title: Racial disparities and sex-based outcomes differences after severe injury.
abstract: BACKGROUND
  Controversy exists about the mechanisms responsible for sex-based outcomes differences post-injury. X-chromosome-linked immune response pathway polymorphisms represent a potential mechanism resulting in sex-based outcomes differences post-injury. The prevalence of these variants is known to differ across race. We sought to characterize racial differences and the strength of any sex-based dimorphism post-injury.
  
  
  METHODS
  A retrospective analysis was performed using data derived from the National Trauma Data Bank 7.1 (2002-2006). Blunt-injured adult (older than 15 years) patients, surviving >24 hours and with an Injury Severity Score >16 were analyzed (n = 244,371). Patients were stratified by race (Caucasian, black, Hispanic, Asian) and multivariable regression analysis was used to characterize the risk of mortality and the strength of protection associated with sex (female vs male).
  
  
  RESULTS
  When stratified by race, multivariable models demonstrated Caucasian females had an 8.5% lower adjusted risk of mortality (odds ratio [OR] = 0.91; 95% CI, 0.88-0.95; p < 0.001) relative to Caucasian males, with no significant association found for Hispanics or blacks. An exaggerated survival benefit was afforded to Asian females relative to Asian males, having a >40% lower adjusted risk of mortality (OR = 0.59; 95% CI, 0.44-78; p < 0.001). Asian males had a >75% higher adjusted risk of mortality relative to non-Asian males (OR = 1.77; 95% CI, 1.5-2.0; p < 0.001), and no significant difference in the mortality risk was found for Asian females relative to non-Asian females.
  
  
  CONCLUSIONS
  These results suggest that Asian race is associated with sex-based outcomes differences that are exaggerated, resulting from worse outcomes for Asian males. These racial disparities suggest a negative male X-chromosome-linked effect as the mechanism responsible for these sex-based outcomes differences.
authors.affiliation: Division of General Surgery andTrauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. sperryjl@upmc.edu
authors.forename: Jason L
authors.initials: JL
authors.lastname: Sperry
authors.forename: Yoram
authors.initials: Y
authors.lastname: Vodovotz
authors.forename: Robert E
authors.initials: RE
authors.lastname: Ferrell
authors.forename: Rami
authors.initials: R
authors.lastname: Namas
authors.forename: Yi-Min
authors.initials: YM
authors.lastname: Chai
authors.forename: Qi-Ming
authors.initials: QM
authors.lastname: Feng
authors.forename: Wei-Ping
authors.initials: WP
authors.lastname: Jia
authors.forename: Raquel M
authors.initials: RM
authors.lastname: Forsythe
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Peitzman
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Billiar
mesh_terms: D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D044469:Racial Groups / Q000208:ethnology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000175:diagnosis / Q000208:ethnology*