Gender differences in acute poisoning: a 35-year cohort study

Drug overdose is an increasingly common cause of death, more commonly in males. In contrast, women present more commonly to emergency departments with overdose. We therefore aim to investigate gender differences in the characteristics and severity of acute poisoning. Adult (18–64 y) poisoning admissions to a tertiary toxicology service were reviewed (1990–2024), and females were compared to males. Data were extracted from a prospective database, including drug/toxin ingested, clinical effects, treatment, length of stay, intensive care admission and death. Primary outcomes were death, intensive care admission and intubation. There were 22,316 (75%) deliberate self-poisonings − 14,101 females (63%), 8,178 males and 37 transgender; 2,101 (7%) recreational overdoses − 695 (33%) females and 1,406 (67%) males. Females ingested more paracetamol/analgesics, antidepressants and quetiapine, while males ingested more alcohol, amphetamines and opioids. Median age for deliberate self-poisoning in females (33 years [IQR:24–44 years]) was similar to males (34 years [IQR:25–44 years]). There were 1,268 females (9.0%) admitted to intensive care, compared to 912 males (11.2%), which was significantly different (absolute difference 2.2%;95% CI:1.3–3.0%; P < 0.001). Less females were intubated than males (790 [5.6%] vs 549 [6.7%]; P = 0.001). Inpatient mortality was similar for females (32; 0.2%) and males (24; 0.3%), and no difference in length of stay. More females had hypotension, while more males developed coma and hepatotoxicity. Males were more likely to receive sedation and naloxone. Gender differences were similar for recreational poisoning, except greater mortality in males. Gender remained an independent predictor of intensive care and intubation in a multivariate logistic regression model, with males more likely to be intubated and admitted to intensive care. More males took recreational overdoses, including opioids, and females had more deliberate self-poisoning, with less toxic medications. Female deliberate self-poisoning patients were less commonly intubated and admitted to intensive care. Drug type did not account for the gender difference in outcomes. We found only minor differences between inpatient morbidity and mortality for females compared to males. Males were more likely to be admitted to intensive care and be intubated, mainly due to higher rates of coma.