| INTRODUC TI ONSince the 1980 publication of the Black Report, 1 there has been a growing awareness of social inequalities in health and health care use. Although ethnicity, age, socioeconomic status (SES), and others factors associated with health inequality have been identified, 2-4 the mechanisms by which these factors work remain unclear. One example is the reported gender-related difference in admission to intensive care units (ICUs). Despite the fact that women greatly outnumber men in older age-groups, substantially more older men than older women are admitted to ICUs. [5][6][7][8][9] This finding is present even after adjustment for differing rates of critical illness between older men and women. 10 Abstract Objective: To evaluate whether the male predominance of older people admitted to intensive care units (ICUs) is due to gender differences in the presence of spouses, partners, or children; rates of gender-specific disease; or triage decisions made by health system personnel. Data Sources and Collection: Three population-based datasets, 2004-2012, of Canadians ≥65 years: provincial health care data from Manitoba (n = 250 190) and national data of nursing home residents (n = 133 982) and community-based homecare recipients (n = 210 090). Study Design: Retrospective observational study, using multivariable Cox proportional hazards and logistic regression. Principal Findings: Males predominated in ICU admissions: from Manitoba (hazard ratio [HR] = 1.87, 95% CI = 1.80-1.95), nursing homes (HR = 1.47, 1.35-1.60), andhomecare (odds ratio = 1.14, 1.11-1.17). Adjustment for spouses, partners, and children did not attenuate this effect. The HR for gender was lower by 13.5 percent, relative, after excluding ICU care for cardiac causes. Male predominance was not present during a second ICU admission among survivors of a first ICU-containing hospitalization (HR = 1.07, 0.96-1.20).
Conclusions:In three older cohorts, the male predominance of ICU admission was not explained by gender differences in the presence of a spouse, partner, or children, or cardiac disease rates. The third finding suggests that triage bias is unlikely to be responsible for the male predominance. K E Y W O R D S acute inpatient care, epidemiology, gender/sex differences in health and health care S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Hill A, Ramsey C, Dodek P, et al. Examining mechanisms for gender differences in admission to intensive care units. Health Serv Res. 2020;55:35-43. https ://