The Relationship of Gender and In-Hospital Death

OBJECTIVES: The prognostic importance of gender in hospitalized patients has been poorly studied. The current study compared in-hospital death rates between men and women after adjusting for severity of illness. DESIGN: Retrospective cohort study. PATIENTS: 89,793 eligible patients with 6 common nonsurgical diagnoses who were discharged from 30 hospitals in Northeast Ohio in 1991 to 1993. METHODS: Admission severity of illness (ie, predicted risk of death) was calculated using multivariable models that were based on data abstracted from patients' clinical records (ROC curve areas, 0.83-0.90). In hospital death rates were then adjusted for predicted risks of death and other covariates using logistic regression analysis. RESULTS: Adjusted odds of death were higher (P < 0.05) in men, compared with women, for 4 diagnoses (stroke [OR, 1.60]; obstructive airway disease [OR, 1.38]; gastrointestinal hemorrhage [OR 1.32]; pneumonia [OR, 1.18]) and similar for two diagnoses (congestive heart failure [OR, 1.12]; and acute myocardial infarction [OR, 0.97]). These differences were somewhat attenuated by excluding patients discharged to skilled nursing facilities or other hospitals from analysis; nonetheless, the odds of death in men remained higher for 3 diagnoses. CONCLUSIONS: The findings indicate that inhospital death rates are generally higher in men than in women, after adjusting for severity of illness. In addition, the risk of in-hospital death in men and women was influenced by diagnosis. These differences may reflect gender-related variation in the utilization of hospital services, the effectiveness of care, over- or underestimation of severity of illness, or biological differences in men and women.