Women receive more trials of noninvasive ventilation for acute respiratory failure than men: a nationwide population-based study

Abstract

Introduction: Previous studies in western countries have observed that women are less likely than men to receive intensive care and mechanical ventilation (MV). We aimed to investigate whether the gender difference also exists in Asian populations and in the provision of different types of MV including invasive (INV) and noninvasive ventilation (NIV).

Methods: We analyzed all adult hospital patients between 2005 and 2007 in the claims data from 1,000,000 randomly selected people in the Taiwan National Health Insurance Research Database. NIV-only was defined as patients receiving NIV as the only ventilator treatment during hospitalization. Gender difference was assessed using multivariable analyses with/without considering a hospital cluster effect by generalized estimating equations models. Subgroup analyses for gender difference in NIV use were performed using propensity score matching method.

Results: Of the 128,327 patients enrolled, 53.8% were men, 9.2% received intensive care and 5.2% used MV. After adjusting for potential confounders, women were less likely than men to receive intensive care (adjusted odds ratio [aOR] 0.77, 95% confidence interval [CI] 0.73-0.82) and MV (aOR 0.84, 95% CI 0.78-0.91). Among MV patients, 6.8% received NIV-only; the proportion of which was higher in women than in men (8.6% vs. 5.7%, P < 0.001). After controlling for confounders and a cluster effect, women remained more likely to receive NIV-only (aOR 1.61, 95% CI 1.32-1.96). Subgroup analyses showed that patients with underlying congestive heart failure (CHF) had the highest difference in the provision of NIV-only (female-to-male aOR 2.76, 95% CI 1.38-5.53). A hospital cluster effect on the gender difference in NIV use was found in patients with diseases other than chronic obstructive pulmonary disease and CHF.

Conclusions: Gender differences existed not only in the provision but also in the types of MV. Further studies are needed to understand why gender differences occur.

Figure 1

Flow diagram of the study patients. The same excluded patient may appear in different categories. F, female; HFOV, high frequency oscillatory ventilation; LHID, the Longitudinal Health Insurance Database of 2005; M, male; MV, mechanical ventilation; NHI, National Health Insurance.

Figure 2

Age-and-gender-specific proportional distributions of patients receiving (a) intensive care, (b) mechanical ventilation (MV), (c) noninvasive and invasive ventilation (NIV/INV) and (d) NIV-only. Note: NIV-only was used to define those receiving NIV as the only ventilator treatment and NIV/INV was for those receiving both NIV and INV during the same hospitalization. ARF, acute respiratory failure.