Effects of Biological Sex on Access to Care and Outcomes After Acute Spinal Cord Injury

While preclinical studies documented potential neuroprotective effects of estrogen/progesterone, the impact of biological sex on outcomes after traumatic spinal cord injury (tSCI) remains incompletely understood. The aim of this study was to compare male and female age-stratified subgroups, which presumably correspond to premenopausal, perimenopausal, and postmenopausal states, concerning access to optimal care and their outcomes after tSCI. A series of propensity score-matched cohort studies was performed, comparing female individuals with male individuals in the younger (age≤ 40 years), middle-aged (41-50 years), and older (>50 years) subgroups regarding baseline data; management strategies; access to optimal care; and hospital, neurologic, and functional outcomes after tSCI. Data were selected from 5,571 individuals with tSCI at C1-L2 who were enrolled in the Rick Hansen Spinal Cord Injury Registry from July 2004 to September 2019. Outcome measures included in-hospital mortality and motor and sensory score changes from admission to an acute care hospital to discharge from a rehabilitation center. In the younger subgroups, female individuals (n = 320, mean age: 26 years) were more often White and had a greater proportion of tSCIs due to falls or transportation-related accidents than male individuals (n = 320, mean age: 26.5 years). Younger female and male subgroups had similar in-hospital mortality rates (0.6% vs 0.6%, p = 1) and motor (4 vs 5, p = 0.8919) and sensory (2 vs 5, p = 0.5) score changes after tSCI. In the middle-aged subgroups, female individuals (n = 133, mean age: 46 years) and male individuals (n = 113, mean age: 46 years) had statistically comparable baseline data, in-hospital mortality rates (2.3% vs 3.0%, p = 1), and motor (12 vs 5, p = 0.8766) and sensory (0 vs 2, p = 0.4918) score changes. In the older subgroups, female individuals (n = 531, mean age: 68 years) showed a higher frequency of fall-related tSCI but they had similar in-hospital mortality rates (7.7% vs 9.8%, p = 0.2324) and motor (9 vs 8, p = 0.7594) and sensory (5 vs 0, p = 0.7204) score changes after tSCI compared with male individuals (n = 531, mean age: 68 years). The results of this study suggest that biological sex does not significantly affect in-hospital mortality and neurologic recovery after tSCI when optimal care is applied, according to data from a Canadian registry. Those findings support the notion that sex equity in management strategies promotes equal outcomes after tSCI.