Sex differences in long-term outcomes after traumatic injury: A mediation analysis

Background: We sought to examine the association and potential mediators between sex and long-term trauma outcomes. Methods: Moderately-to-severely injured patients admitted to 3 level-1 trauma centers were contacted between 6 and 12-months post-injury to assess for functional limitations, use of pain medications, and posttraumatic stress disorder (PTSD). Multivariable adjusted regression analyses were used to compare long-term outcomes by sex. Potential mediators of the relationship between sex and outcomes was explored using mediation analysis. Results: 2607 patients were followed, of which 45% were female. Compared to male, female patients were more likely to have functional limitations (OR: 1.45; 95% CI: 1.31-1.60), take pain medications (OR: 1.17; 95% CI: 1.02-1.38), and screen positive for PTSD (OR: 1.60; 95% CI: 1.46-1.76) post-injury. Age, extremity injury, previous psychiatric illness, and pre-injury unemployment, partially mediated the effect of female sex on long-term outcomes. Conclusions: There are significant sex differences in long-term trauma outcomes, which are partially driven by patient and injury-related factors. (c) 2021 Elsevier Inc. All rights reserved.

Automated summary

The study found significant sex differences in long-term trauma outcomes, with female patients more likely than males to have functional limitations, use pain medications, and screen positive for PTSD. These differences were partially mediated by factors such as age, extremity injury, previous psychiatric illness, and pre-injury unemployment.