Hospital Practices and Research

On Where, and Whether, the Sex Difference Disappears: Denominators and Conditioning in the Timing of ICU Treatment-Limitation Decisions

Articles in Press

Document Type : Editorial

Authors

Mostafa Akbariqomi 1
Amir Vahedian-Azimi 2

1 Tissue Engineering and Regenerative Medicine Research Center, New Health Technologies Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran

2 Nursing Care Research Center, Clinical Sciences Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran

10.30491/hpr.2026.248291
Abstract
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.

Keywords

Sex Difference
Intensive Care Unit
Treatment-Limitation
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Hospital Practices and Research

Articles in Press, Accepted Manuscript
Available Online from 30 June 2026

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