Sex Differences in Mortality, Multidimensional Morbidity, and Health Care Utilization: A Secondary Analysis of the Canadian RECOVER Study

Purpose We assessed for differences in sex and disability group membership in ICU mortality, longitudinal Functional Independence Measure (FIM) scores, Beck Depression Inventory-II (BDI-II), Impact of Event Scale - Revised (IES-R), and healthcare utilization to 1-year after intensive care unit (ICU) discharge. Methods Secondary analysis of medical/surgical patients in the Canadian Towards RECOVER study. Results Of 463 (185 females, 278 males) participants, significantly more males 45 (16.2%) versus females 20 (10.8%) died in the ICU [Hazard Ratio (HR) 1.8 (1.1, 3.1); p = 0.03]. Of 398 (165 females, 233 males) ICU survivors, 391 had FIM scores. Median FIM scores were significantly higher for male (versus female) survivors at 3-months (117 versus 106 points; p = 0.005), 6-months (119 versus 111.5 points; p = 0.005), and 12-months (121 versus 115 points; p = 0.003). Conversely, female (versus male) survivors had significantly higher BDI-II scores at 3-months [12.50 (7.0, 18.0) versus 9.0 (5.3, 14.8); p = 0.036], 6-months [11.8 (6.0, 17.8) versus 7.2 (3.0, 14.0); p = 0.009], 12-months [10.0 (4.0, 19.0) versus 11 (3.0, 26.3); p = 0.036] and higher IES-R scores at 3-months. Female survivors also experienced significantly more moderate (versus mild) [OR 6.9 (3.5, 13.7); p < 0.0001] and severe (versus moderate)[OR 40.9 (17.1, 98.2); p < 0.0001] depression. Whereas female ICU survivors had more rheumatology and nephrology specialty visits, males had more cardiology, endocrinology, surgical, and rehabilitation visits. There were no sex by time or sex by disability group interactions. Conclusions Although male ICU survivors experienced significantly higher ICU mortality, females experienced significantly lower longitudinal FIM scores and more frequent and severe depression.