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The Association between Gender and Mortality among Trauma Patients as Modified by Age

George, Richard L. MD; McGwin, Gerald Jr., MS, PhD; Metzger, Jesse MSPH; Chaudry, Irshad H. PhD; Rue, Loring W. III, MD, FACS

Journal of Trauma and Acute Care Surgery: March 2003 - Volume 54 - Issue 3 - p 464-471
doi: 10.1097/01.TA.0000051939.95039.E6
Original Articles

Background  Several studies have reported a null association between gender and mortality after traumatic injury, whereas others found an age-specific association between male gender and increased mortality. Relatively small sample sizes may have contributed to the heterogeneity among existing studies; therefore, a large-sample-size study was undertaken.

Methods  The National Trauma Data Bank was queried, yielding data for over 150,000 patients involved in blunt or penetrating trauma. Crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for the association between gender and mortality, both overall and according to mechanism of injury and age categories.

Results  Among those who sustained blunt trauma, male patients had a significant increase in the risk of death compared with female patients (OR, 1.49; 95% CI, 1.39–1.59) that was most apparent for those ≥ 50 years of age (OR, 1.97; 95% CI, 1.84–2.11). For penetrating trauma patients, essentially no significant association, either overall (OR, 1.03; 95% CI, 0.91–1.17) or by age category, was apparent.

Conclusion  This study found an association between gender and mortality among blunt trauma patients, particularly those aged ≥ 50 years. Animal studies demonstrate that the sex hormones influence the inflammatory response to injury. These results may highlight the importance of sex hormones in traumatic injury outcomes.

From the Section of Trauma, Burns, and Surgical Critical Care, Division of General Surgery (R.L.G., G.M., L.W.R.), Department of Surgery (R.L.G., G.M., L.W.R., I.H.C.), School of Medicine, Center for Injury Sciences (R.L.G., G.G., J.M., I.H.C., L.W.R), Center for Surgical Research (R.L.G., I.H.C., L.W.R.), and Department of Epidemiology and International Health, School of Public Health (G.G.), University of Alabama at Birmingham, Birmingham, Alabama.

Submitted for publication October 13, 2002.

Accepted for publication November 24, 2002.

Supported, in part, by United States Department of Transportation, Federal Highway Administration grant DTFH61-99-X-00039 and National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases grant 5-T32-AR07450.

Presented at the 61st Annual Meeting of the American Association for the Surgery of Trauma, September 26–28, 2002, Orlando, Florida.

Address for reprints: Gerald McGwin, Jr., MS, PhD, Center for Injury Sciences, 120 Kracke Building, 1922 7th Avenue South, University of Alabama at Birmingham, Birmingham, AL 35294-0016; email:

© 2003 Lippincott Williams & Wilkins, Inc.