This population-based study found that male sex is a risk factor for readmission in patients aged more than 65 years admitted to hospital with the diagnosis of several common respiratory diseases: bronchitis and asthma, pneumonia, pulmonary edema and respiratory failure and COPD.
This sex gap has been reported previously in other studies conducted in various settings, where male sex is indicated as an independent risk factor for readmission for COPD (5, 6). Dal Negro (7), analyzing Italian patients diagnosed with COPD, chronic bronchitis and emphysema, concludes that direct costs for management are higher in male than in female patients. Moreover, this study draws attention to the fact that the major part of direct costs for the management of this diseases is yielded by the inpatient hospitalization. As regards pneumonia, our findings are concordant with literature data, which shows that women have less risk to be readmitted for pneumonia than men (8).
This relevant phenomenon is difficult to explain clinically but could be due to management of disease after discharge. In fact, men report less help-seeking behavior, which may delay accessing care when it is needed (9). Moreover, men use primary care health services less frequently than women, are less involved in preventive initiatives and are less health literate (10). For instance, it has been seen that fewer men understand and attend their follow-up appointments after acute hospitalization compared with women (11).
Help-seeking behavior is a complex phenomenon in which gender plays a fundamental role.
Masculine attitudes, behavior and values in general could lead to men ignoring symptoms of ill-health and failing to seek help from the health services because they see it as a sign of weakness (12). Risk-taking behaviors are also more strongly associated with male role models (13): in many cultures, the use of tobacco (a major risk factor for several lung diseases and associated with their severity) is closely linked with the perception of being a “real man” (14). Some biological factors may also influence the higher risk of rehospitalization for pneumonia in men. For instance, men have a weaker immune response and have also been shown to have more chronic mucus hypersecretion, which may worsen their prognosis and increase the likelihood of death (8). The association of sex with post-hospitalization risk is complex, and likely to be influenced by multiple factors. However, whatever the causes of the phenomenon, it is important to think about how to prevent readmissions.
Indeed, it could be useful to talk about gender-based medicine and prevention strategies, in order to address the resources in the most efficient way to reduce readmission rate and, consequently, costs for the health system.
To achieve this goal, it is important to give male patients adequate access to providers and personnel of intermediate and long-term care plans (15).
In particular, currently, there are few studies that evaluate the effectiveness of interventions that promote the access of men to primary care. A recent review found that physical activity, education, peer support-based interventions improve quality of life in men with long-term conditions (16). More studies are needed to understand what is successful in improving elderly men’s health and reducing the risk of readmission.
This study relied on routinely-collected administrative data, which unfortunately provides no information on the severity of a patient’s disease - a variable strongly associated with the probability of readmission. That said, in order to be considered as a confounder in a multivariate analysis, a variable should be associated with both the outcome and the exposure. For instance, in the present case, to explain the greater risk of readmissions in male by means of confounder effect of severity of the disease, we have to admit that the severity of disease would be greater in male than in female patients admitted to hospital, but the same protocols are used for both sexes when it comes to admitting a patient for hospital care.