Sex differences in outcomes among patients hospitalized with pulmonary embolism: insights from National Inpatient Sample 2002-2020

Abstract Background Pulmonary embolism is one of the leading causes of cardiovascular mortality and morbidity. It is estimated that it contributes to 100,000 death per year. Gender disparities in cardiovascular diseases have been described before with some conflicting results regarding gender disparities in outcomes of pulmonary embolism. We sought to evaluate sex differences in the baseline characteristics and in-hospital outcomes among patients hospitalized for pulmonary embolism. Methods Data were extracted from the National Inpatient Sample database. International Classification of Diseases, 9th and 10th Revision codes were used to identify patients with PE during the years 2002–2020. Patients were stratified based gender into 2 groups. Results A total of 1192030 patients with PE were identified, of whom 564666 (47.4%) were males. Males are more likely to be younger with mean age (61.7 ± 16.3 years vs 63.7 ± 18.1 years, p<0.001) compared to females. Baseline comorbidities such as diabetes mellitus (3.9% vs 3.8%, p<0.001), coronary artery disease (CAD) (20.1% vs. 13.1%, p< 0.001), atrial fibrillation (15.5 vs 13.3%, p<0.001), chronic kidney disease (12.5% vs 10.5%, p<0.001) and pulmonary hypertension (39.5% vs 38.4%, p<0.001) were more prevalent in males while hypertension (54.9% vs 53.7%, p<0.001) and heart failure (18.6% vs 18.5%, p<0.46) were more prevalent in females. Mean length of stay was higher among males compared to females (8.1 ± 10.6 days vs 7.7 ± 9.5 days, P=0.001). With regard outcomes, the likelihood of cardiogenic shock (1.3% vs 1.1%, p<0.001), use of vasopressors (1.2% vs 1%, P<0.001), and use of mechanical ventilation (MV) (10.1% vs 8.1%, p<0.001), were higher among males compared to females, moreover mortality was higher among males (7.4% vs 7%, P<0.001). Utilization of pharmacologic and interventional therapies was more prevalent among males including systemic thrombolytics (2.2% vs 2%, P<0.001), catheter directed thrombolytics (0.5% vs 0.4%, P<0.001), and embolectomy (0.2% vs 0.2%, P<0.001) compared to females. Adjusted hospitalization cost was higher among males ($21493.9 ± 38795.7 vs $18658.1 ± 31667.7, p<0.001) compared to females. Conclusion We report higher rates of cardiogenic shock, use of vasopressors and mechanical ventilation among males compared to females leading to higher utilization of pharmacologic and interventional therapies. We additionally report higher mortality among males. Further clinical investigations are warranted to explore the risk among males.