title: Gender differences in outcome and use of resources do exist in Swedish intensive care, but to no advantage for women of premenopausal age.
abstract: BACKGROUND
  Preclinical data indicate that oestrogen appears to play a beneficial role in the pathophysiology of and recovery from critical illness. In few previous epidemiologic studies, however, have researchers analysed premenopausal women as a separate group when addressing potential gender differences in critical care outcome. Our aim was to see if women of premenopausal age have a better outcome following critical care and to investigate the association between gender and use of intensive care unit (ICU) resources.
  
  
  METHODS
  On the basis of our analysis of 127,254 consecutive Simplified Acute Physiology Score III-scored Swedish Intensive Care Registry ICU admissions from 2008 through 2012, we determined the risk-adjusted 30-day mortality, accumulated nurse workload score and ICU length of stay. To investigate associations with sex, we used logistic regression and multivariate analyses on the entire cohort as well as on two subgroups stratified by median age for menopause (up to and including 45 years and older than 45 years) and six selected diagnostic subgroups (sepsis, multiple trauma, chronic obstructive pulmonary disease, acute respiratory distress syndrome, pneumonia and cardiac arrest).
  
  
  RESULTS
  There was no sex difference in risk-adjusted mortality for the cohort as a whole, and there was no sex difference in risk-adjusted mortality in the group 45 years of age and younger. For the group of patients older than 45 years of age, we found a reduced risk-adjusted mortality in men admitted for cardiac arrest. For the cohort as a whole, and for those admitted with multiple trauma, male sex was associated with a higher nurse workload score and a longer ICU stay.
  
  
  CONCLUSIONS
  Using information derived from a large multiple ICU register database, we found that premenopausal female sex was not associated with a survival advantage following intensive care in Sweden. When the data were adjusted for age and severity of illness, we found that men used more ICU resources per admission than women did.
authors.affiliation: Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö and Lund, Inga Marie Nilssons gata 47 pl. 3, SE21428, Malmö, Sweden. carolina.samuelsson@gmail.com.|Department of Anesthesiology and Intensive Care, Halland Hospital, Halmstad, Sweden. carolina.samuelsson@gmail.com.
authors.forename: Carolina
authors.initials: C
authors.lastname: Samuelsson
authors.affiliation: Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden. folke.sjoberg@liu.se.|Burn Center, Department of Hand, Plastic Surgery and Intensive Care, Linköping University Hospital, Linköping County Council, Linköping, Sweden. folke.sjoberg@liu.se.
authors.forename: Folke
authors.initials: F
authors.lastname: Sjöberg
authors.affiliation: The Swedish Intensive Care Registry, Karlstad, Sweden. goran.karlstrom@icuregswe.org.
authors.forename: Göran
authors.initials: G
authors.lastname: Karlström
authors.affiliation: Department of Anesthesiology and Intensive Care, Kristianstad Central Hospital, Kristianstad, Sweden. nolin.thomas@gmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Nolin
authors.affiliation: Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. sten.walther@telia.com.
authors.forename: Sten M
authors.initials: SM
authors.lastname: Walther
mesh_terms: D018806:APACHE; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017697:Premenopause; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors; D013548:Sweden; D016896:Treatment Outcome