Sex Differences In Mortality Research Articles

Sex differences at different ages in 30-day survival of COVID-19 hospitalized patients in Israel

Abstract Background Sex differences in mortality from COVID-19 have been described. It is not clear to what extent sex is an independent risk factor for mortality or is confounded by co-morbidities and whether it varies by age. It is also not clear whether it is constant over time since diagnosis. We studied sex differences in 30-day mortality rates in patients hospitalized with COVID-19, after controlling for co-morbidities. Methods Data on patients hospitalized with COVID-19 were extracted from the majority of general hospitals in Israel during 2020 to 2022. The outcome variables were death during 30 days from onset of hospitalization. Sex differences in survival rates were assessed using Cox proportional hazards models controlling for age, heart disease, cancer, respiratory disease, diabetes and hypertension. Results Mortality rates in women were significantly lower than in men in all age groups. There was an approximate 5-6 year lag in the mortality rates between men and women. Conclusions Sex was an independent predictor of 30 day mortality from COVID-19 with women experiencing better survival. This advantage was not explained by differences in co-morbidities or the magnitude of the differences in survival by age. The sex differences in the 30-day mortality of hospitalized patients are compatible with the male dominance in the incidence rates of many infectious diseases. Poorer survival of men hospitalized for COVID-19 is likely to be part of the disease mechanism and should be explored further. Key messages • Poorer survival of male COVID-19 patients seems to be part of the disease mechanism and should be explored further. • Sex differences in disease should be included in personalized management of disease.

Sex differences in mortality associated with heatwaves: a systematic review and meta-analysis

Abstract Introduction The existence of sex and gender differences in the mortality associated with heatwaves remains unclear. Methods A systematic review and random-effects meta-analysis of population-based studies that investigated the mortality associated with heatwaves and reported results stratified by sex/gender was conducted (PROSPERO registration CRD42023430208). Bibliographic databases Medline and Embase were searched from inception to May 2024 with MESH terms for heatwaves/extreme heat and mortality. This was complemented with hand-searching of reference lists of relevant studies. The methodological quality of eligible studies was assessed using the Joanna Briggs Institute critical appraisal tool. Results In total, 931 studies were identified, of which 32 studies were included in the qualitative review and 11 in the meta-analysis. Most studies (20/32) reported a higher risk of heat-related death for women than men even after adjusting for or stratifying by age. Twelve studies showed statistically significant higher risks of death for women than men and 7 studies identified an increased risk of death for women, but the wide confidence intervals precluded making definite conclusions. Two studies reported a higher risk of death for men in comparison to women but only one was statistically significant. The remaining 10 studies found comparable risks for women and men. For the 11 studies included in the meta-analysis, women had an 8% increased risk of death in comparison to men (RR 1.08, 95% CI [1.02 to 1.14]). There was significant heterogeneity (I2=69%, p = 0.001) due to the variability in the definition of exposure, population, and setting. Most studies had a low to moderate risk of bias. Conclusions Women appeared to have an increased risk of death associated with heatwaves in comparison to men. Further research is warranted to understand the underlying factors and ensure the health protection response considers the gendered impact of heatwaves.

Sex differences in mortality among patients with lupus nephritis

ObjectiveTo evaluate the prognostic importance of sex in lupus nephritis (LN).MethodsA retrospective cohort of 1048 biopsy-confirmed LN patients, diagnosed between January 1, 1996, and December 31, 2018, was analyzed. Demographics, clinical characteristics, laboratory findings, and renal pathology were assessed. The primary outcome was mortality, and the secondary outcomes included doubling of serum creatinine and end-stage renal disease (ESRD). Sex-associated risks were evaluated using Cox regression models.ResultsAmong the1048 patients, 178 (17%) were male and 870 (83%) were female. Male patients exhibited more aggressive features: higher blood pressure, earlier disease onset, and elevated levels of serum creatinine (Scr), uric acid, blood urea nitrogen. Intriguingly, male patients also displayed more severe histopathological alterations, such as more total crescents, cellular crescents formations, higher level of glomerular leukocyte infiltration and Activity Index (AI), even when overall renal pathology was comparable between sexes. During a median follow-up of 112 months, mortality was registered in 141 patients (15.3%). Mortality rates were conspicuously higher in males (24.2% males vs. 13.4% females, p = 0.0029). Secondary outcomes did not show significant sex differences. Cox regression analysis highlighted male, age of renal biopsy, eGFR, and Chronicity Index (CI) as independent risk factors for survival in LN patients. Notably, infections emerged as the leading cause of mortality among LN patients, with a significant higher rate in male patients.ConclusionIn our cohort with LN, there was a higher rate of all-cause mortality and proportion of infection-related death in male. Recognizing and further exploring these sex disparities is crucial for optimized LN patients care.Graphical

Transformation processes in the osteoarchaeological record between the Iron Age and the Roman times with reference to the civitas Treverorum

AbstractThis paper discusses transformations in human behavior between the Iron Age and the Roman times in the tribal territory of the Treveri, later civitas Treverorum, located between the Rhine and the Ardennes. This aspect has been examined from two perspectives: first, from an anthropological point of view vis‐a‐vis the historical inhabitants, and second, from an archaeozoological perspective regarding domestic animals. Due to small sample sizes and/or difficulty in dating, both regarding humans and domestic animals, transformations in living conditions and animal‐keeping could mostly be outlined only for the La Tène and Roman times. Only the Celtic‐Roman cemetery of Wederath‐Belginum with continued use from middle La Tène to late antiquity offers a more complex insight into human mortality and animal offerings. People lived longer in the Roman times but had more pathologies compared with the previous La Tène period. Body height remained similar in the La Tène and Roman times. However, differences existed within specific human groups (for example, warriors and craftsmen), compared to the normal population. Sex differences in mortality persisted from La Tène to Roman times. The faunal composition in the burials, settlements, and sanctuaries also shows changes. Since the middle La Tène period, chickens have been present. The first oysters can be found in Augustean times, whereas exotic birds such as crested fowls and peacocks are found only in later Roman times and are quite rare. A new direction in animal‐keeping is demonstrated via an increasing logarithmic size index (LSI) in cattle and sheep. The multivariate methods applied in this study offer further insights into the domain and can serve as helpful tools for osteoarchaeological data analysis.

The relationship of sex and aortic diameter at the time of acute type A aortic dissection

ObjectiveEvaluate sex differences in patients undergoing repair of acute type A aortic dissection (ATAAD). MethodsSex-stratified, single-center cohort study of patients undergoing ATAAD repair from 1997 to 2022. The primary outcome was aortic diameter at time of presentation with ATAAD. Secondary outcomes were mortality, myocardial infraction, stroke, hemodialysis, tracheostomy, re-exploration for bleeding, a composite of major adverse events, and long-term survival. ResultsIn 390 consecutive patients (150 women), men were younger than women (61.0 years; interquartile range [IQR], 50-70 years vs 70.5 years; IQR, 59-78 years; P < .001), had higher body mass index (28.6; IQR, 25.1-32.3 vs 25.4; IQR, 21.9-29.2; P < .001), more frequent peripheral vascular disease (11.7% vs 4.7%; P = .03), renal insufficiency (36.7% vs 22%; P = .003), malperfusion (34.2% vs 18.7%; P = .007), and smoking history (65% vs 44%; P < .001). There was no sex difference in median aortic diameter at the time of ATAAD (men: 5.3 cm; IQR, 4.9-6.1 cm and women: 5.2 cm; IQR, 4.6-5.9 cm; P = .12) even when adjusted for body mass index (men: 5.7 cm; IQR, 5.4-6.1 cm and women: 5.4 cm; IQR, 5.4-6.1 cm; P = .19). There was no sex difference in mortality (4.6% vs 6.0%; P = .70), major adverse events, or 10-year survival (50.3% vs 58.5%; P = .13). On multivariable analysis, there was no interaction between aneurysm size and sex (interaction P = .62). Sex was not associated with major adverse events (odds ratio, 0.75; 95% CI, 0.07-7.39; P = .81). ConclusionsThere was no sex difference in aneurysm size at the time of presentation of ATAAD, even after adjustment for body mass index, and no interaction between aneurysm size and sex, suggesting that aortic diameter remains a reasonable criterion for intervention irrespective of sex.

Temporal Trends in Race and Sex Differences in Cardiac Arrest Mortality in the USA, 1999–2020

BackgroundCardiac arrest (CA) affects over 600,000 patients in the USA annually. Despite large-scale public health and educational initiatives, survival rates are lower in certain racial and socioeconomic groups. MethodsA county-level cross-sectional longitudinal study using death data of patients aged 15 years or more from the US Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (WONDER) database from 1999 to 2020. CAs were identified using the International Classification of Diseases, tenth revision, clinical modification codes. ResultsThe CA-related deaths between 1999 and 2020 were 7,710,211 in the entire USA. The annual CA related age-adjusted mortality rates (CA-MR) declined through 2019 (132.9 to 89.7 per 100,000 residents), followed by an increase in 2020 (104.5 per 100,000). White patients constituted 82 % of all deaths and 51 % were female. The overall CA-MR during the study period was 104.48 per 100,000 persons. The CA-MR was higher for men as compared with women (123.5 vs. 89.7 per 100,000) and higher for Black as compared with White adults (154.4 vs. 99.1 per 100,000). ConclusionsCA-MR in the overall population has declined, followed by an increase in 2020, which is likely the impact of the COVID-19 pandemic. There were also significant racial and sex differences in mortality rates.

Birth outcomes and survival by sex among newborns and children under 2 in the Birhan Cohort: a prospective cohort study in the Amhara Region of Ethiopia

IntroductionDespite the progress in reducing child mortality, the rate remains high, particularly in sub-Saharan African countries. Limited data exist on child survival and other birth outcomes by sex. This study...

Diverging Trends in Survival and Functional Outcome between Males and Females after Intracerebral Hemorrhage.

Compared to ischemic stroke, sex differences in patient outcomes following intracerebral hemorrhage (ICH) are underreported. We aimed to determine sex differences in mortality and functional outcomes in a large, unselected Swedish cohort. In this observational study, data on 22,789 patients with spontaneous ICH registered in the Swedish Stroke Register between 2012 and 2019 were used to compare sex differences in 90-day mortality and functional outcome using multivariable Cox and logistic regression analyses, adjusting for relevant confounders. Multiple imputation was used to impute missing data. The crude 90-day mortality rate was 36.7% in females (3,820/10,405) and 31.7% in males (3,929/12,384) (female hazard ratio [HR] 1.20 95% confidence interval [CI]: 1.15-1.25). In multivariable analysis, the HR for 90-day mortality following ICH in females was 0.89 (95% CI: 0.85-0.94). Age was an important driving factor for the effect of sex on mortality. After adjustment for age, vascular risk factors, and stroke severity, the 90-day functional outcome in pre-stroke independent patients was worse in females compared to males (odds ratio: 1.27 95% CI: 1.16-1.40). In this large observational study, despite lower 90-day mortality, the female sex was independently associated with a worse functional outcome compared to males after ICH, even after adjusting for significant covariates. These diverging trends have not been previously reported for ICH. Given the observational design, our findings should be interpreted with caution, thus further external validation is warranted.

Within‐group sex ratios predict growth of social mole‐rats

AbstractGroups of wild animals can vary considerably in their composition, including in the proportion of group members who are male or female, that is the within‐group sex ratio. Variation in within‐group sex ratios can arise from active adjustment of litter sex ratios by mothers, from sex differences in mortality, dispersal and immigration, or from stochastic variation in recruitment. Variation in the within‐group sex ratio can have consequences for within‐group competition and can affect individual life histories throughout development. In this paper, we explore which processes may generate variation in within‐group sex ratios in wild Damaraland mole‐rats (Fukomys damarensis), a singular cooperative breeder. We investigate whether within‐group sex ratios predict the growth, body condition and philopatry of individuals. We show that although the population‐level sex ratio is balanced, skewed within‐group sex ratios are common, particularly among small groups. Our data suggests that stochastic variation in the sex of recruits explains natural variation in the sex ratio of wild groups. Non‐breeding individuals in groups with a sex ratio biased towards their own sex grow more slowly than individuals in groups biased towards the opposite sex, suggesting that intra‐sexual competition may decrease growth rates. We suggest that the costs of competition may contribute to the large variation in growth observed in social mole‐rat groups.

Gender health equity: The case for including men's health

United States' federal policy and infrastructure fail to explicitly consider the health of men, particularly the poor health of marginalized men. This inattention to men's health hinders the nation's ability to improve population health, to achieve gender health equity, and to achieve health equity more broadly. Expanding efforts to consider gender in federal policy and infrastructure to include men, naming men as a population whose poor health warrants policy attention, creating offices of men's health in federal agencies, and utilizing an intersectional lens to develop and analyze policies that affect health would likely yield critical improvements in population health and health equity in the United States. Using data from the Centers for Disease Control and Prevention, I illustrate the persistence of sex differences in mortality and leading causes of death, and how these patterns mask gender gaps in health that are driven largely by marginalized men. Given the common practice of presenting data by sex and race separately, it is difficult to recognize when the health of specific groups of men warrants attention. I utilize the case of Black men to illustrate the importance of an intersectional approach, and why men's health is critical to achieving gender and racial equity in health. While a gender mainstreaming approach has enhanced the nation's ability to consider and address the health of women and girls, it has not expanded to be inclusive of boys and men. Consequently, I argue that if our goal is to achieve health equity, it is critical to employ an intersectional approach that simultaneously considers the full range of factors that influence individual and population health and well-being. An intersectional approach would facilitate efforts to simultaneously explore strategies to achieve racial, ethnic, and gender health equity, which are driven by structural determinants beyond sex and gender related factors.

Did cholera kill selectively by sex ? Sex differences in mortality caused by 1866 cholera epidemic in Poznań

Résumé Cet article examine si l’épidémie de choléra a tué de façon sélective par genre les populations au xix e siècle. Nous avons utilisé l’épidémie de choléra à Poznan en 1866 comme une expérimentation naturelle et spontanée, qui a durée du 18 juin au 22 octobre 1866 et qui été la plus longue épidémie de cette maladie au xix e siècle dans cette ville. Il y a eu considérablement plus de victimes de cholera parmi les femmes que les hommes ce qui a été confirmé par les taux de mortalité spécifiques au choléra : pour les hommes et les femmes 1.98 % et 2.67 %, respectivement. La différence était liée à la division des rôles sociaux entre femmes et hommes. Étant une maladie d’origine hydrique, le cholera affectait plus sévèrement les personnes qui travaillaient avec l’eau. Les femmes avaient souvent des activités domestiques en lien avec l’eau et pouvaient potentiellement avoir contact avec de l’eau contaminé pendant qu’elles cuisinaient ou préparaient de la nourriture, nettoyaient les maisons et les toilettes, lavaient, faisaient la vaisselle, etc. Des taux de mortalité plus élevés dus au cholera ont été observés parmi les femmes dont les occupations demandaient d’être en contact avec l’eau (par exemple gouvernantes, domestiques, cuisinières, infirmières et nourrices) que parmi les hommes : 61.7 % vs 38.3 %. En plus, un nombre plus important de femmes est décédé de cholera dans des hôpitaux, abris, et orphelinats, 55.1 % vs 45.9 % et dans des maisons individuelles 57.8 % vs 42.2 %.

Abstract 1108: Sex And Racial Differences In The Outcomes Of Intravascular Ultrasound-guided Percutaneous Coronary Intervention: A Five-year Retrospective Analysis

Introduction: Studies have shown the superiority of intravascular ultrasound-guided percutaneous coronary intervention (IVUS-PCI) over angiographic PCI alone. We studied the racial and sex differences in outcomes. Methods: Using the National Inpatient Sample database (2016-2020) and ICD-10 codes, we identified the IVUS-PCI population. Chi-square and student T-tests were used to compare categorical and mean differences. Multivariate logistic regression analysis was used to account for potential confounding variables such as sex, age, comorbidities, hospital size, and teaching status and to estimate the probability of outcomes. Our primary outcome was mortality. A p≤0.05 was significant. Results: Of the 271,530 PCI hospitalizations, 12% (32,675) got IVUS-PCI (63.7 years ± 11.7), of which 30.4% (9,925) were females. The probability of receiving IVUS-PCI was similar among all races: 1.04 (0.9-1.1, p=0.7) and sex 1.01 (0.9-1.03, p=0.6). Compared to Whites, Blacks 0.8 (0.6-1.2), Hispanics 0.9 (0.7-1.4), and Asians 1.3 (0.8-2.2), (p&gt;0.05, each) did not differ in mortality. Also, no sex differences in mortality, with females 1.2 (1.0-1.5, p&gt;0.05). Post-procedural shock 2.5 (1.5-4.0), bleeding 1.8 (1.3-2.6), and anemia 1.5 (1.3-1.8) (p&lt;0.05, each) were more likely in females. No racial differences were noted. Conclusion: In our IVUS-PCI population, there was no difference in mortality among race or sex. However, females were more likely to suffer peri and post-procedural complications. More research is needed to identify the drivers of these disparities.

Sex differences in the prognosis of nonsustained ventricular tachycardia detected on Holter recording

BackgroundNon-sustained ventricular tachycardia (NSVT) is a common finding during cardiac evaluation and has been linked to increased mortality. While some studies report a sex difference, most data stem from research cohorts. ObjectiveThis study aimed to assess the prognostic significance of NSVT in a real-life outpatient clinic, focusing on sex differences in mortality. MethodsAnalysis was performed on a cohort of consecutive patients referred to 48-hour Holter monitoring between 2009 and 2011 at Copenhagen University Hospital - Bispebjerg. Indications for Holter monitoring included palpitations, dizziness, syncope, or arrhythmia testing. Baseline characteristics, blood tests, echocardiography results, and mortality data were obtained from electronic patient records. Results762 females (mean age 59±18 years) and 693 males (mean age 59±17 years) were enrolled. At least one episode of NSVT was detected in 9.7% of females and 20.6% of males. The median follow-up was 8.3 years. 20% of females and 24% of males died during follow-up.In multivariable models, NSVT was linked to mortality in males (HR: 1.6, 95% CI: 1.1-2.3) but not in females (HR: 1.2, 95% CI: 0.7-2.1).In case-control pairs matched on the propensity of being male conditional on relevant risk factors, NSVT was again linked to mortality in males (HR: 3.1 (2.0-4.8) but not in females (HR: 1.4 CI: 0.8-2.4). ConclusionIn consecutive patients referred to symptom driven Holter monitoring, NSVT was associated with elevated all-cause mortality in males but not in females. These results can contribute to the risk assessment of patients presenting with NSVT.

Sex differences in mortality and liver-related events in non-alcoholic fatty liver disease: A systematic review and meta-analysis.

Many systematic reviews explore the association of non-alcoholic fatty liver disease (NAFLD) with mortality, but none of them explores sex-based differences in detail. We aimed to assess whether NAFLD is associated with cause-specific mortality, all-cause mortality, and cancer incidence in both men and women. The PubMed, Embase, and Medline databases were searched from inception through April 2023 for eligible studies. We separately pooled relative risks (RRs) for men and women using a random effects model. Subsequently, the RRs and 95% CIs (confidence intervals) in each study were used to calculate the women-to-men ratio of RRs (RRR). Furthermore, subgroup analyses were performed to explore the robustness of outcomes. The random-effects model was employed to conduct sensitivity analyses to determine the impact of specific studies on the overall findings. The meta-analysis included nine cohort studies comprising 557 614 patients with NAFLD were chosen. Women were 44% more likely than men to get cancer among those with NAFLD (RRR: 1.44; 95% CI: 1.02-2.04; p = .039). However, no sex-related differences were observed between NAFLD and all-cause mortality (RRR: 1.06; 95% CI: 0.56-2.01; p = .861), liver-related mortality (RRR: 1.06; 95% CI: 0.02-69.82; p = .977), cardiovascular mortality (RRR: 1; 95% CI: 0.65-1.53; p = .987) and liver cancer (RRR: 0.76; 95% CI: 0.43-1.36; p = .36). There may be sex variations between NAFLD and the risk of cancer, with the connection being stronger in females than in males.

Abstract WMP77: In-Hospital Mortality Sex Differences in Young Adults With Intracerebral Hemorrhage

Introduction: Intracerebral hemorrhage (ICH) accounts for 10-20% of strokes and is associated with severe disability and high mortality. While males are reported to have worse outcomes in older patients with ICH, data are limited regarding sex differences in mortality risk after ICH for younger patients. Methods: We conducted a cross-sectional study of 134 adults aged 18-44 admitted to our academic medical center with ICH from 01/01/2012-12/31/2021, using data from an internal stroke registry and the Intracerebral Hemorrhage Outcomes Project (ICHOP). All vascular and non-vascular causes were included other than trauma. We used logistic regression models to calculate odds ratios (OR) and 95% confidence intervals (CI) for the association between sex and in-hospital mortality, adjusting for comorbidities and presence of multicompartmental hemorrhage (including intraventricular extension). Results: Characteristics of the study sample are summarized in the Table. Males had higher proportion of chronic hypertension and subcortical ICH location. Adjusting for hypertension, ICH location, multicompartmental extension, and use of antiplatelet medication, males had higher odds of death (OR 4.0, 95% CI 1.1-15.4) than females. Functional outcomes at discharge are shown in the Figure. Conclusion: In our cohort of young adults with ICH, males had 4-fold higher odds of in-hospital death than females. Future research should investigate the social and biological mechanisms that may underlie sex differences in mortality for young adults with ICH, including differences in ICH etiology, and potentially differential withdrawal of life sustaining treatment.

Sex differences in mortality and hospitalization in heart failure with preserved and mid-range ejection fraction: a systematic review and meta-analysis of cohort studies.

The influence of sex on the prognosis of heart failure with preserved or intermediate ejection fraction (HFpEF and HFmrEF) remains uncertain. This study aimed to investigate whether sex differences impact the prognosis of patients diagnosed with HFpEF and HFmrEF. A comprehensive search across three databases (PubMed, the Cochrane Library, and Embase) was conducted to identify sex-related prognostic cohort studies focusing on HFpEF and HFmrEF. Risk estimates were synthesized using the random effects model. The analysis included 14 cohorts comprising 41,508 HFpEF patients (44.65% males) and 10,692 HFmrEF patients (61.79% males). Among HFpEF patients, men exhibited significantly higher rates of all-cause mortality (13 studies; hazard ratio (HR): 1.24, 95% confidence interval (CI): 1.15 to 1.33)) and cardiovascular disease mortality (5 studies; HR: 1.22, 95% CI: 1.14 to 1.31) compared to women. However, no significant difference was observed in HF admissions. For HFmrEF patients, men displayed notably higher all-cause mortality (HR: 1.21, 95% CI: 1.12 to 1.31) but no significant differences in cardiovascular mortality or HF admissions. These findings suggest that male patients diagnosed with HFpEF and HFmrEF may face a more unfavorable prognosis in terms of all-cause mortality. Variations were noted in cardiovascular mortality and HF admissions, indicating potential complexities in sex-related prognostic factors within these heart failure categories. In summary, male patients with HFpEF and HFmrEF may have a more unfavorable prognosis.

Sex differences in COVID-19 mortality: A large US-based cohort study (2020–2022)

&lt;sec&gt;&lt;title&gt;Background&lt;/title&gt;&lt;p&gt;In the present study, we aim to assess the trend in mortality in COVID-19 by time and sex in a large cohort using Datavant's Death Index database. The main objectives of this study are to analyze mortality cases over time, which are categorized by sex and age, and to identify potential reasons for the observed differences.&lt;/p&gt;&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;Methods&lt;/title&gt;&lt;p&gt;This is a retrospective cohort containing information on deceased individuals in the United States and Canada (n = 4,384,265). We included adult male and female patients with a clinical diagnosis of COVID-19 (January–December 2022) (ICD-10 code: U07.1). Mortality cases for males and females were presented over a three-year period of COVID-19 pandemic. Sex ratios presenting the change of mortality cases over time was also computed as the number of diagnosed males over female patients. Sex-differences in the mortality rates were illustrated by age groups.&lt;/p&gt;&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;Results&lt;/title&gt;&lt;p&gt;In 2020, mortality cases increased to reach up to 200,000 cases per day and fluctuated due to social and/or cultural events in the US. In 2021, mortality cases reached the highest peak over the time period despite the US vaccine rollout due to holiday gatherings during November and December 2021, as well as the spread of a more contagious strain of the virus. In 2022, mortality cases decreased due to widespread vaccinations and a rise in natural immunity following the first Omicron surge. Furthermore, the proportion of COVID-19 cases in males and females remained stable during the pandemic; however, the number of diagnosed male patients markedly increased during the first months of 2022. Gender discrepancies suggest the role of various factors such as occupation, underlying comorbidities, and behavioral and immunological factors.&lt;/p&gt;&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;Conclusion&lt;/title&gt;&lt;p&gt;Our study highlights higher mortality rates observed among males, suggesting that several factors may contribute to such differences, including social, behavioral, and biological factors. Our findings highlight the importance of implementing sex-specific treatment approaches in COVID-19 patients.&lt;/p&gt;&lt;/sec&gt;

Trends of Sex Differences and Associated Factors in Stroke Outcomes Among Patients With Acute Ischemic Stroke: 2007 to 2018

Female patients have been shown to experience worse clinical outcomes after acute ischemic stroke (AIS) compared with male patients. We aimed to estimate the temporal trends in the sex differences in stroke outcomes and identify risk factors contributing to the sex differences spanning 10 years in China. This cohort study was conducted based on data from the China National Stroke Registries (CNSRs, comprising 3 phases, I-III, from 2007 to 2018). Patients with ischemic stroke within 7 days of symptom onset were included. The primary outcome was a 12-month poor functional outcome. Other outcomes included mortality and disability-adjusted life-year (DALY) lost. The sex differences in outcomes and associated factors were estimated using multivariable logistic regression. The sex differences between CNSRs were tested by the interaction of sex and time. Among 42,564 patients included, 35.4% were female. The age-adjusted event rate of 12-month poor functional outcome and mortality decreased both in male and female patients after stroke onset (CNSRs I, II, and III, all p varies over time <0.001). There was a decrease in DALY lost for both sexes over the decade (male patients: from 10.1 to 9.3 DALYs; female patients: from 10.9 to 9.6 DALYs). Female patients showed worse 12-month poor functional outcome in CNSRs I and II (odds ratio [OR] with 95% CI: 1.24 [1.10-1.39] and 1.12 [1.01-1.25], respectively) compared with male patients, but the sex difference attenuated in CNSR III (OR with 95% CI: 1.02 [0.89-1.16]), with the temporal trend (p varies over time = 0.004). The sex difference and the temporal trend of the sex difference in mortality from 2007 to 2018 were not found (p varies over time = 0.45). The most important factors attenuating the sex difference in poor functional outcome in CNSRs I and III were education level, socioeconomic deprivation, baseline stroke severity, and current smoking. This study demonstrated that the sex disparity in poor functional outcome at 12 months was substantially narrowed covering 10 years and completely attenuated in 2015-2018. The findings suggested that female patients have experienced larger improvements in stroke outcomes than male patients over the past decade.

Association of women-specific size threshold and mortality in elective abdominal aortic aneurysm repair.

It is unclear whether women derive mortality benefit from early repair of abdominal aortic aneurysms (AAA). The aim of this study was to compare short- and mid-term mortality for women treated at small versus large diameters. Women receiving elective repair of AAA at small (49-54 mm) and large (≥55 mm) diameters from 2008 to 2022 were extracted from the Swedish National Registry for Vascular Surgery (n = 1642 women). The effect of diameter on 90-day, 1- and 3-year mortality was studied in logistic regression and propensity score models. Age, co-morbidities, smoking and repair modality were considered as confounders. Men (n = 9047) were analysed in parallel. Some 1642 women were analysed, of whom 34% underwent repair at small diameters (versus 52% of men). Women with small (versus large) AAAs were younger (73 versus 75 years, P < 0.001), and 63% of women in both size groups had endovascular repairs (P = 0.120). Mortality was 3.5% (90 days), 7.1% (1 year) and 15.8% (3 years), with no differences between the size strata. There was no consistent association between AAA size and mortality in multivariable models. Sex differences in mortality were almost entirely due to mortality in younger-than-average women versus men (3-year mortality: small AAAs 11.1% versus 7.3%, P < 0.030, or large 14.4% versus 10.7%, P < 0.038). Mortality in women is high and unaffected by AAA size at repair. The optimal threshold for women remains undefined. The higher rupture risk in women should not automatically translate into a lower, women-specific threshold.

Sex-Differences in Long-term Mortality in Patients with ST-Segment elevation myocardial infarction with and without obstructive coronary arteries

Abstract Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a complex and understudied syndrome that disproportionally affects females. Studies to date evaluating sex-differences in ST-segment elevation MINOCA (STE-MINOCA) are limited; therefore, it remains uncertain whether the sex disparities observed in STEMI due to obstructive coronary arteries (STEMI-Obstruction) are also present in STE-MINOCA patients. Objectives Compare clinical characteristics and long-term mortality risk in male versus female patients presenting with STE-MINOCA and STEMI-Obstruction. Methods A multicenter registry-based cohort study enrolled consecutive STEMI patients at three regional, tertiary STEMI centers from 2003 to 2020. STE-MINOCA inluded patients with (1) coronary stenosis less than 60% as determined by coronary angiography, (2) evidence of ischemia with elevated troponin, and (3) no alternative diagnosis. Survival times between males and females with each diagnosis (STE-MINOCA &amp; STEMI-Obstruction) were estimated using the Kaplan Meier method and compared using log-rank tests. The risk of 5-year mortality in patients surviving to discharge was estimated from a Cox regression model with the interaction term for sex and diagnosis STE-MINOCA or STEMI-Obstruction) and adjusted for age, hypertension, diabetes, dyslipidemia, year of event and clustered by the study site. Results Out of 8,566 STEMI patients, 420 (4.9%) had STE-MINOCA of whom 52.9% were female and 8146 (95.1%) had STEMI-Obstruction of whom 29.3% were female. Median follow-up was 7.1 years. Females had significantly higher 5-year mortality risk compared to male counterparts in both STE-MINOCA [HR 2.37 (1.37-4.11, p=0.002)] and STEMI-Obstruction [HR 1.81 (1.59-2.07, p&amp;lt;0.001)] (Figure). After adjusting for confounding variables, the sex difference in mortality risk were not significant: HR 1.04 (0.60-1.81, p=0.89) in STE-MINOCA and HR 1.06 (0.92-1.21, p=0.45) in STEMI-Obstruction. Conclusions In this first study of consecutive STEMI patients examining sex differences by obstructive and non-obstructive mechanism, we report higher 5-year mortality risk in females presenting with STE-MINOCA and STEMI-Obstruction that was attenuated when accounting for age and baseline comorbidities. This study highlights the importance of standardized STEMI protocols to eliminate sex disparities. Abbreviations and Acronyms: Myocardial infarction with non-obstructive coronary arteries (MINOCA), ST-segment elevation MINOCA (STE-MINOCA) STEMI due to obstructive coronary arteries (STEMI-Obstruction)Figure