Baqiyatallah University of Medical Sciences Hospital Practices and Research 2476-390X 11 2 2026 06 01 On Where, and Whether, the Sex Difference Disappears: Denominators and Conditioning in the Timing of ICU Treatment-Limitation Decisions 847 850 248291 10.30491/hpr.2026.248291 EN Mostafa Akbariqomi Tissue Engineering and Regenerative Medicine Research Center, New Health Technologies Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran 0000-0002-3533-2393 Amir Vahedian-Azimi Nursing Care Research Center, Clinical Sciences Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran 0000-0002-1678-7608 Journal Article 2026 06 28 Amacher and colleagues have assembled a dataset and posed exactly the right question: not merely whether women and men differ in how often life-sustaining therapy is curtailed, but when along the care pathway that divergence takes shape. Their headline finding is elegant in its symmetry. A pronounced female excess at admission (adjusted odds ratio 1.26, 95% CI 1.24–1.28) gives way, they report, to parity once treatment is under way, the during-stay rates standing at “5.5% versus 5.5%.” From this they infer that decisions grow more even-handed as objective clinical information accrues. We admire the study but believe two linked problems undermine that inference. The first is arithmetical and present on the face of Table 1; the second is structural and inheres in the staged design itself. Both deserve closer scrutiny than they have so far received. https://www.jhpr.ir/article_248291_91506e6c0cd6dd5de3a4032b7d4d6853.pdf