title: Differences in Terminal Hospitalization Care Between U.S. Men and Women.
abstract: In many settings, men and women receive different care.
  
  
  
  We sought to determine whether men and women receive different care during terminal hospitalizations.
  
  
  
  We analyzed data of 98,314 adult patients who died while hospitalized in 458 acute care hospitals in the U.S. during 2011. We examined sex-based differences in lengths of stay (LOS), resuscitation status, and intensive interventions and processes of care, adjusting for patient- and hospital-level characteristics.
  
  
  
  Women represented half of the sample (48,509; 49.34%), were older than men (73.8 vs. 70.6 years, P < 0.0001), and less likely to be married (27.7% vs. 48.3%, P < 0.001). Among all patients, median LOS was four days (interquartile range 2-10); 19.1% of subjects received cardiopulmonary resuscitation; 37.6% had a do-not-resuscitate order during the admission; and 51.6% received mechanical ventilation. Compared with men, women had slightly shorter hospitalizations (adjusted LOS: -0.16 days; 95% CI -0.19, -0.12) and were more likely to have a do-not-resuscitate order (odds ratio [OR] 1.08; 95% CI 1.05, 1.11). Women remained less likely to receive care in an intensive care unit (OR 0.95; 95% CI 0.93, 0.98), cardiopulmonary resuscitation (OR 0.83; 95% CI 0.80, 0.86), mechanical ventilation (OR 0.94; 95% CI 0.91, 0.97), hemodialysis (adjusted OR 0.81; 95% CI 0.78, 0.86), or surgical procedures (OR 0.88; 95% CI 0.84, 0.93).
  
  
  
  Men who die in hospitals receive more aggressive care than women. Further research should examine potential causes of this overall pattern.
authors.affiliation: Departments of Medicine and Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana, USA.
authors.forename: Erica
authors.initials: E
authors.lastname: Just
authors.affiliation: Department of Medicine, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Medical Ethics and Health Policy, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; The Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Casarett
authors.affiliation: Department of Medicine, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; The Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA; VA Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Asch
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
authors.forename: Dingwei
authors.initials: D
authors.lastname: Dai
authors.affiliation: Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; The Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. Electronic address: feudtner@email.chop.edu.
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D054625:Healthcare Disparities; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D016414:Resuscitation Orders; D012189:Retrospective Studies; D012737:Sex Factors; D013727:Terminal Care / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult
keywords: Sex differences; end-of-life care