• J. Am. Coll. Surg. · Jun 2012

    Comparative Study

    Racial disparities and sex-based outcomes differences after severe injury.

    • Jason L Sperry, Yoram Vodovotz, Robert E Ferrell, Rami Namas, Yi-Min Chai, Qi-Ming Feng, Wei-Ping Jia, Raquel M Forsythe, Andrew B Peitzman, and Timothy R Billiar.
    • Division of General Surgery andTrauma, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. sperryjl@upmc.edu
    • J. Am. Coll. Surg. 2012 Jun 1; 214 (6): 973-80.

    BackgroundControversy exists about the mechanisms responsible for sex-based outcomes differences post-injury. X-chromosome-linked immune response pathway polymorphisms represent a potential mechanism resulting in sex-based outcomes differences post-injury. The prevalence of these variants is known to differ across race. We sought to characterize racial differences and the strength of any sex-based dimorphism post-injury.Study DesignA retrospective analysis was performed using data derived from the National Trauma Data Bank 7.1 (2002-2006). Blunt-injured adult (older than 15 years) patients, surviving >24 hours and with an Injury Severity Score >16 were analyzed (n = 244,371). Patients were stratified by race (Caucasian, black, Hispanic, Asian) and multivariable regression analysis was used to characterize the risk of mortality and the strength of protection associated with sex (female vs male).ResultsWhen stratified by race, multivariable models demonstrated Caucasian females had an 8.5% lower adjusted risk of mortality (odds ratio [OR] = 0.91; 95% CI, 0.88-0.95; p < 0.001) relative to Caucasian males, with no significant association found for Hispanics or blacks. An exaggerated survival benefit was afforded to Asian females relative to Asian males, having a >40% lower adjusted risk of mortality (OR = 0.59; 95% CI, 0.44-78; p < 0.001). Asian males had a >75% higher adjusted risk of mortality relative to non-Asian males (OR = 1.77; 95% CI, 1.5-2.0; p < 0.001), and no significant difference in the mortality risk was found for Asian females relative to non-Asian females.ConclusionsThese results suggest that Asian race is associated with sex-based outcomes differences that are exaggerated, resulting from worse outcomes for Asian males. These racial disparities suggest a negative male X-chromosome-linked effect as the mechanism responsible for these sex-based outcomes differences.Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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