Daniel M. Keller, PhD

June 10, 2013

PHILADELPHIA, Pennsylvania — Women are less likely than men to receive care in a trauma center after severe injury, according to a Canada-wide study of more than 98,000 patients.

"Women had a 22% lower odds of care in a trauma center than men. And this was after controlling for confounders including age, injury severity score, site of injury, and location of injury in terms of province or urban and rural area," said study author Andrea Hill, PhD, a postdoctoral fellow at Sunnybrook Health Sciences Centre and the University of Toronto.

The findings from this study complement other evidence coming from Canada and the United States that shows unequal access to trauma center care for women, despite data that support improved outcomes when severely injured patients are treated in trauma centers, Dr. Hill told Medscape Medical News.

She presented the study results here at the American Thoracic Society 2013 International Conference.

This retrospective cohort study involved 33,080 severely injured women and 65,791 severely injured men admitted to an acute care hospital in any Canadian province or territory except Quebec. All patients were 16 years and older and had an injury severity score above 15 or died within 24 hours of hospitalization.

Fewer severely injured women than men were treated in a trauma center (49.6% vs 63.2%; < .001)

There was also a disparity in trauma care by age. More older than younger patients were not seen in a trauma center (56% vs 30%).

Even among patients older than 65 years, there was a disparity in trauma care by sex. Fewer older women than older men received care in a trauma center (37.5% vs 49.6%; P < .001).

The researchers stratified patients by age, injury severity, anatomic site of injury, and mechanism of injury, such as from falls or motor vehicle accidents. They found the lower odds of trauma center care for women was "relatively consistent across all of these strata," Dr. Hill reported. This disparity was consistent across income groups and between urban and rural populations.

Table. Likelihood of Trauma Center Care for Severely Injured Women

Injuries Odds Ratio* 95% Confidence Interval
All 0.79 0.76–0.82
Fall-related 0.74 0.70–0.78
Motor vehicle-related 0.89 0.84–0.94
*After adjustment for demographic, clinical, and socioeconomic variables.

Coauthor Robert Fowler, MD, senior scientist at Sunnybrook Health Sciences Centre and associate professor of medicine at the University of Toronto, said the reasons for the disparities are probably multifactorial. "It would seem, maybe more from a Canadian than American perspective, that there are likely differences at the provider level in terms of decision making, patient preferences, and family decision making that may track along both gender and age lines," he said.

Although it is hard to determine causality from administrative data such as these, the causes of the disparities are likely multifactorial in nature, agreed Greg Martin, MD, associate professor of medicine at Emory University and chief of pulmonary medicine and director of medical and coronary care at Grady Memorial Hospital in Atlanta, Georgia. He was asked by Medscape Medical News for his perspective on the study.

"We need to figure out how much of this is due to each of the different factors, explained Dr. Martin. For example, "for heart attack in the United States, women express different preferences. They may not want to go to the hospital, they may want to be cared for in a hospital near their house, or they may feel that they don't have the resources to go to the hospital, so they minimize and they put off whatever they see as a major health condition," he said. Figuring out which factors contribute to the sex and age disparities and to what degree "is really going to be hard."

In addition, Dr. Martin noted that there is a lot of variability in the kind of traumatic injuries sustained by men and women, citing gun shot and motor vehicle injuries as examples.

Finally, he wondered about possible disparities in the continuity of care, and whether men and women get the same care once they are in the healthcare system and after they leave the system.

There was no commercial funding for the study. Dr. Hill, Dr. Fowler, and Dr. Martin have disclosed no relevant financial relationships.

American Thoracic Society (ATS) 2013 International Conference: Abstract A4953. Presented May 21, 2013.

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