“Gender-based disparities in access to healthcare services in general have been recognized for some time and evidence is emerging that these disparities extend to the treatment of severe injuries in trauma centers,” says lead author Andrea Hill. MSc, PhD, a post-doctoral fellow at Sunnybrook Health Sciences Centre and the University of Toronto in Ontario, Canada. “Our study confirms and expands on these earlier findings by evaluating the relationship between gender and trauma center care in a large cohort of patients from across Canada.”
The study results were presented at the ATS 2013 International Conference in Philadelphia.
The retrospective cohort study included 98,871 adult patients with severe injury (Injury Severity Score>15 or death within 24 hours of hospital admission).
Of the 33,080 women in the cohort, 49.6% received care in a trauma center, compared to 63.2% of males, a statistically significant (p<0.0001) difference. In the subgroup of patients aged 65 or older, 37.5% of women received trauma center care, compared with 49.6% of men, again a significant (p<0.0001) difference.
After adjusting for the effects of clinical, demographic, and socioeconomic variables, severely injured womenremained less likely to be treated in a traumacenter than men (odds ratio 0.79, 95% confidence interval 0.76 – 0.82). Separate analyses of women with fall-related injuries and women with motor vehicle-related injuries revealed that they were also less likely to receive trauma center care than men.
This pattern of gender differences in access to trauma center care was consistent across different mechanisms of injury, different income levels and among both urban and rural patients.
“Our study provides yet more evidence of important gender differences in access to trauma center care for people with severe injuries,” said Dr. Hill. “Future research should focus on the factors underlying these differences and on the effects of these disparities on patient outcomes.”
American Thoracic Society International Conference May 17-22, 2013 Philadelphia, Pennsylvania
* Please note that numbers in this release may differ slightly from those in the abstract. Many of these investigations are ongoing; the release represents the most up-to-date data available at press time.
Access To Trauma Centre Care Following Severe Injury: Are Women At A Disadvantage?
Type: Scientific Abstract
Category: 09.15 – Gender Issues (CP/BSHSR)
Authors: A. Hill, R. Pinto, A. Nathens, R. Fowler; Sunnybrook Health Science Centre – Toronto/CA
Rationale: Despite data that supports improved outcomes for severely injured patients that are managed in trauma centres, emerging evidence suggest that severely injured women are less likely to receive care in a trauma centre than men. To advance these earlier findings, this population-based study examined the relationship between gender and receipt of trauma centre care using data from across Canada.
Methods: This was a retrospective cohort study of 98,871 adult patients with severe injury (ISS > 15 or death within 24 hours of hospitalization) admitted to an acute care hospital between April 1, 2002 and March 31, 2010. Multivariable analyses were used to compare access to trauma centre for severely injured women versus men.
Results: Of the 33,080 (33.5%) severely injured women, 49.6% received care in a trauma centre compared to 63.2% of males (p <0.0001). Among older women (≥ 65 years), 37.5% received care in a trauma centre compared to 49.6% of older men (p<0.0001). In the multivariate analysis controlling for important demographic, clinical and socio-economic variables, severely injured women were less likely be treated in a trauma centre than men (odds ratio 0.79 95% confidence interval (CI) 0.76 – 0.82). The adjusted odds ratio for patients with fall related injuries was 0.74 (95% CI: 0.70 – 0.78). For patients with motor vehicle related injuries this figure was 0.89 (95% CI: 0.84 – 0.94). This observation was consistent across groups defined by income and urban-rural location of residence.
Conclusion: Female gender was associated with a decreased likelihood of receiving care in a trauma centre following severe injury. The consistency of the pattern across different mechanism of injury and income strata suggest that further studies examining the underlying reasons for the gender disparity in access to trauma centre care are warranted.