Sex differences in limitations of life-sustaining treatment in the intensive care unit: A nationwide cohort study.
4 affiliations
- 1Department of Physiology and Pharmacology, Karolinska Institutet, Solna, Sweden.
- 2Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
- 3Department of Anaesthesia and Intensive Care Medicine, and Department of Biomedical and Clinical Sciences, Vrinnevi Hospital, Norrköping, Sweden.
- 4Department of Cardiothoracic and Vascular Surgery and Anaesthesia, and Department of Medical and Health Sciences Linköping University Hospital, Linköping, Sweden.
Abstract
Previous research suggests that limitations of life-sustaining treatment (LST) may be more common in women than men, but few studies have included data on clinical reasoning or limitation type. This study aimed to investigate sex differences in LST-limitations in the ICU and in their documented characteristics. All adult (≥18 years) ICU patients registered in the Swedish Intensive Care Register between 2019 and 2024 were included. A multivariable logistic regression model, adjusted for SAPS3 and age, analysed the association between sex and LST-limitations. Limitation characteristics were compared using Chi-square test (categorical variables) and Wilcoxon rank-sum test (numeric variables). The cohort included 111,354 patients; 41.7% women. LST-limitations occurred in 24.4% of patients and were more frequent in women than in men (25.3% vs. 23.8%, p < 0.0001). In adjusted analyses women had higher odds of receiving an LST-limitation than men, both in the full cohort (OR 1.21, 95% CI 1.17-1.25) and among 30-day non-survivors (OR 1.24, 95% CI 1.18-1.32). Women received LST-limitations earlier than men (2.8 h after admission vs 4.5 h, p < 0.0001). Acute disease and therapy failure were more often documented reasons in men than in women (78.8% vs 74.3%, p < 0.0001; 21.2% vs. 18.6%, p = 0.0001), whereas autonomy and chronic disease were more frequent in women (7.8% vs 5.9%, p < 0.0001; 63.2% vs. 60.7%, p = 0.0021). Women were more often involved in decision-making (13.3% vs 11.8%, p = 0.0074). Women were more likely to receive LST-limitations and received them earlier. Men who died within 30 days were less likely to have had an LST-limitation than women. Documented reasons for LST-limitations differed by sex, and women had higher rates of documented patient involvement.
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BibTeX
@article{hagglof2026differences,
title = {{Sex differences in limitations of life-sustaining treatment in the intensive care unit: A nationwide cohort study.}},
author = {Elsa Hägglöf and Jesper Eriksson and Max Bell and Linn Hallqvist and Lars Engerström and Emma Larsson},
journal = {Annals of intensive care},
year = {2026},
month = oct,
doi = {10.1016/j.aicoj.2026.100190},
url = {https://europepmc.org/article/MED/42997026},
note = {CC BY},
}
RIS
TY - JOUR
TI - Sex differences in limitations of life-sustaining treatment in the intensive care unit: A nationwide cohort study.
AU - Elsa Hägglöf
AU - Jesper Eriksson
AU - Max Bell
AU - Linn Hallqvist
AU - Lars Engerström
AU - Emma Larsson
PY - 2026
DA - 2026/10/17
JO - Annals of intensive care
DO - 10.1016/j.aicoj.2026.100190
UR - https://europepmc.org/article/MED/42997026
AB - Previous research suggests that limitations of life-sustaining treatment (LST) may be more common in women than men, but few studies have included data on clinical reasoning or limitation type. This study aimed to investigate sex differences in LST-limitations in the ICU and in their documented characteristics. All adult (≥18 years) ICU patients registered in the Swedish Intensive Care Register between 2019 and 2024 were included. A multivariable logistic regression model, adjusted for SAPS3 and age, analysed the association between sex and LST-limitations. Limitation characteristics were compared using Chi-square test (categorical variables) and Wilcoxon rank-sum test (numeric variables). The cohort included 111,354 patients; 41.7% women. LST-limitations occurred in 24.4% of patients and were more frequent in women than in men (25.3% vs. 23.8%, p < 0.0001). In adjusted analyses women had higher odds of receiving an LST-limitation than men, both in the full cohort (OR 1.21, 95% CI 1.17-1.25) and among 30-day non-survivors (OR 1.24, 95% CI 1.18-1.32). Women received LST-limitations earlier than men (2.8 h after admission vs 4.5 h, p < 0.0001). Acute disease and therapy failure were more often documented reasons in men than in women (78.8% vs 74.3%, p < 0.0001; 21.2% vs. 18.6%, p = 0.0001), whereas autonomy and chronic disease were more frequent in women (7.8% vs 5.9%, p < 0.0001; 63.2% vs. 60.7%, p = 0.0021). Women were more often involved in decision-making (13.3% vs 11.8%, p = 0.0074). Women were more likely to receive LST-limitations and received them earlier. Men who died within 30 days were less likely to have had an LST-limitation than women. Documented reasons for LST-limitations differed by sex, and women had higher rates of documented patient involvement.
SN - 2110-5820
ER -