, African American/Black, American Indian/Alaskan native and Asian/Pacific Islander) and gender. All stages and ages were included in the analysis. t-test was used to determine statistically significant differences between various subgroups. Linearized trend lines were used to visualize the mortality trends of all sub groups.ResultsAcross all races, the male to female gender disparity in mortality was ~1:3 in patients with nasopharynx and became worse to ~1:4 and ~1:5 for patients with oropharyngeal and hypopharyngeal cancers, respectively. Notably, the highest incidence-based mortality for nasopharyngeal cancers is seen in Asian/pacific Islander males and a similar peak is noted for hypopharyngeal cancers in African American/Black males. Incidence-based mortality rates (per 1000) for nasopharyngeal, oropharyngeal and hypopharyngeal cancer of all races and both the genders was noted to be divergent.ConclusionA significant gender disparity exists in all three pharyngeal cancers across all races. It is unclear if female gender is protective but further study is warranted in a stage-specific and age-specific manner to better understand this disparity.

Gender disparities operate in opposite directions for hospitalizations and mortality among individuals receiving long-term ART in rural Uganda.

We conducted an analysis to determine if differences in health-seeking behaviour can explain gender disparities in mortality among long-term survivors receiving antiretroviral therapy (ART) in rural Uganda. From June 2012 to January 2014, we enrolled patients receiving a first-line ART regimen for at least 4 years without previous viral load (VL) testing in Jinja, Uganda. We measured HIV VL at study entry. We switched participants to second-line therapy, if VL was≥1000 copies/mL on two measurements, and followed participants for 3 years. We collected clinical and behavioural data at enrolment and every 6 months after that. We used Poisson regression to examine factors associated with hospitalizations and Cox proportional hazards modelling to assess mortality to September 2016. We enrolled 616 participants (75.3% female), with a median age of 44years and a median duration of ART use of 6years. Of these, 113 (18.3%) had VLs≥1000 copies/mL. Hospitalizations occurred in 101 participants (7% of men vs. 20% of women; P<0.001). A total of 22 (3.6%) deaths occurred, 9% of men vs. 2% of women (P<0.001). Multivariate modelling revealed that mortality was associated with age [adjusted hazard ratio (AHR)=1.07 per year increase; 95% confidence interval (CI): 1.01-1.13], male gender (AHR=2.57; 95% CI 1.06-6.23) and time-updated CD4 counts (AHR=0.67 per 100 cell increment; 95% CI: 0.52-0.88). Virological failure was not associated with mortality (P=0.762). Female patients receiving ART in rural Uganda were three times more likely to be hospitalized than men, but male mortality was nearly four times higher. Facilitating care for acute medical problems may help to improve survival among male ART patients.

No country for old men: gender disparities in Portuguese mortality

Abstract Background Portugal is divided into 25 NUTS 3 (Nomenclature of Territorial Units for Statistics). Mortality tracking is one of the core elements of SDG3 indicators. It can also be used as an essential metric to SDG5 on gender disparities. This study looked into gender disparities in mortality in Portugal. Methods We used data from Statistics Portugal, precisely the standardized rate of potential years of life lost per 100 000 inhabitants to all causes of death using the standard European population by gender. We subdivided by NUTS 3 and we have plotted PYLL for males, females, and the difference between both for the year 2018 using ArcMap 10.7.1. Further descriptive analysis was conducted in R 3.61 and Rstudio 1.2.5033. Results We have found significant gender disparities in mortality. These gender disparities afflicted men the most. In 88% of NUTS3, the PYLL difference of more than 2000 years/100000 when comparing men with women. The higher disparities were in the Azores, Alto Tâmega, and the Douro. Some of the critical specific causes of mortality that lead to this disparity are malignant tumors, mental health problems, alcohol abuse, circulatory system diseases, accidents, and suicides. Conclusions We have found that there are significant disparities in gender mortality targeting men. Although it is higher in some Portuguese regions, the problem is widespread. Further research is needed to address the causes of gender disparity in health outcomes in Portugal. Key messages Huge gap in YPLL between men and women, starting an young adult age. The urgent need for health programs that target men health problems.

Consensus Scientific Statement on Advisory Working Guidelines and Recommendations for the Female Population in COVID-19 Era by WINCARS

We are presently facing the rapid progression and uncontrolled spread of the COVID-19 pandemic, with uncertainties in its management. There are national and international guidelines in general for the diagnosis and management of COVID and precautions needed for non-COVID patients. There is an apparent gender disparity in mortality due to COVID 19, which is less in women than in men. However, many diseases are specific to (like pregnancy-related complications and ovarian carcinoma) or more frequent (many rheumatological diseases and mitral stenosis) in females, and have hardly been discussed in the context of the COVID pandemic. Moreover, recommendations are not available for our population. We, from the Women in Cardiology and Related Sciences (WINCARS) association, prepared a consensus scientific statement for the female population in this COVID-19 era.

Analysis of race and gender disparities in mortality trends from patients diagnosed with nasopharyngeal, oropharyngeal and hypopharyngeal cancer from 2000 to 2014.

e17533 Background: Squamous cell carcinoma of the nasopharynx, oropharynx and hypopharynx constitutes a majority of head neck malignancies. The incidence-based mortality across different races has been noted to be divergent. This study analyzes the trend in incidence-based mortality from the years 2000 to 2014 amongst both the genders in Caucasian/White and African American/Black patients. Methods: The Surveillance, Epidemiology, and End Results (SEER) Database was queried to conduct a nation-wide analysis for the years 2000 to 2014. Incidence-based mortality for all stages of nasopharyngeal, oropharyngeal and hypopharyngeal cancer was queried and the results were grouped by race (Caucasian/White, African American/Black, American Indian/Alaskan native and Asian/Pacific Islander) and gender. All stages and ages were included in the analysis. T-test was used to determine statistically significance difference between various subgroups. Linearized trend lines were used to visualize the mortality trends of all sub groups. Results: Incidence-based mortality rates (per 1000) for nasopharyngeal, oropharyngeal and hypopharyngeal cancer all races and both the genders is shown in the table below. The male to female gender disparity in mortality is~ 1:3 in patients with nasopharynx across all races and becomes worse to ~1:4 and ~1:5 for patients with oropharyngeal and hypopharyngeal cancers respectively. Notably the highest incidence based mortality for nasopharyngeal cancers is seen in Asian/pacific Islander males and a similar peak is noted for hypopharyngeal cancers in African American/Black males. Conclusions: A significant gender disparity exists in all there pharyngeal cancers across all races. It is unclear if female gender is protective but further study is warranted in a stage- specific and age-specific manner to better understand this disparity.[Table: see text]

Future healthy life expectancy among older adults in the US: a forecast based on cohort smoking and obesity history.

BackgroundIn the past three decades, the elderly population in the United States experienced increase in life expectancy (LE) and disability-free life expectancy (LEND), but decrease in life expectancy with disability (LED). Smoking and obesity are two major risk factors that had negative impacts on these trends. While smoking prevalence continues to decline in recent decades, obesity prevalence has been growing and is currently at a high level. This study aims to forecast the healthy life expectancy for older adults aged 55 to 85 in the US from 2011 to 2040, in relation to their smoking and obesity history.MethodsFirst, population-level mortality data from the Human Mortality Database (HMD) and individual-level disability data from the US National Health Interview Survey (NHIS) were used to estimate the transition rates between different health states from 1982 to 2010, using a multi-state life table (MSLT) model. Second, the estimated transition rates were fitted and projected up to 2040, using a modified Lee-Carter model that incorporates cohort smoking and obesity history from NHIS.ResultsMortality and morbidity for both sexes will continue to decline in the next decades. Relative to 2010, men are expected to have 3.2 years gain in LEND and 0.8 years loss in LED. For women, there will be 1.8 years gain in LEND and 0.8 years loss in LED. By 2040, men and women are expected to spend respectively 80 % and 75 % of their remaining life expectancy between 55 and 85 disability-free.ConclusionsSmoking and obesity have independent negative impacts on both the survival and disability of the US older population in the coming decades, and are responsible for the present and future gender disparity in mortality and morbidity. Overall, the US older population is expected to enjoy sustained health improvements and compression of disability, largely due to decline in smoking.Electronic supplementary materialThe online version of this article (doi:10.1186/s12963-016-0092-2) contains supplementary material, which is available to authorized users.

Gender disparities in mortality from infectious diseases in Serbia, 1991-2014: a time of civil wars and global crisis.

Infectious diseases remain one of the leading causes of death worldwide. The aim of this descriptive epidemiological study was to analyse the trends in mortality from infectious diseases in Serbia (excluding the Autonomous Province of Kosovo & Metohia) from 1991 to 2014 using joinpoint regression analysis. The mortality rates from infectious diseases were found to have increased markedly from 1991 to 1994 (+12·4% per year), followed by a significant decline from 1994 to 2009 (-4·6% per year) and then another increase from 2009 to 2014 (+4·3% per year). Throughout the study period, mortality rates were consistently higher in men than in women. Although a substantial decline was observed for young people of both sexes, no consistent pattern was evident for the middle-aged nor the elderly. Since 1991, septicaemia has emerged as a leading cause of infectious disease mortality, particularly in older men. The Yugoslav civil wars in the 1990s and the global financial crisis in 2008 corresponded with changes in the trends in mortality from infectious diseases in Serbia, with the elderly showing particular vulnerability during those time periods. Data presented in this study might be useful to improve control of infectious diseases in Serbia.

Gender disparities in mortality : challenges for health equity in Puerto Rico.

The aim of this study is to deepen the analysis of mortality indicators by sex in Puerto Rico. The gender perspective is used to identify the differentials and inequalities that generate disparities in mortality among women and men in that country. In 2008- 2010, life expectancy at birth for both sexes reached 78.83 years, with a gap of 7.71 years among women and men, which is higher in the group of very low mortality countries, internationally. The years of potential life lost (YPLL) by age and external causes of death and natural death are used, among other indicators, for further analysis of male mortality from a gender perspective. Young men have a very high premature mortality because many deaths are due to by external causes: homicides, suicides and accidents. In the case of women’s, premature deaths are prevalent due natural causes in all age groups. The result of the study is to promote gender mainstreaming to achieve health equity for women and men. Puerto Rico requires health plans, programs and policies that take into account gender disparities in order to achieve a longer life span-free of preventable disease, disability, injury and premature death- which currently affects more men than women.

Health in the working-age population: Health in Sweden: The National Public Health Report 2012. Chapter 4

Summary The present chapter deals with health in the working-age population (aged 25–64). The working age span covers a substantial portion of people’s lives, and morbidity rates vary considerably at the beginning and end of the age range. In this age group, for example, 10–20 times more people die at the age of 64 than at the age of 25. Since the beginning of the 1950s accidents, followed by suicide, have been the leading cause of death among men in the 25–44 age group, while cancer has been the most common cause of death among women in the same age group. For a long time, cardiovascular diseases were the most common cause of death among men aged 45– 64. However cardiovascular mortality has declined significantly and cancer is now an equally common cause of death. Since 1952, cancer has been the leading cause of death among women aged 45–64, as it has been among younger women. More working-age women than men die of cancer. This is because breast, uterine, and ovarian cancer often occur in women before retirement age. Breast cancer is the most common form of cancer among women. However; although breast cancer morbidity is rising, mortality has shown a slight decline. Overall, significantly more working-age men than women die, due to the higher risk among men of death from cardiovascular diseases, in accidents, from suicide and from alcohol-related causes. Mortality from these causes has declined significantly over the past 25 years, along with a corresponding decline in gender disparities in mortality. Impaired mental wellbeing became increasingly prevalent in the 1990s. The deterioration in mental wellbeing was more pronounced among younger people than older people. The percentage of women aged 25–44 who suffer from anxiousness, nervousness, and anxiety (angst) has doubled since the end of the 1980s, and these problems are now more common than in the 45–64 age group, which was not the case in the 1980s. In recent years, however, the trend has reversed, and mental wellbeing appears to be improving among women and men in both age groups. Mental ill-health and pain are the most common causes of reduced work capacity. Reduced work capacity due to illness has also become more prevalent among women in all age groups since the 1980s. The same adverse trend has also been observed in men in the younger age groups, although work capacity has improved among men aged 55–64. Since the end of the 1990s, it has become more common for mental strain to cause work-related health issues.

Gender Disparities In Mortality Among Medical Admissions Of A Tertiary Health Facility In Ilorin, Nigeria

We retrospectively assessed sex-related differences in duration of hospital stay and mortality among medical admissions at the University of Ilorin Teaching Hospital (UITH), Nigeria between January 1996 and December, 2005. Seventeen thousand six hundred and fifty patients, consisting of 10,040 (56.9%) males and 7,610 (43.1%) females were admitted during the period under review. Of these, 4220 died which was made up of 2624 (62.2%) males and 1596 (37.8%) females with overall percentage mortality of 23.9%. Mortality rate was significantly higher (Chi=62.5, p=0.0001) in males (26.1%) than in females (20.97%). The percentages of deaths due to Human Immunodeficiency Virus (HIV)/Tuberculosis (TB), neoplasms and haematological disorders were higher in females than in males (p=0.0001, 0.0001 and 0.0001 respectively). However, deaths from gastrointestinal system and liver, and endocrine system were higher in males (p=0.0001 and 0.02 respectively) than in females. We recommend gender specific community interventions for the control of HIV/AIDS, TB and liver diseases in the population studied.

Ethnic dimensions of gender differentials in mortality in Malaysia

Higher mortality rates among males are a common occurrence across different cultures and countries. The causes of this higher mortality can be biological as well as behavioural in nature. The biological evidence applies across all nations and communities, but the behavioural causes, arising from the decision processes and communication strategies of individuals, will necessarily have cultural and environmental dimensions that change with time. This study examines gender disparities in mortality across ethnicity and time in Malaysia. The study shows that there is a consistent gender differential across time but it has widened for the Malays and the Indians and narrowed for the Chinese. Most importantly, it has widened considerably for young adults. Analysis of the leading causes of death show that young adult males are more likely to engage in risk-taking behaviour, and that the related causes and the extent of such causes vary across the ethnic groups.

Race, Gender, and SES Disparities in Self-Assessed Health, 1974-2004

Despite improvements in the status of Blacks and women over the past 30 years, racial and gender disparities in mortality and morbidity persist. Using General Social Survey (GSS) data from 1974 to 2004, the authors explore the extent to which race, gender, and socioeconomic status converge to produce differences in self-assessed health. The intersectionality paradigm is used to guide this work on health disparities. The authors find that the gender gap in self-assessed health has narrowed significantly over this 30-year time period. This decreased gap is especially pronounced because of the marked improvement over time in Black women's reports of their health. However, Black women continue to report the lowest levels of self-assessed health even in 2004. In fact, Black women who hold a college degree report worse health than White men, White women, and Black men with a high school diploma.