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INTRODUCTION: Decisions to prescribe opioids to patients depend on many factors, including illness severity, pain assessment, and patient age, race, ethnicity, and gender. Gender and sex disparities have been documented in many healthcare settings, but are understudied in inpatient general medicine hospital settings. OBJECTIVE: We assessed for differences in opioid administration and prescription patterns by legal sex in adult patient hospitalizations from the general medicine service at a large urban academic center. DESIGNS, SETTING, AND PARTICIPANTS: This study included all adult patient hospitalizations discharged from the acute care inpatient general medicine services at the University of California, San Francisco (UCSF) Helen Diller Medical Center at Parnassus Heights from 1/1/2013 to 9/30/2021. MAIN OUTCOME AND MEASURES: The primary outcomes were (1) average daily inpatient opioids received and (2) days of opioids prescribed on discharge. For both outcomes, we first performed logistic regression to assess differences in whether or not any opioids were administered or prescribed. Then, we performed negative binomial regression to assess differences in the amount of opioids given. We also performed all analyses on a subgroup of hospitalizations with pain-related diagnoses. RESULTS: Our study cohort included 48,745 hospitalizations involving 27,777 patients. Of these, 24,398 (50.1%) hospitalizations were female patients and 24,347 (49.9%) were male. Controlling for demographic, clinical, and hospitalization-level variables, female patients were less likely to receive inpatient opioids compared to male patents (adjusted OR 0.87; 95% CI 0.82, 0.92) and received 27.5 fewer morphine milligram equivalents per day on average (95% CI - 39.0, - 16.0). When considering discharge opioids, no significant differences were found between sexes. In the subgroup analysis of pain-related diagnoses, female patients received fewer inpatient opioids. CONCLUSIONS: Female patients were less likely to receive inpatient opioids and received fewer opioids when prescribed. Future work to promote equity should identify strategies to ensure all patients receive adequate pain management.

BackgroundSex and racial disparities in the presentation and management of chest pain persist, however, the impact of coronavirus disease 2019 (COVID-19) on these disparities have not been studied. We sought to determine whether the COVID-19 pandemic contributed to pre-existing sex and racial disparities in the presentation, management, and outcomes of patients presenting to the emergency department (ED) with chest pain.MethodsWe conducted an observational cohort study with retrospective data collection of patients between January 1, 2016, and May 1, 2022. This was a single study conducted at a quaternary academic medical center of all patients who presented to the ED with a complaint of chest pain or chest pain equivalent symptoms. Patient were further segregated into different groups based on sex (male, female), race, ethnicity (Asian, Black, Hispanic, White, and other), and age (18 - 40, 41 - 65, > 65). We compared diagnostic evaluations, treatment decisions, and outcomes during prespecified time points before, during, and after the COVID-19 pandemic.ResultsThis study included 95,764 chest pain encounters. Total chest pain presentations to the ED fell about 38% during the early pandemic months. Females presented significantly less than males during initial COVID-19 (48% vs. 52%, P < 0.001) and Asian females were least likely to present. There was an increase in the total number of troponins and echocardiograms ordered during peak COVID-19 across both sexes, but females were still less likely to have these tests ordered across all timepoints. The number of coronary angiograms did not increase during peak COVID-19, and females were less likely to undergo coronary angiogram during all timepoints. Finally, females with chest pain were less likely to be diagnosed with acute myocardial infarction (AMI) during all timepoints, while in-hospital deaths were similar between males and females during all timepoints.ConclusionsDuring COVID-19, females, especially Asian females, were less likely to present to the ED for chest pain. Non-White patients were less likely to present to the ED compared to White patients prior to and during the pandemic. Disparities in management and outcomes of chest pain encounters remained similar to pre-COVID-19, with females receiving less cardiac workup and AMI diagnoses than males, but in-hospital mortality remaining similar between groups and timepoints.

Background: Conflicting data exist regarding sex-specific outcomes after cardiac arrest. This study investigates sex disparities in the provision of critical care and outcomes of in-hospital (IHCA) and out-of-hospital cardiac arrest (OHCA) patients. Methods: Analysis of adult cardiac arrest patients admitted to certified Swiss intensive care units (ICUs) (01/2008–12/2022) using the nationwide prospective ICU registry. The primary outcome was ICU mortality, with secondary outcomes including ICU admission probability and advanced treatment provision. Results: Among 41,733 individuals (34.9% women), 21,692 patients (30.6% women) were admitted to ICUs (16,571 OHCA patients/5121 IHCA patients). Women were less likely to be admitted to the ICU than men (incidence rate ratio 0.82 [95% CI 0.80–0.85] and had a higher ICU mortality (41.8% vs 36.2%; p < 0.001). Mortality differences were more pronounced in OHCA patients (unadjusted HR: 1.35 [95% CI 1.28–1.43]; adjusted HR: 1.19 [95% CI 1.12–1.25]). In IHCA patients, mortality differences were less pronounced (unadjusted HR: 1.14 [95% CI 1.04–1.25]) and vanished after adjustment for confounders: adjusted HR: 1.03 [95% CI 0.94–1.13]). Women after cardiac arrest were older, more severely ill, and received fewer interventions before (44.7% vs 54.0%; p < 0.001) and during ICU stay. A subgroup analysis of 11,202 patients revealed that treatment limitations were more frequent in women (46.7% vs 38.7%; p < 0.001). However, these limitations were associated with an increased risk of death in both sexes. Conclusions: This study highlights sex disparities in short-term mortality and ICU resource allocation among cardiac arrest patients, with women potentially facing disadvantages, in particular after OHCA. The limitations of ICU registry data, particularly the lack of detailed cardiac arrest-specific and comorbidity information, restrict definitive conclusions. Future research should prioritize prospective studies with more granular data to better understand and address these disparities. [ABSTRACT FROM AUTHOR]

Background/Objectives: Cardiogenic shock (CS) is associated with high mortality, particularly in women. With early intervention being a cornerstone of CS management, this study aims to explore whether sex differences exist in the utilization of critical interventions, timing of treatment, and in-hospital mortality for patients with acute myocardial infarction (AMI) and non-AMI-CS. Methods: For this retrospective cohort study, we queried the National Inpatient Sample (years 2016–2021) for CS-related hospitalizations. We assessed sex differences in utilization, timing, and outcomes of CS interventions, adjusting for demographics, comorbidities, and prior cardiac interventions via multivariate logistic regressions. Results: Of 1,052,360 weighted CS hospitalizations, 60% were for non-AMI-CS and 40% were for AMI-CS. Women with CS had lower rates of all interventions. For AMI-CS, women had higher likelihoods of in-hospital mortality after revascularization (adjusted odds ratio 1.15 [95% confidence interval 1.09–1.22]), mechanical circulatory support (MCS) (1.15 [1.08–1.22]), and right heart catheterization (RHC) (1.10 [1.02–1.19]) (all p < 0.001). Similar trends were seen in the non-AMI-CS group. Women with AMI-CS were less likely to receive early (within 24 h of admission) revascularization (0.93 [0.89–0.96]), MCS (0.76 [0.73–0.80]), or RHC (0.89 [0.84–0.95]); women with non-AMI-CS were less likely to receive early revascularization (0.78 [0.73–0.84]) or RHC (0.83 [0.79–0.88]) (all p < 0.001). Regardless of CS type, in-hospital mortality was not significantly different between men and women receiving early MCS or revascularization. Conclusions: Sex disparities in the frequency of treatment of CS persist on a national scale, with women being more likely to die following treatment and less likely to receive early treatment. However, in-hospital mortality does not differ significantly when men and women are treated equally within 24 h of admission, suggesting that early intervention should be made a priority to mitigate sex-based differences in CS outcomes. [ABSTRACT FROM AUTHOR]

Background: Thousands of females undergo inguinal hernia repair annually, yet females have been excluded from prior clinical trials evaluating inguinal hernia repairs. Research shows females face worse outcomes after hernia repair compared to males, including higher recurrence rates, increased chronic pain, and limited data to guide treatment. Prospective studies focused on optimizing outcomes for females are critically needed. Prior to conducting such trials, it is essential to obtain preliminary data from female participants to ensure that the studies are designed appropriately to address their priorities and improve sex disparities in outcomes. Methods: Semi-structured qualitative interviews were conducted between July 7 and December 31, 2023, with 34 females evaluated for groin hernia. Interviews were conducted via Zoom at an academic medical center. The discussions aimed to explore the challenges in diagnosing hernias, the considerations for selecting treatment options, and the priorities for future research. The transcripts were analyzed using descriptive content analysis, facilitated by MAXQDA software. Results: Diagnostic challenges included delayed recognition due to underappreciation of female hernias. Participants desired greater familiarity with hernias and treatment options from providers. For surgical decisions, fear of complications drove some towards surgery, while others prioritized avoiding recovery time for asymptomatic hernias. Participants called for research on female-specific risk factors, pain experiences, recovery impacts, and non-operative approaches. The majority of participants agreed or considered participating and serving as an advisor in a future study. Conclusion: Females with hernia face sex-based disparities in diagnosis and treatment. Improving provider awareness and developing guidelines are needed. This qualitative study identifies key areas for future research to optimize person-centered hernia care for females based directly on personal perspectives and priorities, laying the groundwork for prospective trials aimed at improving outcomes. [ABSTRACT FROM AUTHOR]

Background: Neurological disorders are a major global health concern, especially in BRICS nations (Brazil, Russia, India, China, South Africa), where demographic and socio-economic changes have amplified their impact. This study evaluates trends in incidence, prevalence, mortality, and Disability-Adjusted Life Years (DALYs) associated with neurological diseases in these countries from 1990 to 2021, focusing on sex disparities and key risk factors. Methods: Data were obtained from the Global Burden of Disease (GBD) 2021 database. Join point regression and Estimated Annual Percentage Change (EAPC) analyses were used to assess trends in neurological disease burden. Age-standardized rates for incidence, prevalence, and mortality were calculated, along with DALYs, and key risk factors were analyzed. Results: China showed the largest increase in incidence (7541.89 to 8031.37 per 100,000) and prevalence (26494.85 to 28534.79 per 100,000). Mortality increased in India (21.01 to 24.27 per 100,000) and South Africa (27.66 to 30.65 per 100,000), while China showed a decline (39.59 to 37.30 per 100,000). Brazil experienced a substantial rise in DALYs (1610.65 to 42024.59). Sex disparities showed higher DALY rates for females across all nations. Conclusion: The research highlights the rising burden of neurological disorders in BRICS nations, especially in China and Brazil due to aging populations and metabolic risks. It emphasizes the need for targeted interventions in India and South Africa, where increasing mortality rates and DALYs are concerning. Effective health policies should focus on early detection, managing metabolic risks, and implementing sex-specific strategies to address these issues. [ABSTRACT FROM AUTHOR]

Background: Sex disparities are known modifiers of health and disease. In neuroendocrine neoplasms (NENs), sex-based differences have been observed in the epidemiology and treatment-related side effects. Objectives: To examine sex differences in demographics, diagnoses present during hospital admission, comorbidities, and outcomes of hospital course among hospitalized patients with NENs. Design: Retrospective analysis. Methods: A descriptive analysis of sex differences was performed on patients with NENs discharged from U.S. community hospitals in 2019 from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project, and Agency for Healthcare Research and Quality. Results: A total of 7334 patients with NENs were identified; 4284 patients had primary NENs, and 3050 patients had metastatic NENs. In total, 48.7% were males and 51.3% were females. Distributions of race and ethnicity, and payer types differed by sex (p < 0.001 and p = 0.027, respectively). For race and ethnicity, there were more females in White, Black, and Native American races, and Hispanic ethnicity. For payer types, female predominance was seen with Medicare, Medicaid, private insurance, and self-pay groups. Sex differences were seen in diagnosis made during hospital stay. In all NENs, oral (p = 0.036) and neurologic (p < 0.001) diagnoses were more common in females; ascites (p = 0.002), dysphagia (p = 0.002), biliary ductal obstruction (p = 0.014), and jaundice (p = 0.048) were more common in males. In primary NENs, ascites (p < 0.001) was male predominant. In metastatic NENs, dysphagia (p = 0.003) and jaundice (p = 0.034) were male predominant, whereas females had more headaches (p < 0.001). Nausea and vomiting were female predominant in all NENs (p < 0.001), primary (p = 0.044), and metastatic (p < 0.001) NENs. For comorbidities, arthropathies (p < 0.001), depression (p < 0.001), hypothyroidism (p < 0.001), other thyroid disorders (p < 0.001), chronic pulmonary disease (p = 0.002), and obesity (p < 0.001) were female predominant. Conclusion: There were sex differences in the race and ethnicity, payer types, diagnoses present during hospital admission, and comorbidities among the 2019 NIS hospital discharge sample of patients with NENs. Plain language summary: Sex differences in patients with neuroendocrine tumors during hospital admission This study explored sex differences in neuroendocrine neoplasms (NENs) using 2019 hospital discharge data. There were variations in demographics, diagnoses, and comorbidities between males and females. Female patients had higher rates of oral and neurologic issues, while males had more ascites, dysphagia, and jaundice. Certain comorbidities like arthritis, depression, hypothyroidism, and obesity were more common in females. Hospital stays and mortality rates did not differ significantly based on sex. In summary, this research highlights distinct sex-related patterns in NENs, shedding light on potential areas for tailored interventions or further investigation. [ABSTRACT FROM AUTHOR]

Background: Expanding ultrasound use has increased the detection of thyroid cancer. Incidence has always been higher among females, a disparity that has grown over time. The sex difference in thyroid cancer is understudied in the context of diagnostic testing, particularly among privately insured adults in whom thyroid cancer is most common. We evaluated the association between thyroid ultrasound, fine needle aspiration biopsy (FNAB), and cancer incidence by sex in a large, integrated health system. Methods: This longitudinal retrospective cohort study included Kaiser Permanente of Washington enrollees aged 18 and over who underwent thyroid ultrasound from 1997 to 2019. Data included electronic billing claims for patients linked to tumor registry diagnoses. We estimated (1) annual overall ultrasound, FNAB, and cancer incidence rates; (2) the proportion of ultrasound requiring FNAB; and (3) cancer diagnoses per FNAB. A Poisson model with offset determined the relationship between sex and the proportion of ultrasound requiring FNAB adjusting for patient and sociodemographic characteristics. Results: A total of 33,589 patients underwent ultrasound (78% females; mean age 56). Ultrasound rates per 100,000 covered lives, defined as insured individuals per year, increased five-fold among males (111.11–490.97) and >four-fold among females (382.27–1331.14) between 1997 and 2019. FNAB rates also increased over time (rates per 100,000: 174.09–430.37 in females vs. 58.38–189.13 in men). Overall, FNAB rates per ultrasound changed little over time, and FNAB per ultrasound was greater in males compared with females (Adj rate ratio = 1.06 [confidence interval 1.01–1.11]). Cancer incidence was higher in females over the study period, but cancer incidence per FNAB was similar between sexes (both 0.06, p = 0.4). Conclusions: Sex disparities in thyroid ultrasound rates are stark and are a likely driver of sex disparities in thyroid cancer incidence. Interestingly, ultrasound-triggered FNAB was more common in males and changed little over time, challenging the prevailing understanding that females have much higher rates of thyroid cancer. Although the population-based differences between sexes for FNAB and cancer were large, the differences among people who had ultrasound were small. [ABSTRACT FROM AUTHOR]

Background and Aims: The role of sex disparities in in‐hospital outcomes after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in patients with a history of coronary artery bypass grafting (CABG) remains underexplored. This study aimed to identify sex disparities in in‐hospital outcomes after PCI in patients with AMI and a history of CABG. Methods: Using the National Inpatient Sample database, we identified patients hospitalized for AMI with a history of CABG who underwent PCI between 2016 and 2019. 1:1 propensity score matching was used to minimize standardized mean differences of baseline variables and compare in‐-hospital outcomes. Results: In total, 75,185 weighted hospitalizations of patients were identified. Compared with male patients, female patients exhibited elevated risks of in‐hospital mortality (3.72% vs. 2.85%; adjusted odds ratio [aOR] 1.48; 95% confidence interval [CI] 1.14–1.93), major adverse cardiac or cerebrovascular events (MACCEs) (4.96% vs. 3.75%; aOR 1.46; 95% CI 1.18–1.82), bleeding (4.91% vs. 3.01%; aOR 1.56; 95% CI 1.27–1.79), and longer length of stay (4.64 days vs. 3.96 days; β 0.42; 95% CI 0.28–0.55). After propensity matching, female patients remained associated with increased risks of in‐hospital mortality (3.81% vs. 2.81%; aOR 1.37; 95% CI 1.06–1.78), MACCEs (5.08% vs. 3.84%; aOR 1.35; 95% CI 1.08–1.70), bleeding (5.03% vs. 3.11%; aOR 1.57; 95% CI 1.24–2.00), and longer length of stay (4.61 ± 4.76 days vs. 4.06 ± 4.10 days; β 0.39; 95% CI 0.18–0.59). Female patients aged > 60 years were more vulnerable to in‐hospital mortality than were their male counterparts (3.06% vs. 4.15%; aOR 1.56; 95% CI 1.18–2.05). Conclusions: Female patients who underwent PCI for AMI with a history of CABG had higher risks of in‐hospital mortality, MACCEs, bleeding, and longer length of stay, with in‐hospital mortality rates being particularly pronounced among older patients. [ABSTRACT FROM AUTHOR]

Abstract Purpose This study aimed to comprehensively assess the safety of rimegepant administration in real-world clinical settings. Methods Data from the Food and Drug Administration Adverse Event Reporting System (FAERS) spanning the second quarter of 2020 through the first quarter of 2023 were retrospectively analyzed in this pharmacovigilance investigation. This study focuses on employing subgroup analysis to monitor rimegepant drug safety. Descriptive analysis was employed to examine clinical characteristics and concomitant medication of adverse event reports associated with rimegepant, including report season, reporter country, sex, age, weight, dose, and frequency, onset time, et al. Correlation analysis, including techniques such as violin plots, was utilized to explore relationships between clinical characteristics in greater detail. Additionally, four disproportionality analysis methods were applied to assess adverse event signals associated with rimegepant. Results A total of 5,416,969 adverse event reports extracted from the FAERS database, 10, 194 adverse events were identified as the “primary suspect” (PS) drug attributed to rimegepant. Rimegepant-associated adverse events involved 27 System Organ Classes (SOCs), and the significant SOC meeting all four detection criteria was “general disorders and administration site conditions” (SOC: 10018065). Additionally, new significant adverse events were discovered, including “vomiting projectile” (PT: 10047708), “eructation” (PT: 10015137), “motion sickness” (PT: 10027990), “feeling drunk” (PT: 10016330), “reaction to food additive” (PT: 10037977), etc. Descriptive analysis indicated that the majority of reporters were consumers (88.1%), with most reports involving female patients. Significant differences were observed between female and male patients across age categories, and the concomitant use of rimegepant with other medications was complex. Conclusion This study has preliminarily identified potential new adverse events associated with rimegepant, such as those involving the gastrointestinal system, nervous system, and immune system, which warrant further research to determine their exact mechanisms and risk factors. Additionally, significant differences in rimegepant-related adverse events were observed across different age groups and sexes, and the complexity of concomitant medication use should be given special attention in clinical practice.

Abstract Colorectal cancer (CRC) is one of the most fatal cancers in the United States. Although the overall incidence and mortality rates are declining, an alarming rise in early-onset colorectal cancer (EOCRC), defined as CRC diagnosis in patients aged

We investigate differential effects of neighborhood structure on the arrest rates of men versus women. Given potential disparities in the use of discretion by offense severity, we disaggregate crime to aggravated assaults, burglaries, and drug offenses. We employ negative binomial regression models to predict the number of arrests by sex for each crime type, and test for significant differences within and between sex across offense severity. We find few differences within and across sex, however, levels of disorder and the racial composition of a neighborhood are important structural factors in understanding arrests by sex and across offense type. Neighborhood composition is associated with differential rates of arrest by sex and across offense severity, which has implications for gender disparities in the criminal justice system. [ABSTRACT FROM AUTHOR]

Historically, studies show that female patients with cystic fibrosis (CF) have worse pulmonary outcomes than male patients, including decreased life expectancy. It is unknown whether this disparity persists in the new era of highly effective modulator therapies. Ivacaftor has been available in the United States for > 10 years, allowing for the opportunity to understand the impact this therapy may have on sex disparities in CF. We hypothesized that female patients will continue to show worse outcomes because we suspect that the disparity is not driven solely by ion channel dysfunction. Does a difference in outcomes between male and female patients persist after the initiation of ivacaftor in people with CF? We conducted a retrospective cohort study using the CF Foundation Patient Registry comparing changes in pulmonary exacerbation rate, lung function (FEV 1 % predicted), and presence of Pseudomonas aeruginosa among male patients vs female patients before and after initiation of treatment with the highly effective modulator ivacaftor. The cohort comprised 1,900 people with CF who were treated with ivacaftor between 2010 and 2017; 928 patients (48.84%) were male and 972 patients (51.16%) were female with a mean age of 33.09 years. Male patients showed a significant decrease in pulmonary exacerbations after ivacaftor treatment (from 0.38 to 0.34; adjusted rate ratio, 0.89; P =.028), whereas female patients did not (from 0.48 to 0.45; adjusted rate ratio, 0.95; P =.174). FEV 1 % predicted similarly decreased in both male and female patients before vs after ivacaftor treatment. P aeruginosa prevalence decreased to a similar extent in both male and female patients after ivacaftor treatment. Our findings demonstrate that sex disparities in CF persist in those treated with ivacaftor because of differences in pulmonary exacerbations. More research is needed to determine the specific pathophysiologic drivers of this disparity. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to comprehensively assess the safety of rimegepant administration in real-world clinical settings. Methods: Data from the Food and Drug Administration Adverse Event Reporting System (FAERS) spanning the second quarter of 2020 through the first quarter of 2023 were retrospectively analyzed in this pharmacovigilance investigation. This study focuses on employing subgroup analysis to monitor rimegepant drug safety. Descriptive analysis was employed to examine clinical characteristics and concomitant medication of adverse event reports associated with rimegepant, including report season, reporter country, sex, age, weight, dose, and frequency, onset time, et al. Correlation analysis, including techniques such as violin plots, was utilized to explore relationships between clinical characteristics in greater detail. Additionally, four disproportionality analysis methods were applied to assess adverse event signals associated with rimegepant. Results: A total of 5,416,969 adverse event reports extracted from the FAERS database, 10, 194 adverse events were identified as the "primary suspect" (PS) drug attributed to rimegepant. Rimegepant-associated adverse events involved 27 System Organ Classes (SOCs), and the significant SOC meeting all four detection criteria was "general disorders and administration site conditions" (SOC: 10018065). Additionally, new significant adverse events were discovered, including "vomiting projectile" (PT: 10047708), "eructation" (PT: 10015137), "motion sickness" (PT: 10027990), "feeling drunk" (PT: 10016330), "reaction to food additive" (PT: 10037977), etc. Descriptive analysis indicated that the majority of reporters were consumers (88.1%), with most reports involving female patients. Significant differences were observed between female and male patients across age categories, and the concomitant use of rimegepant with other medications was complex. Conclusion: This study has preliminarily identified potential new adverse events associated with rimegepant, such as those involving the gastrointestinal system, nervous system, and immune system, which warrant further research to determine their exact mechanisms and risk factors. Additionally, significant differences in rimegepant-related adverse events were observed across different age groups and sexes, and the complexity of concomitant medication use should be given special attention in clinical practice. [ABSTRACT FROM AUTHOR]

Simple Summary: In recent years, researchers have begun to investigate the relation between sex and cancer. We wanted to look at the relation between sex and non-small cell lung cancer among high-risk patients to see if this relationship needs further exploration. In order to do this, we chose to look at large publicly available databases that contained information on lung cancer incidence. Our research found indications that females have an elevated risk of lung cancer incidence in comparison with males within high-risk populations. These results suggest that the difference in sex-specific cancer biomechanisms should be further investigated and explored. Background/Objectives: Non-small cell lung cancer (NSCLC) has seen a relative rise in incidence among females versus males in recent years, although males still have a higher overall incidence. However, it is unclear whether this trend is consistent across all populations. Therefore, we retrospectively examined this relationship in two large high-risk clinical cohorts. Methods: First, we analyzed lung cancer incidence among individuals with a smoking history of over 40 pack-years in the National Lung Screening Trial (NLST). Then, we investigated the incidence of second primary NSCLC in patients who underwent lobectomy for previous stage I lung cancer using the Surveillance, Epidemiology, and End Results (SEER) database. We performed both univariate and multivariable time-to-event analyses to investigate the relationship between sex and lung cancer incidence. Results: In the NLST cohort (n = 37,627), females had a higher risk of developing primary NSCLC than males (HR = 1.11 [1.007–1.222], p = 0.035) after adjusting for age and pack-year history. In the SEER cohort (n = 19,327), females again exhibited an increased risk of developing a second primary lung cancer (HR = 1.138 [1.02–1.269], p = 0.021), after adjusting for age, race, grade, and histology. Conclusions: Our analysis reveals that females have a modestly higher lung cancer incidence than males in high-risk populations. These findings underscore the importance of further researching the underlying cellular processes that may cause sex-specific differences in lung cancer incidence. [ABSTRACT FROM AUTHOR]

Introduction/Aims: Given the importance of early diagnosis and treatment of myasthenia gravis (MG), it is critical to understand disparities in MG care. We aimed to determine if there are any differences in testing, treatment, and/or access to neurologists for patients of varying sex and race/ethnicity with MG. Methods: We used a nationally representative healthcare claims database of privately insured individuals (2001–2018) to identify incident cases of MG using a validated definition. Diagnostic testing, steroid‐sparing agents, intravenous immunoglobulin (IVIG), plasma exchange (PLEX), and thymectomy were defined using drug names or CPT codes. Steroid use was defined using AHFS class codes. We also determined whether an individual had a visit to a neurologist and the time between primary care and neurologist visits. Logistic regression determined associations between sex and race/ethnicity and testing, treatments, and access to neurologists. Results: Female patients were less likely to get a computed tomography (CT) chest (odds ratio (OR) 0.73, 95% confidence interval (CI): 0.64–0.83), receive steroids (OR: 0.85, 95% CI: 0.75–0.97), steroid‐sparing agents (OR: 0.84, 95% CI: 0.72–0.97), and IVIG or PLEX (OR: 0.80, 95% CI: 0.67–0.95). Black patients were less likely to receive steroids (OR: 0.78, 95% CI: 0.63–0.96). No significant disparities were seen in access to neurologists. Discussion: We found healthcare disparities in MG treatment with female and Black patients receiving less treatment than men and those of other races/ethnicities. Further research and detailed assessments accounting for individual patient factors are needed to confirm these apparent disparities. [ABSTRACT FROM AUTHOR]

Introduction: Transvenous lead extraction (TLE) is generally considered a safe procedure, albeit not without risks. While gender‐based disparities have been noted in short‐term outcomes following TLE, a notable gap exists in understanding the long‐term consequences of this procedure. The objective of this analysis was to investigate sex differences in both acute and long‐term outcomes among patients who underwent TLE at a tertiary referral center. Methods: In this retrospective cohort study, consecutive patients who underwent TLE between January 2014 and January 2016 were enrolled. The primary outcome comprised a composite of all‐cause mortality and need for repeated TLE procedures. Secondary outcomes included fluoroscopy time, lead extraction techniques, success rates, and major and minor complications. Results were compared between female and male cohorts. Results: The study population comprised 191 patients (median age, 70 years), 29 (15.2%) being women and 162 men (84.8%). Study groups had similar baseline characteristics. Complete procedural success was achieved in 189 out of 191 patients (99.0%), with no significant difference observed between the two groups (p =.17). No major complications were reported in the total cohort. However, there was a significantly higher incidence of minor complications in women compared to men (17.2% vs. 2.5%, p <.01). Following a median follow‐up of 6.5 years, the incidence of the primary composite outcome occurred similarly between the study groups (log‐rank p =.68). Conclusion: Women who underwent TLE exhibited a significantly higher incidence of minor acute intra‐ and peri‐procedural complications than men. However, no differences in long‐term outcomes between genders were observed. [ABSTRACT FROM AUTHOR]

Introduction: In patients with cardiac sarcoidosis (CS), implantable cardioverter‐defibrillators (ICDs) are important for preventing sudden cardiac death. This study aimed to investigate sex disparities in CS patients undergoing ICD implantation. Methods: The 2016–2020 National Inpatient Sample (NIS) database compared the characteristics and outcomes of males and females with CS receiving ICDs. Results: Among 760 CS patients who underwent inpatient ICD implantation, 66.4% were male. Males were younger (55.0 vs. 56.9 years, p <.01), had higher rates of diabetes (31.7% vs. 21.6%, p <.01) and chronic kidney disease (CKD) (16.8% vs. 7.8%, p <.01) but lower prevalence of atrial fibrillation (AF) (11.9% vs. 23.5%, p <.01), sick sinus syndrome (4.0% vs. 7.8%, p =.024), ventricular fibrillation (VF) (9.9% vs. 15.7%, p =.02), and black ancestry (31.9% vs. 58.0%, p <.01). Unadjusted major adverse cardiovascular events (MACE), defined as a composite of in‐hospital death, myocardial infarction (MI), and ischemic stroke, was higher in females (11.8% vs. 6.9%, p =.024), but when adjusted for age and tCharlson Comorbidity Index (CCI), females demonstrated significantly lower odds of experiencing MACE (aOR: 0.048, 95% CI: 0.006–0.395, p =.005). Incidence of acute kidney injury (AKI) post‐ICD was significantly lower in females (15.7% vs. 23.8%, p =.01) as was the adjusted odds (aOR: 0.282, 95% CI: 0.146–0.546, p <.01). There was comparable mean length of stay and hospital charges. Conclusion: ICD utilization in CS patients is more common among males, who have a higher prevalence of diabetes and CKD but a lower prevalence of AF, sick sinus syndrome, and VF. Adjusted MACE and AKI were significantly lower in females. [ABSTRACT FROM AUTHOR]

Sex-based disparities have been demonstrated in care delivery for females with cardiogenic shock (CS), including lower use of coronary angiography (CAG), percutaneous intervention (PCI) and mechanical circulatory support (MCS). We evaluated whether sex-based disparities exist and are associated with worse CS outcomes in females. We studied a retrospective cohort of 1498 consecutive, unique adult cardiovascular intensive care unit (CICU) admissions with CS from 2007–2018. Compared to males, females (n = 566, 37.1%) were older (71.7 vs 67.8 years; P < 0.001) but had similar burdens of medical comorbidities. Acute myocardial infarction (AMI) was present in 54.1% of females and 59.1% of males (P = 0.06). There were no sex-based differences in the use of CAG and PCI, but females received temporary MCS less commonly. Specifically, females with non-AMI CS received MCS devices less commonly (17.6% vs 24.4%; P = 0.04). There was no difference in in-hospital or 1-year mortality rates between the sexes. Compared to males, females who received PCI had lower risks of 1-year mortality (unadjusted HR 0.72; P = 0.03), whereas females who received CAG without PCI had higher risks of 1-year mortality (unadjusted HR 1.41; P = 0.02). No sex-based disparities in mortality due to CS were demonstrated in this large, diverse cohort of patients with CICU admissions. Females who underwent PCI demonstrated lower risks of 1-year mortality, whereas females who underwent CAG without PCI demonstrated higher risks of 1-year mortality compared to males. This may reflect underuse of PCI as a mortality-reducing therapy in females. • Females with cardiogenic shock (n = 566/1499; 37.1%) were older but had comorbidities and etiologies similar to those of males. • Females and males received coronary angiography and PCI at similar rates, but females less often received temporary MCS. • In-hospital and 1-year mortality rates were similar in both sexes, both overall and according to the etiologies. • Among patients who received coronary angiography, females who received PCI had better outcomes, and females who did not receive PCI had worse outcomes. [Display omitted] [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is one of the most fatal cancers in the United States. Although the overall incidence and mortality rates are declining, an alarming rise in early-onset colorectal cancer (EOCRC), defined as CRC diagnosis in patients aged < 50 years, was previously reported. Our study focuses on analyzing sex-specific differences in survival among EOCRC patients and comparing sex-specific predictors of survival in both males and females in the United States. We retrieved and utilized data from the Surveillance, Epidemiology, and End Results (SEER) program. EOCRC patients, between the ages of 20 and 49, were exclusively included. We conducted thorough survival analyses using Kaplan–Meier curves, log-rank tests, Cox regression models, and propensity score matching to control for potential biases. Our study included 58,667 EOCRC patients (27,662 females, 31,005 males) diagnosed between 2000 and 2017. The baseline characteristics at the time of diagnosis were significantly heterogeneous between males and females. Males exhibited significantly worse overall survival (OS), cancer-specific survival (CSS), and noncancer-specific survival (NCSS) in comparison to females in both the general cohort, and the matched cohort. Predictors of survival outcomes generally followed a similar pattern in both sexes except for minor differences. In conclusion, we identified sex as an independent prognostic factor of EOCRC, suggesting disparities in survival between sexes. Further understanding of the epidemiological and genetic bases of these differences could facilitate targeted, personalized therapeutic approaches for EOCRC. [ABSTRACT FROM AUTHOR]

(1) Background: Few studies focus on the development of obesity as a chronic disease as opposed to an acute condition. The "general purpose" C3H/HeJ (C3H) mouse strain is an alternative model for obesity development with regards to sex disparities and non-predisposed populations over time. (2) Methods: In this study, 64 female and 64 male C3H mice were separated into two groups (n = 32) and maintained on a control or high-fat diet (HFD) for up to 18 months. At 6-month intervals, a cross-sectional cohort (n = ~8) was censored for evaluation. The mice were monitored for change in total, lean and fat mass, survivability, and tumor incidence. (3) Results: Both sexes in the C3H mouse strain developed diet-induced obesity (DIO). An increase in total mass consistent with a HF diet was observed in both female and male C3H mice. Survivorship at 18 months was the highest in the HF-diet-fed males (~62%) and lowest in the males fed the control diet (~19%). Females showed survivability at ~40%, regardless of diet. Cancer development increased more notably in the males with the HF diet and showed sex bias for liver cancer (males) and ovarian cancer (females) incidence with age. (4) Conclusions: This study establishes a baseline for future use of C3H mice as a strong model for studying obesity as a chronic disease, in both sexes, and as long-term model for age-related diet-induced obesity and cancer development. [ABSTRACT FROM AUTHOR]

Female patients frequently experience worse clinical outcomes than male patients after undergoing vascular surgery procedures. However, it is unclear whether these sex-based disparities also impact mental health outcomes. This study was designed to investigate sex differences in patient-reported outcome measures of depression for patients undergoing vascular surgery. We retrospectively analyzed 107 patients (73 males and 34 females) who underwent vascular surgery procedures between January 2016 and April 2023. These patients completed a Patient-Reported Outcome Measurement Information System (PROMIS) Item Bank v1.0-Depression assessment 90 d before surgery and at least once after surgery. After stratifying patients by sex, we analyzed changes in PROMIS depression scores using a multiple mixed-effects linear regression model. Then, logistic regression was used to compare the proportion of patients who achieved a clinically meaningful difference in PROMIS depression score within 15 mo after surgery. There was no significant difference between female and male patients among rates of complications, length of hospital stay, or rates of nonhome discharge. However, female sex was associated with significantly improved PROMIS depression scores after surgery compared to male sex (P = 0.034). Furthermore, female patients were over 3-fold more likely than male patients to reach the minimal clinically important difference threshold for improvement in PROMIS depression scores (odds ratio 4.66, 95% confidence interval 1.39-15.61). These results suggest that female sex is associated with improved patient-reported measures of depression after undergoing vascular surgery. Clinicians should consider these mental health benefits when evaluating female patients for vascular interventions. • Females more likely to achieve minimal clinically important difference in Patient-Reported Outcome Measurement Information System depression after vascular surgery. • No sex differences found in clinical outcomes after vascular surgery. • Mental health outcomes are important to evaluate following surgical procedures. [ABSTRACT FROM AUTHOR]

OBJECTIVES Degenerative mitral regurgitation is associated with heart failure, arrhythmia and mortality. The impact of sex on timing of surgical referral and outcomes has not been reported comprehensively. We examined preoperative status and surgical outcomes of male versus female degenerative mitral valve regurgitation patients undergoing surgery. METHODS We reviewed our institutional database for all patients undergoing surgery for degenerative mitral regurgitation between 2013 and 2021. Preoperative clinical and echocardiographic variables, surgical characteristics and outcomes were compared, and left atrial strain in available images. RESULTS Of 963 patients, 314 (32.6%) were female. Women were older (67 vs 64 years, P  = 0.031) and more often had bileaflet prolapse (19.4% vs 13.8%, P  = 0.028), mitral annular calcification (12.1% vs 5.4%, P  < 0.001) and tricuspid regurgitation (TR; 31.8% vs 22.5%, P  = 0.001). Indexed left ventricular end-diastolic and end-systolic diameters were higher in women, with 29.4 vs 26.7 mm/m2 (P  < 0.001) and 18.2 vs 17 mm/m2 (P  < 0.001), respectively, and left atrial conduit strain lower (17.6% vs, 21.2%, P  = 0.001). Predicted risk of mortality was 0.73% vs 0.54% in men (P  = 0.023). Women required mechanical circulatory support more frequently (1.3% vs 0%, P  = 0.011), had longer intensive care unit stay (29 vs 26 h, P  < 0.001), mechanical ventilation (5.4 vs 5 h, P  = 0.036), and overall hospitalization (7 vs 6 days, P  < 0.001). There was no difference in long-term reoperation-free survival (P  = 0.35). CONCLUSIONS Women undergoing mitral valve repair are older and show indicators of more advanced disease with long-standing left ventricular impairment. Guidelines may need to be adjusted and address this disparity, to improve postoperative recovery times and outcomes. [ABSTRACT FROM AUTHOR]

Objective: To examine case logs reported by general surgery residents and identify potential disparities in operative experience. Background: A recent study of 21 institutions noted significant differences between the number of cases reported during general surgery residency by trainees who are underrepresented in medicine (URiM) versus trainees who are not URiM (non-URiM). This study also identified differences between female residents and male residents. We partnered with the Accreditation Council for Graduate Medical Education to examine case logs reported from all accredited general surgery programs in the United States. This is the first time these data have been examined nationally. Methods: We examined total case logs submitted by graduating residents between 2017 and 2022. Group differences in mean reported case logs were examined using paired t tests for female versus male and URiM versus non-URiM overall case numbers. Results: A total of 6458 residents submitted case logs from 319 accredited programs. Eight-hundred fifty-four (13%) were URiM and 5604 (87%) were non-URiM. Over the 5-year study period, URM residents submitted 1096.95 (SD ± 160.57) major cases versus 1115.96 (±160.53) for non-URiM residents (difference = 19 cases, P = 0.001). Case logs were submitted by 3833 (60.1%) male residents and 2625 (39.9%) female residents over the 5-year study period. Male residents reported 1128.56 (SD ± 168.32) cases versus 1091.38 (±145.98) cases reported by females (difference = 37.18, P < 0.001). When looking at surgeon chief and teaching assistant cases, there was no significant difference noted between cases submitted by URiM versus non-URiM residents. However, male residents reported significantly more in both categories than their female peers (P < 0.001). Conclusions: Overall, URiM residents submitted fewer cases in the 5-year study period than their non-URiM peers. The gap in submitted cases between male and female residents was more pronounced, with male residents submitting significantly more cases than their female counterparts. This finding was consistent and statistically significant throughout the entire study period, in most case categories, and without narrowing of difference over time. A difference of 30 to 40 cases can amount to 1 to 3 months of surgical training and is a concerning national trend deserving the attention of every training program and our governing institutions. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and Aims The role of sex disparities in in‐hospital outcomes after percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in patients with a history of coronary artery bypass grafting (CABG) remains underexplored. This study aimed to identify sex disparities in in‐hospital outcomes after PCI in patients with AMI and a history of CABG. Methods Using the National Inpatient Sample database, we identified patients hospitalized for AMI with a history of CABG who underwent PCI between 2016 and 2019. 1:1 propensity score matching was used to minimize standardized mean differences of baseline variables and compare in‐­hospital outcomes. Results In total, 75,185 weighted hospitalizations of patients were identified. Compared with male patients, female patients exhibited elevated risks of in‐hospital mortality (3.72% vs. 2.85%; adjusted odds ratio [aOR] 1.48; 95% confidence interval [CI] 1.14–1.93), major adverse cardiac or cerebrovascular events (MACCEs) (4.96% vs. 3.75%; aOR 1.46; 95% CI 1.18–1.82), bleeding (4.91% vs. 3.01%; aOR 1.56; 95% CI 1.27–1.79), and longer length of stay (4.64 days vs. 3.96 days; β 0.42; 95% CI 0.28–0.55). After propensity matching, female patients remained associated with increased risks of in‐hospital mortality (3.81% vs. 2.81%; aOR 1.37; 95% CI 1.06–1.78), MACCEs (5.08% vs. 3.84%; aOR 1.35; 95% CI 1.08–1.70), bleeding (5.03% vs. 3.11%; aOR 1.57; 95% CI 1.24–2.00), and longer length of stay (4.61 ± 4.76 days vs. 4.06 ± 4.10 days; β 0.39; 95% CI 0.18–0.59). Female patients aged > 60 years were more vulnerable to in‐hospital mortality than were their male counterparts (3.06% vs. 4.15%; aOR 1.56; 95% CI 1.18–2.05). Conclusions Female patients who underwent PCI for AMI with a history of CABG had higher risks of in‐hospital mortality, MACCEs, bleeding, and longer length of stay, with in‐hospital mortality rates being particularly pronounced among older patients.

Purpose Cardiovascular disease (CVD) is one of the leading causes of death in women, largely underpinned by hypertension. Current guidelines recommend first-line therapy with a RAAS-blocking agent especially in young people. There are well documented sex disparities in CVD outcomes and management. We evaluate the management of patients with newly diagnosed hypertension in a tertiary care clinic to assess male–female differences in investigation and treatment.Methods Clinic letters of all new patients under the age of 51 attending the Glasgow Blood Pressure Clinic between January and December 2023 were reviewed. The primary outcomes measured were first-line treatment choices, deviations from guideline-recommended treatment, investigations for secondary hypertension, and documentation of female-specific risk factors and family planning advice. Secondary outcomes included clinical characteristics such as systolic and diastolic blood pressure at referral and at the new patient appointment, age at diagnosis, age at first appointment, and the number of antihypertensive drugs prescribed at referral.Results One hundred and five (59:46, M:F) new patient encounters were reviewed after sixteen exclusions for non-attendance and inappropriate clinic coding. Choice of first line antihypertensive agent did not vary between sexes with no deviation from guideline-recommended medical therapy. Men, however, had more biochemical investigations conducted for secondary causes across all ages. This was greatest in those under 40 years old. There was suboptimal documentation of female-specific risk factors (obstetric and gynaecological history), contraceptive drug history and family planning with 35%, 20%, and 15.6%, respectively.Conclusion In 2023, women under 51 years of age seen in a tertiary care hypertension clinic received similar first-line treatment to their male peers. However, relevant female-specific histories were suboptimally documented for these patients. Whilst therapeutic approaches in men and women appear to be similar in this clinic, there are opportunities to improve CVD prevention in women, even in a specialised clinic setting.

Purpose: Cardiovascular disease (CVD) is one of the leading causes of death in women, largely underpinned by hypertension. Current guidelines recommend first-line therapy with a RAAS-blocking agent especially in young people. There are well documented sex disparities in CVD outcomes and management. We evaluate the management of patients with newly diagnosed hypertension in a tertiary care clinic to assess male–female differences in investigation and treatment. Methods: Clinic letters of all new patients under the age of 51 attending the Glasgow Blood Pressure Clinic between January and December 2023 were reviewed. The primary outcomes measured were first-line treatment choices, deviations from guideline-recommended treatment, investigations for secondary hypertension, and documentation of female-specific risk factors and family planning advice. Secondary outcomes included clinical characteristics such as systolic and diastolic blood pressure at referral and at the new patient appointment, age at diagnosis, age at first appointment, and the number of antihypertensive drugs prescribed at referral. Results: One hundred and five (59:46, M:F) new patient encounters were reviewed after sixteen exclusions for non-attendance and inappropriate clinic coding. Choice of first line antihypertensive agent did not vary between sexes with no deviation from guideline-recommended medical therapy. Men, however, had more biochemical investigations conducted for secondary causes across all ages. This was greatest in those under 40 years old. There was suboptimal documentation of female-specific risk factors (obstetric and gynaecological history), contraceptive drug history and family planning with 35%, 20%, and 15.6%, respectively. Conclusion: In 2023, women under 51 years of age seen in a tertiary care hypertension clinic received similar first-line treatment to their male peers. However, relevant female-specific histories were suboptimally documented for these patients. Whilst therapeutic approaches in men and women appear to be similar in this clinic, there are opportunities to improve CVD prevention in women, even in a specialised clinic setting. PLAIN LANGUAGE SUMMARY: Hypertension, or persistent high blood pressure, is a condition that can lead to serious cardiovascular diseases such as stroke and heart failure. Evidence has shown that women have cardiovascular disease more than men and it is the leading cause of death in women in Europe. To understand how male and female patients are treated for hypertension, we examined documented consultations and treatments of 105 patients under the age of 51 (46 women and 59 men) at a Glasgow hypertension clinic in 2023. We found that men had more investigations for specific causes of their hypertension across all ages (men = 88%, women = 61%). Recording of reproductive history (35%), contraceptive drug history (20%) and advice on family planning (15.6%) was not as thorough as they could be. Incorrect management of female reproductive history and contraceptive drug history can increase the risk of long-term hypertension complications, so managing this is crucial. A class of drugs commonly used to manage hypertension called RAAS blockers are dangerous to the foetus when pregnant - another factor to consider when managing young women with high blood pressure. Overall, these findings mean that there may be a need for more thorough consideration of women's health factors in hypertension treatment. By paying attention to these areas, we can enhance long-term cardiovascular health for women. [ABSTRACT FROM AUTHOR]

(1) Background: Previous studies have identified disparities in stroke care and outcomes by sex. Therefore, the main objective of this study was to evaluate the average cost of stroke care and the existence of differences in care provision by biological sex. (2) Methods: This observational study adhered to the recommendations of the STROBE statement. The calculation of costs was performed based on the production cost of the service or the rate paid for a set of services, depending on the availability of the corresponding information. (3) Results: A total of 336 patients were included, of which 47.9% were women, with a mean age of 73.3 ± 11.6 years. Women were typically older, had a higher prevalence of hypertension (p = 0.005), lower pre-stroke proportion of mRS 0-2 (p = 0.014), greater stroke severity (p < 0.001), and longer hospital stays (p = 0.017), and more were referred to residential services (p = 0.001) at 90 days. Women also required higher healthcare costs related to cardiovascular risk factors, transient ischemic strokes, institutionalization, and support needs; in contrast, they necessitated lower healthcare costs when undergoing endovascular therapy and receiving rehabilitation services. The unadjusted averaged cost of stroke care was EUR 22,605.66 (CI95% 20,442.8–24,768.4), being higher in women [p = 0.027]. The primary cost concept was hospital treatment (38.8%), followed by the costs associated with dependence and support needs (36.3%). At one year post-stroke, the percentage of women not evaluated for a degree of dependency was lower (p = 0.008). (4) Conclusions: The total unadjusted costs averaged EUR 22,605.66 (CI95% EUR 20,442.8–24,768.4), being higher in women compared to men. The primary cost concept was hospital treatment (38.8%), followed by the costs associated with dependence and support needs (36.3%). [ABSTRACT FROM AUTHOR]

There is limited real-world data highlighting recent temporal in-hospital morbidity and mortality trends for cases of acute myocardial infarction complicated by cardiogenic shock. The role of mechanical circulatory support within this patient population remains unclear. The US National Inpatient Sample database was sampled from 2011 to 2018 identifying 206,396 hospitalizations with a primary admission diagnosis of ST- or Non-ST elevation myocardial infarction complicated by cardiogenic shock. The primary outcomes included trends of all-cause in-hospital mortality, mechanical circulatory support use, and sex-specific trends for acute myocardial infarction complicated by cardiogenic shock (AMI-CS) over the study period. The annual number of AMI-CS hospitalizations increased from 22,851 in 2011 to 30,015 in 2018 and in-hospital mortality trends remained similar (42.9 % to 43.7 %, ptrend < 0.001). The proportion of patients receiving any temporary MCS device decreased (46.4 % to 44.4 %). The use of intra-aortic balloon pump (IABP) decreased (44.9 % to 32.9 %) and the use of any other non-IABP MCS device increased (2.5 % to 15.6 %), ptrend<0.001. Sex-specific mortality indicate female in-hospital mortality remained similar (50.3 % to 51 %, ptrend<0.001), but higher than male in-hospital mortality, which increased non-significantly (38.8 % to 40.2 %, ptrend = 0.372). From 2011 to 2018, hospitalizations for AMI-CS patients have increased in number. However, there has been no recent appreciable change in AMI-CS mortality despite a changing treatment landscape with decreasing use of IABPs and increasing use of non-IABP MCS devices. Further research is necessary to examine the appropriate use of MCS devices within this population. • AMI complicated by cardiogenic shock (AMI-CS) is a highly morbid condition. • The number of AMI-CS cases has increased from 22,851 in 2011 to 30,015 in 2018 and mortality has remained unchanged at 40–45%. • Intra-aortic balloon pump use in AMI-CS patients is decreasing (44.9% to 32.9%, p-value<0.001). • Use of other temporary mechanical circulatory devices is increasing (2.5% to 15.6%, p-value<0.001). • Mortality of female AMI-CS patients is consistently nearly 10 % higher than males. [ABSTRACT FROM AUTHOR]

Background Cardiovascular health (CVH) in young adulthood is associated with CVD in later life, yet CVH in young adults in the United States falls below ideal levels, with noticeable sex differences. Research on CVH in young adults in Puerto Rico is scarce. This study examined CVH and sex differences in CVH in a large cohort of young adults in Puerto Rico. Methods and Results Data from 2162 Puerto Rican young adults aged 18 to 29 residing in PR were obtained from the PR‐OUTLOOK (Puerto Rico Young Adults' Stress, Contextual, Behavioral, and Cardiometabolic Risk) study (2020–2023). Participants were recruited through various media and community outreach. CVH scores, graded on a 0 (worst) to 100 (best) scale, were derived from survey responses, physical exams, and laboratory assays. Linear regression with the margins postestimation command was used to determine adjusted means (95% CIs) for CVH scores by sex, controlling for age, marital status, education, childhood material deprivation, subjective social status, health insurance, and depressive symptoms. CVH was less than ideal (score

Background Previous work has demonstrated disparities in the management of cardiovascular disease among men and women. We sought to evaluate these disparities and their associations with clinical outcomes among patients admitted with acute coronary syndromes to the Veterans Affairs Healthcare System. Methods and Results We identified all patients that were discharged with acute coronary syndromes within the Veterans Affairs Healthcare System from October 1, 2015 to September 30, 2022. Medical and procedural management of patients was subsequently assessed, stratified by sex. In doing so, we identified 76 454 unique admissions (2327 women, 3.04%), which after propensity matching created an analytic cohort composed of 6765 men (74.5%) and 2295 women (25.3%). Women admitted with acute coronary syndromes were younger with fewer cardiovascular comorbidities and a lower prevalence of preexisting prescriptions for cardiovascular medications. Women also had less coronary anatomic complexity compared with men (5 versus 8, standardized mean difference [SMD]=0.40), as calculated by the Veterans Affairs SYNTAX score. After discharge, women were significantly less likely to receive cardiology follow‐up at 30 days (hazard ratio [HR], 0.858 [95% CI, 0.794–0.928]) or 1 year (HR, 0.891 [95% CI, 0.842–0.943]), or receive prescriptions for guideline‐indicated cardiovascular medications. Despite this, 1‐year mortality rates were lower for women compared with men (HR, 0.841 [95% CI, 0.747–0.948]). Conclusions Women are less likely to receive appropriate cardiovascular follow‐up and medication prescriptions after hospitalization for acute coronary syndromes. Despite these differences, the clinical outcomes for women remain comparable. These data suggest an opportunity to improve the posthospitalization management of cardiovascular disease regardless of sex.

Introduction Despite the existence of numerous studies highlighting the adverse effects of smoking on kidney function, the investigation of the correlation between serum cotinine and chronic kidney disease (CKD) remains inconclusive due to insufficient evidence. Consequently, the primary objective of this study was to ascertain the association between serum cotinine levels and CKD. Methods This study analyzed data from 10900 Americans participating in the National Health and Nutrition Examination Survey between 2005 and 2016. The independent variable under investigation was log serum cotinine, while the dependent variable was the presence of CKD. To investigate the potential linear and non-linear correlations between serum cotinine and CKD, logistic regression models and generalized additive models (GAM) were employed. Furthermore, stratified analyses and interaction tests were conducted to evaluate potential disparities in the relationship between serum cotinine and CKD, based on sex. Results The median age in the study participants was 49.28 ± 17.96 years, and the median log serum cotinine (ng/mL) was -0.54 ± 1.68. The prevalence of CKD was found to be 17.04%. Multifactorial regression analysis did not show a statistically significant association between log serum cotinine and CKD (OR=1.02; 95% CI: 0.98–1.06, p=0.4387). A statistically significant non-linear association between log serum cotinine and CKD was also not observed in the GAM analysis (p nonlinear value=0.091). Subgroup analyses revealed sex differences in the association between log serum cotinine and CKD. Briefly, males had a positive association between log serum cotinine and incident CKD (OR=1.08; 95% CI: 1.02–1.15, p=0.0049). In females, there was a U-shaped association between log serum cotinine and CKD, with an optimal inflection point for log serum cotinine of -0.30 (serum cotinine=0.5 ng/mL). Conclusions Cross-sectional analyses of NHANES data showed gender differences in the association between serum cotinine and the development of CKD.

Abstract Background There is an ongoing debate on whether sex affects immune-suppressive tumor microenvironment and immunotherapy. Here, we explored the underlying molecular bases for sex dimorphisms and their impact on the efficacy of immunotherapy in esophageal cancer (EC). Methods 2360 EC patients from phase 3 trials were pooled to compare overall survivals by calculating hazard ratios (HRs) and their 95% confidence intervals (CIs). Genomic data of 1425 samples were integrated to depict the genomic landscapes and antigenic features. We also examined the sex disparities based on single-cell RNA sequencing and T cell receptor-sequencing data from 105,145 immune cells in 60 patients. Results Immunotherapy was associated with favorable outcomes in men (HR, 0.71; 95% CI, 0.65–0.79; P

Background: We sought to investigate the differential impact of EVAR (endovascular aneurysm repair) vis-à-vis OSR (open surgical repair) on ruptured AAA (abdominal aortic aneurysm) mortality by sex and geographically. Methods: We performed a retrospective study of administrative data on EVAR from state statistical agencies, vascular registries, and academic publications, as well as ruptured AAA mortality rates from the World Health Organization for 14 14 states across Australasia, East Asia, Europe, and North America. Results: Between 2011–2016, the proportion of treatment of ruptured AAAs by EVAR increased from 26.1 to 43.8 percent among females, and from 25.7 to 41.2 percent among males, and age-adjusted ruptured AAA mortality rates fell from 12.62 to 9.50 per million among females, and from 34.14 to 26.54 per million among males. The association of EVAR with reduced mortality was more than three times larger (2.2 vis-à-vis 0.6 percent of prevalence per 10 percentage point increase in EVAR) among females than males. The association of EVAR with reduced mortality was substantially larger (1.7 vis-à-vis 1.1 percent of prevalence per 10 percentage point increase in EVAR) among East Asian states than European+ states. Conclusions: The increasing adoption of EVAR coincided with a decrease in ruptured AAA mortality. The relationship between EVAR and mortality was more pronounced among females than males, and in East Asian than European+ states. Sex and ethnic heterogeneity should be further investigated. [ABSTRACT FROM AUTHOR]

Transition to dolutegravir among 21 167 individuals experienced in antiretroviral therapy in West Africa showed heterogeneous timelines and patterns. Initially reported sex disparities tended to catch up over time with persisting disparities, according to contributing HIV clinics. Key factors facilitating dolutegravir switch were male sex, age <50 years, viral suppression, and regimens not based on protease inhibitors. [ABSTRACT FROM AUTHOR]

Background: Heart failure–related cardiogenic shock (HF-CS) accounts for a significant proportion of all CS cases. Nevertheless, there is a lack of evidence on sex-related differences in HF-CS, especially regarding use of treatment and mortality risk in women vs. men. This study aimed to investigate potential differences in clinical presentation, use of treatments, and mortality between women and men with HF-CS. Methods: In this international observational study, patients with HF-CS (without acute myocardial infarction) from 16 tertiary-care centers in five countries were enrolled between 2010 and 2021. Logistic and Cox regression models were used to assess differences in clinical presentation, use of treatments, and 30-day mortality in women vs. men with HF-CS. Results: N = 1030 patients with HF-CS were analyzed, of whom 290 (28.2%) were women. Compared to men, women were more likely to be older, less likely to have a known history of heart failure or cardiovascular risk factors, and lower rates of highly depressed left ventricular ejection fraction and renal dysfunction. Nevertheless, CS severity as well as use of treatments were comparable, and female sex was not independently associated with 30-day mortality (53.0% vs. 50.8%; adjusted HR 0.94, 95% CI 0.75–1.19). Conclusions: In this large HF-CS registry, sex disparities in risk factors and clinical presentation were observed. Despite these differences, the use of treatments was comparable, and both sexes exhibited similarly high mortality rates. Further research is necessary to evaluate if sex-tailored treatment, accounting for the differences in cardiovascular risk factors and clinical presentation, might improve outcomes in HF-CS. Sex-related differences in clinical characteristics, shock severity, and mortality in patients with heart failure–related cardiogenic shock. Summary for the main study findings. AMI, acute myocardial infarction; CI, confidence interval; HF-CS, heart failure–related cardiogenic shock; LVEF, left ventricular ejection fraction; MCS, mechanical circulatory support; SCAI, Society for Cardiovascular Angiography & Interventions. [ABSTRACT FROM AUTHOR]

Sex differences in clinical outcomes following acute myocardial infarction (AMI) are well known. However, data on sex differences among patients with familial hypercholesterolemia (FH) are limited. We aimed to explore sex differences in outcomes of AMI among patients with FH from a national administrative dataset. We utilized the National Inpatient Sample to identify admissions with a primary diagnosis of AMI and a secondary diagnosis of FH. Our primary outcome of interest was in-hospital mortality; secondary outcomes were performance of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), respiratory complications, use of inotropes, use of mechanical circulatory support (MCS), bleeding complications, transfusion and facility discharge. We adjusted for demographics (model A), comorbidities (model B), and intervention (model C). Between October 2016 and December 2020, 5,714,993 admissions with a primary diagnosis of AMI were identified, of which 3,035 (0.05%) had a secondary diagnosis of FH. In-hospital mortality did not differ between men and women (Model C, adjusted OR = 0.85; 95% CI 0.28–2.60, p = 0.773). There was no sex difference in the secondary outcomes. Despite generally being older and having more comorbidities, women with FH fair equally with men with FH in terms of mortality during AMI admission. [ABSTRACT FROM AUTHOR]

Background: There is an ongoing debate on whether sex affects immune-suppressive tumor microenvironment and immunotherapy. Here, we explored the underlying molecular bases for sex dimorphisms and their impact on the efficacy of immunotherapy in esophageal cancer (EC). Methods: 2360 EC patients from phase 3 trials were pooled to compare overall survivals by calculating hazard ratios (HRs) and their 95% confidence intervals (CIs). Genomic data of 1425 samples were integrated to depict the genomic landscapes and antigenic features. We also examined the sex disparities based on single-cell RNA sequencing and T cell receptor-sequencing data from 105,145 immune cells in 60 patients. Results: Immunotherapy was associated with favorable outcomes in men (HR, 0.71; 95% CI, 0.65–0.79; P < 0.001), but not in women (HR, 0.98; 95% CI, 0.78–1.23; P = 0.84) (Pinteraction =0.02). The frequencies of 8 gene mutations, 12 single base substitutions signatures, and 131 reactome pathways were significantly different between male and female. Additionally, six subtypes of HLA-II antigens were enriched in women. Hence, we constructed and then validated a sex-related signature to better predict the outcomes of immunotherapy. Exhausted CD8+ T cells were highly infiltrated in men, while naïve CD8+ T cells were more common in women. Further examinations on multiple malignancies suggested exhausted CD8+ T cells were enriched in patients who responded to immunotherapy. Conclusions: Our study delineated the robust genomic and cellular sex disparities in EC. Furthermore, male, rather than female, derived significantly benefits from immunotherapy. These results have implications for treatment decision-making and developing immunotherapy for personalized care. Plain English Summary: In the past several years, immunotherapy has gradually replaced the traditional chemotherapy as the standard treatment in esophageal cancer. It is well-established that immunological responses in male and female differ significantly. However, there is an ongoing debate on whether sex can impact the treatment outcomes in immunotherapy. In the present study, we systematically characterized the genomic and cellular landscapes of esophageal cancer, and revealed the significant differences between male and female patients. Furthermore, with over 2000 patients with esophageal cancer, we showed that only men can benefit from immunotherapy. In women, immunotherapy failed to show superior over chemotherapy. These results have implications for treatment decision-making and developing next-generation immunotherapy for personalized care. Highlights: • In esophageal cancer (EC), immunotherapy was associated with favorable outcomes in men, but not in women. • The frequencies of 8 mutant genes, 12 SBS, and 131 reactome pathways were significantly different between male and female. • We developed a sex-related signature to predict the outcomes of EC immunotherapy. • Exhausted CD8+ T cells were highly infiltrated in male EC patients, while naïve CD8+ T cells were more common in female patients. [ABSTRACT FROM AUTHOR]

Although disparities in mental health occur within racially, ethnically, and sex-diverse civilian populations, it is unclear whether these disparities persist within US military populations. Using cross-sectional data from the Millennium Cohort Study (2014–2016; n  = 103,184; 70.3% male; 75.7% non-Hispanic White), a series of logistic regression analyses were conducted to examine whether racial, ethnic, and/or sex disparities were found in mental health outcomes (posttraumatic stress disorder (PTSD), depression, anxiety, and problematic anger), hierarchically adjusting for sociodemographic, military, health-related, and social support factors. Compared with non-Hispanic White individuals, those who identified as American Indian/Alaska Native, non-Hispanic Black, Hispanic/Latino, or multiracial showed greater risk of PTSD, depression, anxiety, and problematic anger in unadjusted models. Racial and ethnic disparities in mental health were partially explained by health-related and social support factors. Women showed greater risk of depression and anxiety and lower risk of PTSD than men. Evidence of intersectionality emerged for problematic anger among Hispanic/Latino and Asian or Pacific Islander women. Overall, racial, ethnic, and sex disparities in mental health persisted among service members and veterans. Future research and interventions are recommended to reduce these disparities and improve the health and well-being of diverse service members and veterans. [ABSTRACT FROM AUTHOR]

Background Women are known to be disadvantaged compared with men in the early links of the Chain of Survival, receiving fewer bystander interventions. We aimed to describe sex‐based disparities in emergency medical service resuscitation quality and processes of care for out‐of‐hospital cardiac arrest. Methods and Results We conducted a retrospective analysis of patients who were nontraumatic with out‐of‐hospital cardiac arrest aged ≥16 years where resuscitation was attempted between March 2019 and June 2023. We investigated 18 routinely captured performance metrics and performed adjusted logistic and quantile regression analyses to assess sex‐based differences in these metrics. During the study period, 10 161 patients with out‐of‐hospital cardiac arrest met the eligibility criteria, of whom 3216 (32%) were women. There were no clinically relevant sex‐based differences observed in regard to external cardiac compressions; however, women were 34% less likely to achieve a systolic blood pressure >100 mm Hg on arrival at the hospital (adjusted odds ratio [AOR], 0.66 [95% CI, 0.47–0.92]). Furthermore, women had a longer time to 12‐lead ECG acquisition after return of spontaneous circulation (median adjusted difference, 1.00 minute [95% CI, 0.38–1.62]) and 33% reduced odds of being transported to a 24‐hour percutaneous coronary intervention‐capable facility (AOR, 0.67 [95% CI, 0.49–0.91]). Resuscitation was also terminated sooner for women compared with men (median adjusted difference, −4.82 minutes [95% CI, −6.77 to −2.87]). Conclusions Although external cardiac compression quality did not vary by sex, significant sex‐based disparities were seen in emergency medical services processes of care following out‐of‐hospital cardiac arrest. Further investigation is required to elucidate the underlying causes of these differences and examine their influence on patient outcomes.

Abstract Background Globally, the burden of disease is shifting towards non-communicable diseases (NCDs), including diabetes. Sub-Saharan Africa (SSA) faces an increasing prevalence of diabetes, hindering the achievement of global health goals. This study investigates the determinants of non-use of diabetes medication, specifically exploring potential sex differences in four SSA countries. Methods This cross-sectional study analyzed recent Demographic and Health Survey (DHS) data (2017–2021) from four SSA countries (Benin, Cameroon, Madagascar, and Mauritania). Samples included 23,695 women and 25,339 men, focusing on individuals with diabetes not using medication (248 women, 162 men). Descriptive and inferential analyses, including chi-square tests and binary logistic regression models, were conducted using Stata version 14. Odds ratios were calculated with a 95% confidence interval to determine the associations. Results This study found that a larger proportion of female patients with diabetes (64.1%) were not using diabetes medication compared to their male counterparts (59.4%). Age influenced medication non-use in males, with older individuals exhibiting lower odds of non-usage. Higher wealth status was associated with lower odds of non-use of diabetes medications. The presence of heart disease was associated with a lower likelihood of medication non-use among females. Conclusions This study demonstrates sex disparities, age differences, wealth status, heart disease, and country-specific variations in medication non-use. Tailored interventions for different age groups, as well as socioeconomic support, are critical, as is integrated cardiovascular and diabetes care. These actions can improve medication use and adherence, quality of life, and long-term diabetes management outcomes.

IntroductionDespite ongoing efforts to minimize sex bias in diagnosis and treatment of acute coronary syndrome (ACS), data still shows outcomes differences between sexes including higher risk of all-cause mortality rate among females. Hence, the aim of the current study was to examine sex differences in ACS in-hospital mortality, and to implement artificial intelligence (AI) models for prediction of in-hospital mortality among females with ACS.MethodsAll ACS patients admitted to a tertiary care center intensive cardiac care unit (ICCU) between July 2019 and July 2023 were prospectively enrolled. The primary outcome was in-hospital mortality. Three prediction algorithms, including gradient boosting classifier (GBC) random forest classifier (RFC), and logistic regression (LR) were used to develop and validate prediction models for in-hospital mortality among females with ACS, using only available features at presentation.ResultsA total of 2,346 ACS patients with a median age of 64 (IQR: 56–74) were included. Of them, 453 (19.3%) were female. Female patients had higher prevalence of NSTEMI (49.2% vs. 39.8%, p