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Published at www.cmaj.ca on Nov. 14, 2007.
In the not-too-distant past the 70-kg male was the paradigm for medical practice and women were systematically excluded from clinical trials. In a relatively short period, sex- and gender-based analyses have contributed to an exponential growth in our knowledge about healthrelated differences between women and men. Advances in molecular biology and genomics have found that differences between the sexes extend to the cellular level.1 Sex differences in pathophysiology and phamacokinetics increasingly have important implications for clinical practice. Clinical epidemiology, health services research, outcomes research and the social sciences are all making profound contributions to our understanding of sex and gender differences in health and disease. Women and men differ not only in patterns of illness and disease risk factors, but also in their social contexts. Consequently, they have different experiences with health care, including differences in access, quality and health outcomes. Although sex and gender differences have been most extensively studied in cardiovascular care,2,3 the more we examine other areas, the more differences we find.
In a large retrospective cohort study published in this issue of CMAJ, Fowler and colleagues4 report on important disparities associated with sex that they found in intensive care use and outcomes between men and women. Specifically, older women (aged 50 or older) were less likely than older men to be admitted to the intensive care unit (ICU) or to receive life-saving interventions such as mechanical ventilation, and more likely to die when admitted because of a critical illness. Despite similar severity of illness between women and men upon ICU admission, women had shorter stays in the ICU but longer overall stays in hospital. By linking data from the Canadian Critical Care Research Network registry to administrative data, the authors were able to control for a large number of potential confounders, including demographic characteristics, principal diagnosis, comorbidities and illness severity (APACHE [Acute Physiologic and Chronic Health Evaluation] scores). Because these findings are consistent with those from prior studies that suggest the existence of sex and gender disparities in ICU care, we can have a high level of confidence that, despite the limitations of the study by Fowler and colleagues, the sex disparities they identify are real. Particularly troubling is the finding of...