Lower Risk for Death in Women vs Men Hospitalized With Esophageal Variceal Bleeding

Women hospitalized with esophageal variceal bleeding have a decreased risk for mortality compared with men.

Women hospitalized with esophageal variceal bleeding have a reduced risk for death compared with men, according to study findings in Annals of Medicine.

Researchers conducted a retrospective observational cohort study using the National Inpatient Sample (NIS) database to find associations between sex and hospitalization outcomes among patients with esophageal variceal bleeding in the United States. Researchers also screened 173,075 patients diagnosed with primary or secondary esophageal variceal bleeding and included a total of 167,760 patients in the final analysis.

The primary exposure variable was sex, and other variables were patient age (divided into <44 years, 45-64 years, and >65 years), race, insurance information, hospital characteristics, and transfer status.

In the study population, 32.7% were women, with most women in the age range of 45 to 64 years (53.03%), and a higher proportion of women than men were above 65 years (31.95% vs 22.05%). The mean age for women was 58.45 years compared with 55.65 years for men.

The development of gender-specific management programs would help target the needs of women and men living with cirrhosis.

The International Classification of Diseases 10th Version, Clinical Modification (ICD-10 CM) diagnosis codes were used to classify patients.

The primary outcome was the difference in inpatient mortality from esophageal variceal bleeding between men and women. Researchers also compared the hospital length of stay and health care costs, divided into hospital charges and hospital costs. Hospital charges were the dollar amount the hospital charged for service before negotiation with insurers, and hospital costs were the amount the hospital takes in after insurance negotiations.

Researchers assessed comorbidities according to the Elixhauser Comorbidity Index, which has 31 comorbid categories. Continuous variables were compared using the independent sample t-test, and categorical variables were assessed using chi-square.

The total mortality of the study population was 15,645 (9.38%), and the rates in men compared with women were 9.91% and 8.31%, respectively (adjusted odds ratio [aOR], 0.88; P =.008). The average length of stay was 6.09±0.05 days for men and 6.18±0.08 days for women (P =.252).

The mean charges and costs were $89,398.79 and $20,763.7 for men (adjusted coefficient, $2,135.59; P =.247) compared with $87,052.14 and $20,236.93 for women, respectively (adjusted coefficient, $607.16; P =.183).

In this study, 27.54% of men and 24.83% of women developed acute kidney injury (aOR, 0.82; P <.001). Out of all patients, 20.38% of men and 16.93% of women were admitted to the intensive care unit (ICU). Women had decreased odds of being admitted to the ICU compared with men (aOR, 0.84; P <.001). Similarly, women had lower odds of requiring transjugular intrahepatic portosystemic shunts (TIPS) compared with men (aOR, 0.83; P =.002).

There were no statistically significant differences between men and women for endoscopies, sepsis, and blood transfusions.

Study limitations include the inability to calculate severity of illness scores, allowing patients to continue medications that could impact patient outcomes, and the lack of follow-up with participants.

“Further research is needed to elucidate the factors responsible for the reduced mortality in female patients,” the study authors wrote. “The development of gender-specific management programs would help target the needs of women and men living with cirrhosis.”


Sohal A, Chaudhry H, Dhaliwal A, et al. Gender differences in esophageal variceal bleeding in the United States. Ann. Med. 2022;54(1):2115-2122. doi:10.1080/07853890.2022.2104920