Abstract Rationale Gender differences in Intensive Care Unit (ICU) admissions have been consistently reported, and emerging evidence suggests that these differences may contribute to outcome variations between female and male patients. While prior work has highlighted differences in ICU utilization, less is known about whether gender-based differences extend to the use of life-sustaining therapies like endotracheal intubation. This study evaluated gender-based differences in ICU admissions and intubations and examined whether differences in illness acuity, reflected by APACHE scores, might explain these findings. Methods We conducted a retrospective analysis of ICU admissions of patients 16 years across ten ICUs in the WMCHealth system from October 2015 to December 2024 (n = 59,680). Gender, as recorded in the medical record, was used for analysis. Gender-based distributions were compared for all ICU admissions and for the subset requiring intubation (n = 19,711). APACHE scores were calculated at admission. Gender ratios were analyzed using chi-square tests and mean APACHE scores were compared via two-sample t tests. A difference-in-differences approach evaluated whether the female-male APACHE gap at admission differed from that among the subset of intubated patients. Results Among the 59,673 ICU admissions with identified gender, 24,645 (41.3%) were female and 35,028 (58.7%) were male. Of the 19,708 intubated patients,7,331 (37.2%) were female and 12,377 (62.8%) were male - a significant decline in the proportion of females (p 0.0001). At ICU admission, females had a slightly higher mean APACHE score than males (57.87 vs.57.01; diff=0.86; p 0.0001). Among intubated patients, this difference widened (77.17 vs. 74.88; diff=2.29; p 0.0001). The increase in the female-male APACHE gap from admission to intubation (0.86 to 2.29) was statistically significant (p = 0.006). Conclusions Male patients represented a greater proportion of ICU admissions overall, consistent with prior reports across many health systems. However, females presented with higher acuity at admission, and this difference widened further among intubated patients. These findings suggest that female patients may be admitted to the ICU later in the course of illness or face higher thresholds for ICU admission and intubation. The higher acuity among females at both admission and intubation raises concerns that non-clinical factors may be influencing care delivery. While many factors such as biological differences, comorbidities, family/social dynamics and health-seeking behaviors may play a role, the possibility of subconscious gender bias among providers cannot be excluded. Further research should explore causal mechanisms and assess interventions, such as standardized admission and intubation criteria, to promote equitable access to critical care services. This abstract is funded by: None
Ramesh et al. (Fri,) studied this question.