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Nu sing Open, 2025; 12:e70132
h ps://doi.o g/10.1002/nop2.70132
Nu sing Open
EMPIRICAL RESEARCH QUANTITATIVE OPEN ACCESS
In luence o Pa ien Gende on In- Hospi al Mo ali y:
A Popula ion- Based C oss- Sec ional S udy
Nahika iVizue e- Alda e1 | Maide Uga emendia- Ye obi1 | Bea izPe eda- Goikoe xea1 |
Nago eZinkunegi- Zubiza e a1 | JosuneZubeldia- E xebe ia1 | UdaneElo di- Guenaga1 | Ha i zA ie a1,2 |
Aini zeLabaka1
1Depa men o Nu sing II, Facul y o Medicine and Nu sing, Uni e si y o he Basque Coun y (UPV/EHU), Donos ia- San Sebas ián, Gipuzkoa,
Spain | 2Biogipuzkoa Heal h Resea ch Ins i u e, Donos ia- San Sebas ián, Gipuzkoa, Spain
Co espondence: Ha i z A ie a (ha i z.a ie [email protected])
Recei ed: 2 Feb ua y 2024 | Re ised: 15 No embe 2024 | Accep ed: 7 Decembe 2024
Funding: This esea ch ecei ed suppo om he Uni e si y o he Basque Coun y (UPV/EHU) and Muje es de Cuidado Associa ion US21/16 join
P ojec G an .
ABSTRACT
Aim: To analyse he associa ion be ween gende and in- hospi al mo ali y odds a ios among pa ien s in he Basque Coun y.
Design: C oss- sec ional s udy.
Me hods: Admission da a pe aining o he pe iod be ween 1 Janua y 2016 and 31 Decembe 2018 we e ga he ed o all egis-
e ed acu e ca e hospi als (bo h public and p i a e) in he Basque Coun y. Odds a ios we e calcula ed h ough binomial logis ic
eg essions o de e mine he associa ion be ween gende and mo ali y in each diagnos ic ca ego y o he ICD- 10.
Resul s: Women had a highe in- hospi al mo ali y odds a io o diseases o he ci cula o y sys em (OR 1.07 [1.01–1.14], p < 0.05).
In con as , men we e a g ea e isk o in- hospi al dea h om neoplasms (OR 0.86 [0.83–0.94], p < 0.05), diseases o he ne ous
sys em (OR 0.83 [0.70–0.97], p < 0.05), diseases o he geni ou ina y sys em (OR 0.83 [0.71–0.96], p < 0.05), endoc ine diseases
(OR 0.67 [0.54–0.84], p < 0.05), inju y, poisoning and o he consequences o ex e nal causes (OR 0.60 [0.54–0.67], p < 0.05) and
diseases o he musculoskele al sys em and connec i e issue (OR 0.69 [0.50–0.93], p < 0.05).
Pa ien o Public Con ibu ion: No pa ien o public con ibu ions.
1 | In oduc ion
In he ield o public heal h nu sing, epidemiology is used o as-
sess he in e ac ion o heal h de e minan s wi hin he heal h-
illness con inuum o bo h indi iduals and communi ies (Eg y
e al.2018; Melo e al. 2021). Cu en ly, he c i ical examina-
ion o social de e minan s by he nu sing sec o and he sub-
sequen measu es aken cons i u e he d i ing o ce behind
he e o bo h o imp o e heal h ou comes o he popula ion
and o de elop and consolida e ou p o ession (Jones, Edwa ds,
and Alexande 2022). One o he ac ions ecommended by he
Council o Public Heal h Nu sing O ganisa ions (CPHNO) is he
ope a ionalisa ion o heal h equi y. In o he wo ds, i is neces-
sa y o iden i y and unde s and how social s uc u es may a ec
clinical a endance, in o de o enable he design o subsequen
p e en i e in e ac ions (Engle and Campbell 2019). Al hough
he CPHNO p esen s his ac ion in he amewo k o comba ing
acism, public heal h nu sing should also inco po a e sex and
gende as key heal h de e minan s, since hey in luence bo h he
indi idual's sel - ca e and he way in which he heal h sys em
esponds o hei needs (Malamou2015).
In o de o ende he gende gap in heal h mo e isible, in
2019, o he i s ime, he Wo ld Heal h O ganiza ion (WHO)
published i s Wo ld Heal h S a is ics disagg ega ed by sex, and
called upon o he ins i u ions o ollow i s example, claiming
ha his would help heal h sys ems iden i y gende inequali ies
in heal h, unde s and how gende in e ac s wi h o he ac o s o
This is an open access a icle unde he e ms o he C ea i e Commons A ibu ion License, which pe mi s use, dis ibu ion and ep oduc ion in any medium, p o ided he o iginal wo k is
p ope ly ci ed.
© 2025 The Au ho (s). Nu sing Open published by John Wiley & Sons L d.
2 o 12 Nu sing Open, 2025
in luence heal h ou comes and assign he necessa y esou ces
acco dingly (Cabanillas- Mon e e and Giménez- Bona é2022).
Howe e , he gende di e ences p esen in he da a ha e ye o
be ende ed comple ely isible in he ield o heal h, and much
he same can be said in e ms o compa ing heal h ou comes in
acco dance wi h sex (Wo ld Heal h O ganiza ion (WHO)2023).
In- hospi al mo ali y is an impo an indica o o clinical and
epidemiological esea ch, o en used o moni o he quali y o
ca e (Ga cía O ega, Ba ios, and Ga cía O ega 1997). Many
s udies ha e analysed in- hospi al mo ali y by sex in spe-
ci ic pa hologies such as acu e myoca dial in a c ion (Ribe a
e al.2006; Rod íguez- Padial e al.2021; Roque e al.2020), ce -
ain ypes o cance (Abdel- Fa ah e al.2022; B uno e al.2022;
Lee e al.2020; Send a- Gu ié ez e al.2009; Taioli e al.2017)
and Alzheime 's disease (Golüke e al.2019; P ice e al.2021;
Shayne e al.2013; Wang e al.2014), among o he s. Howe e ,
we ailed o ind any s a is ical da abases ha sys ema ically
compa e di e ences in his indica o by sex o gende .
Such a compa ison is necessa y inso a as sex and gende clea ly
in luence mo ali y: women ha e a g ea e li e expec ancy
han men (Lopez- de- And es e al.2023), bu su e om poo e
heal h o mos o hei li es (Da bà and Ma sà2021; Nakanishi,
Yamasaki, and Nishida2018). The di e ence in li e expec ancy
may be explained by biological sex di e ences and he di e en
beha iou s ha con i m gende , wi h nei he one alone being
wholly esponsible (Ca illo- La co and Be nabé- O iz 2018;
Concepción- Za ale a e al. 2015; Nakanishi, Yamasaki, and
Nishida2018). F om a physiological s andpoin , he in e ac ion
be ween gene ic di e ences, he ole o sex ho mones, he sexual
dimo phism o he immune sys em and he dis ibu ion o body
a has an impac on mo bidi y and mo ali y (Ca illo- La co and
Be nabé- O iz2018). Fo hei pa , gende di e ences linked o
social unc ions and access o in o ma ion, esou ces and p e-
en i e and cu a i e measu es also in luence heal h and li e ex-
pec ancy (Mo adabadi, Hannani, and To kash and2023).
O e looking he biological and social di e ences be ween
men and women in e ms o mo ali y may lead o biased clin-
ical p ac ice among nu sing p ac i ione s. In his line, Kuhn
e al.(2017) ound ha eme gency depa men nu ses ended
o alloca e women wi h acu e co ona y synd ome a less p i-
o i y iage ca ego y han men wi h he same symp oms, and
ha women wai ed longe o app op ia e diagnos ic es s,
such as hei i s elec oca diog aph. In addi ion, P ego-
Jimenez e al.(2022) epo ed, in a sample mainly comp ised
by egis e ed nu ses and physicians, ha gende s e eo ypes
could unde mine he legi ima ion o low back pain, he will-
ingness o o e suppo and c edibili y o emale pa ien s,
bu no o male pa ien s. The e o e, i is c ucial o conside
bo h nu ses' gende - sensi i e clinical judgemen and pa ien s'
heal h li e acy when assessing how heal h s a us o disease
impac s li e expec ancy. These ac o s a e i al componen s o
nu se- led gende - sensi i e heal h educa ion. Indeed, esea ch
indica es ha inadequa e heal h li e acy co ela es wi h a
heigh ened isk o mo ali y and hospi alisa ion (F anchi-
Al a o e al.2018; Sal ado Ma ín e al.2021), and s udies ha e
shown ha women gene ally possess lowe le els o heal h li -
e acy compa ed o men (Kuhn e al.2017).
In ligh o he abo e, i is i al o public heal h nu sing o adop
a gende - sensi i e pe spec i e when in e p e ing epidemiological
esul s. Howe e , we ailed o ind any s a is ical indica o ha
simul aneously sc eens o gende di e ences in all egis e ed
diseases o a popula ion. Consequen ly, he aim o he p esen
s udy is o analyse he associa ion be ween gende and in- hospi al
mo ali y odds a ios among pa ien s om he Basque Coun y
o each o he diagnos ic ca ego ies included in he In e na ional
Classi ica ion o Diseases 10 (ICD- 10) (AppendixI).
2 | Me hods
2.1 | Design and Da a Collec ion
A c oss- sec ional e ospec i e s udy was ca ied ou o anal-
yse he associa ion be ween gende , eason o hospi al admis-
sion and in- hospi al mo ali y among pa ien s in he Basque
Coun y.
Admission da a pe aining o he pe iod be ween 1 Janua y 2016
and 31 Decembe 2018 we e ga he ed o all egis e ed acu e
ca e hospi als (bo h public and p i a e) in he Basque Coun y.
The da a we e p o ided by Eus a , he Basque S a is ics Ins i u e
(Eus a 2020). The eason o admission was e lec ed h ough
he p incipal diagnosis, which is es ablished on he basis o he
necessa y examina ion and is iden i ied as he cause o he pa-
ien 's con ac wi h he hospi al (Minis e io de Sanidad Se icios
Sociales e Igualdad2015). P incipal diagnoses we e ca ego ised
in acco dance wi h ICD- 10 codes (AppendixI).
2.2 | Measu es
2.2.1 | Independen Va iable
Gende was ca ego ised as man o woman on he basis o he
in o ma ion con ained in he Se o Basic Minimum Da a o
Specialis Ca e in he Basque Coun y egis e .
2.2.2 | Dependen Va iable
Mo ali y was ca ego ised as a dicho omous a iable: (a) dis-
cha ged as deceased o (b) ali e upon discha ge. This la e
g oup comp ised pa ien s who we e discha ged home, ans-
e ed o ano he hospi al o social- heal h cen e o ano he pos-
sible des ina ion.
2.2.3 | Con ol Va iables
The a iable p o ince e e s o he h ee p o inces o he Basque
Coun y: A aba, Gipuzkoa and Bizkaia. This a iable indica es
he loca ion in which he pa ien ecei ed he co esponding
medical a en ion.
Age was ca ego ised in acco dance wi h i e g oups: (a)
≤ 14 yea s, (b) 15–44 yea s, (c) 45–64 yea s, (d) 65–84 yea s and
(e) ≥ 85 yea s.
20541058, 2025, 1, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1002/nop2.70132 by Uni e sidad Del Pais Vasco, Wiley Online Lib a y on [22/01/2025]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License
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Hospi als we e ca ego ised as ei he public o p i a e, depending
on he legal o ganisa ion o en i y o which hey belonged.
2.3 | S a is ical Analysis
In e ms o desc ip i e s a is ics, equencies and pe cen ages
we e used o summa ise he cha ac e is ics o ou sample. Odds
a ios (OR) we e calcula ed h ough binomial logis ic eg essions
o de e mine he associa ion be ween gende and in- hospi al
mo ali y o each diagnos ic ca ego y. The assump ions o lin-
ea i y, independence o e o s and mul icollinea i y ha e been
espec ed (Field2013). We p esen ed he co esponding OR and
95% con idence in e als adjus ed by e i o y, hospi al owne -
ship and pa ien 's age. S a is ical signi icance was se a p < 0.05.
The analyses we e conduc ed using SPSS 29.0 (IBM Co p.,
A monk, NY).
3 | Resul s
As shown in Table1, 45.6% o in- hospi al dea hs in he Basque
Coun y du ing he 3 yea s co e ed by he s udy co espond o
women (as opposed o 54.4% co esponding o men). I should
be no ed ha acco ding o he o al alues o he 2016–2018 pe-
iod, in bo h ypes o hospi al (public and p i a e), in all h ee
p o inces (A aba, Gipuzkoa and Bizkaia) and o all ages unde
84 yea s, mo e men han women died in hospi al. In con as ,
among hose aged ≥ 85 yea s, women had a highe in- hospi al
mo ali y a e.
3.1 | Risk o Dea h by Gende
The coe icien s ob ained indica e ha he odds a io o
dying in hospi al we e signi ican ly highe o women han
o men in ela ion o diseases o he ci cula o y sys em (OR
1.07 [1.01–1.14], p < 0.05), a he oscle osis (OR 1.57 [1.13–2.20],
p < 0.05), acu e myoca dial in a c ion (OR 1.52 [1.21–1.91],
p < 0.05) and ce eb o ascula diseases (OR 1.14 [1.02–1.27],
p < 0.05) (Figu e1).
Fo hei pa , men we e mo e likely o die om neoplasms (OR
0.86 [0.83–0.94], p < 0.05), diseases o he ne ous sys em (OR
0.83 [0.70–0.97], p < 0.05), diseases o he geni ou ina y sys-
em (OR 0.83 [0.71–0.96], p < 0.05), malignan neoplasms o he
colon, ec um and anus (OR 0.77 [0.63–0.94], p < 0.05), ca diac
conduc ion diso de s and dys hy hmias (OR 0.72 [0.56–0.92],
p < 0.05), diseases o he musculoskele al sys em and connec-
i e issue (OR 0.69 [0.50–0.93], p < 0.05), endoc ine, nu i ional
and me abolic diseases (OR 0.67 [0.54–0.84], p < 0.05), in ac a-
nial auma (OR 0.64 [0.50–0.82], p < 0.05), inju y, poisoning
and o he consequences o ex e nal causes (OR 0.60 [0.54–0.67],
p < 0.05), ac u e o he emu (OR 0.57 [0.47–0.69], p < 0.05),
in es inal di e icula (OR 0.57 [0.32–0.99], p < 0.05) and glo-
me ula and ubuloin e s i ial diseases (OR 0.36 [0.14–0.97],
p < 0.05) (Figu e1).
No s a is ically signi ican di e ences we e ound be ween gen-
de s in mo ali y o any o he o he ICD- 10 diagnos ic ca ego-
ies (AppendixII).
4 | Discussion
The analysis o he associa ion be ween gende and in- hospi al
mo ali y o each ICD- 10 ca ego y o he 2016–2018 pe iod in
he Basque Coun y e ealed se e al s a is ically signi ican di -
e ences. Fi s , women we e ound o ha e a s a is ically highe
in- hospi al mo ali y odds a io han men in ela ion o diseases
o he ci cula o y sys em. In con as , o neoplasms, diseases
o he ne ous sys em, diseases o he geni ou ina y sys em, en-
doc ine diseases, inju y, poisoning and o he consequences o
ex e nal causes, diseases o he musculoskele al sys em and con-
nec i e issue and in es inal di e icula, men we e a a highe
isk o dea h han women.
Consis en ly wi h he esul s ound he e, se e al o he s udies
ha e also epo ed a highe isk o in- hospi al mo ali y among
women diagnosed wi h acu e myoca dial in a c ion (B uno
e al.2022; Rod íguez- Padial e al.2021; Roque e al.2020),
s oke (Abdel- Fa ah e al.2022; A boix e al.2014) and a h-
e oscle osis (Lee e al. 2020). Fu he mo e, despi e he ac
ha only 30% o myoca dial in a c ions, including hose wi h
ST- segmen ele a ion, occu in women (Rod íguez- Padial
e al. 2021), acu e myoca dial in a c ion emains a leading
cause o mo ali y among emales (DeFilippis e al. 2020;
Ibanez e al.2018). This could be in luenced by se e al ac o s,
such as olde age a he ime o he e en , a highe p e alence
o a ypical clinical p esen a ion, a g ea e numbe o isk ac-
o s and di e ences in bo h he pa hophysiology o he dis-
ease and he ea men ecei ed (Hol zman e al.2023; Ibanez
e al.2018).
In ela ion o ce eb o ascula diseases, hese di e ences ha e
been associa ed wi h women's g ea e li e expec ancy (since
he incidence a e o s oke inc eases wi h age), as well as wi h
a g ea e p e alence o his disease among emales (A boix
e al.2014).
As o neoplasms, he highe likelihood o in- hospi al mo al-
i y due o colo ec al cance obse ed among men by Puccia elli
e al.(2017) in I aly be ween 2005 and 2014 seems o be con-
sis en wi h he highe odds a io ound among he men in ou
sample o dea h owing o malignan neoplasms o he colon,
ec um and anus. In ela ion o lung cance , no gende di e -
ences we e obse ed in ou sample. This is consis en wi h ha
epo ed by Taioli e al.(2017), who also ailed o ind di e -
ences a e analysing a sample o pa ien s wi h lung cance
who unde wen limi ed esec ion o lobec omy be ween 1995
and 2012 in he s a e o New Yo k. Howe e , ano he s udy con-
duc ed in Spain in 2005 ound a high a e o in- hospi al mo -
ali y among men admi ed o he i s ime as a esul o his
ype o cance (Send a- Gu ié ez e al.2009). The di e ence in
he esul s ound in ou s udy and he one ci ed abo e may be
due o he ac ha he isk o in- hospi al mo ali y a ies in
acco dance wi h ime om diagnosis. A highe isk was ound
o men among newly- admi ed pa ien s, whe eas no gende
di e ences we e obse ed in ou sample, which included bo h
i s ime and ecu en admissions. Indeed, di e ences be-
ween men and women ha e been epo ed in ela ion o he
cou se o lung cance , since women ecei e mo e chemo he -
apy du ing hei i s hospi al admission, ha e ewe adeno-
ca cinomas and epide moid umou s, smoke less and unde go
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4 o 12 Nu sing Open, 2025
TABLE 1 | Dea hs in acu e ca e hospi als o he Basque Coun y o he pe iod 2016–2018.
2016 2017 2018 To al 2016–2018
Women Men Women Men Women Men Women Men
To al, N (%)a3259 (2.80%) 3966 (3.44%) 3465 (3.00%) 4110 (3.51%) 3401 (2.93%) 4023 (3.37%) 10125 (2.91%) 12099 (3.44%)
Te i o y
A aba 577 (3.23%) 675 (3.61%) 612 (3.45%) 715 (3.76%) 557 (3.06%) 679 (3.49%) 1746 (3.25%) 2069 (3.62%)
Gipuzkoa 1131 (2.87%) 1283 (3.30%) 1135 (2.96%) 1308 (3.40%) 1106 (2.92%) 1248 (3.23%) 3372 (2.92%) 3839 (3.31%)
Bizkaia 1551 (2.61%) 2008 (3.47%) 1718 (2.89%) 2087 (3.49%) 1738 (2.89%) 2096 (3.41%) 5007 (2.80%) 6191 (3.46%)
Hospi al owne ship
Public 2867 (2.97%) 3608 (3.78%) 2927 (3.06%) 3539 (3.63%) 2849 (2.95%) 3414 (3.43%) 8643 (2.99%) 10561 (3.61%)
P i a e 392 (1.96%) 358 (1.80%) 538 (2.71%) 571 (2.91%) 552 (2.84%) 609 (3.07%) 1482 (2.50%) 1538 (2.59%)
Age
≤ 14 yea s 16 (0.32%) 29 (0.44%) 13 (0.29%) 24 (0.37%) 33 (0.69%) 26 (0.40%) 62 (0.44%) 79 (0.40%)
15–44 yea s 64 (0.18%) 65 (0.38%) 44 (0.13%) 72 (0.42%) 52 (0.16%) 66 (0.39%) 160 (0.16%) 203 (0.40%)
45–64 yea s 386 (1.58%) 692 (2.08%) 409 (1.67%) 632 (1.88%) 398 (1.59%) 619 (1.80%) 1193 (1.61%) 1943 (1.92%)
65–84 yea s 1302 (3.54%) 2084 (4.37%) 1318 (3.59%) 2192 (4.49%) 1244 (3.39%) 2083 (4.18%) 3864 (3.51%) 6359 (4.35%)
≥ 85 yea s 1491 (9.61%) 1096 (10.30%) 1681 (10.11%) 1190 (10.48%) 1674 (9.81%) 1229 (10.24%) 4846 (9.85%) 3515 (10.34%)
aPe cen ages o deceased women and men, acco ding o he numbe o admi ed women and men o acu e ca e hospi als.
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ewe su gical p ocedu es when eadmi ed han men (Send a-
Gu ié ez e al. 2009). Howe e , he di e ences be ween he
samples in e ms o inclusion c i e ia, loca ion and yea p e-
clude any di ec compa ison o he esul s.
In he case o diseases o he ne ous sys em, in he Basque
Coun y, he likelihood o in- hospi al dea h was highe among
men. In ela ion o his, some au ho s ha e obse ed a g ea e
likelihood o in- hospi al dea h among men o he diagnos-
ic subg oups demen ia and/o Alzheime 's disease (Golüke
e al.2019; Lopez- de- And es e al.2023; Nakanishi, Yamasaki,
and Nishida2018). Fo example, in Japan, an obse a ional s udy
in ol ing 960,423 people aged o e 65 yea s who had died om
Alzheime 's disease, ascula demen ia o ano he kind o de-
men ia, concluded ha men we e mo e a isk o dying in hos-
pi al han women (Nakanishi, Yamasaki, and Nishida2018). In
con as , in Spain, om 2011 o 2016, he in- hospi al mo ali y
a e was highe among emale han among male Alzheime 's
pa ien s (Da bà and Ma sà2021). No s a is ically signi ican di -
e ences ha e been ound be ween sexes o ei he epilepsy (Si
e al.2018) o mul iple scle osis (Pi isalo e al.2018). Howe e ,
al hough some s udies epo a g ea e likelihood o in- hospi al
dea h among men as a esul o di e en ypes o demen ia, a
inding ha is simila o ha obse ed o diseases o he ne -
ous sys em in ou s udy, he esul s o o he pa hologies a y.
In ela ion o diseases o he geni ou ina y sys em, men in he
Basque Coun y had a highe in- hospi al mo ali y a e han
women. Consis en ly wi h his inding, in he Uni ed S a es,
emale pa ien s wi h end- s age enal disease on dialysis who
a e hospi alised wi h hea ailu e we e ound o be 25% less
likely o die in hospi al han hei male coun e pa s (Inampudi
e al.2019). In con as , Ca illo- La co and Be nabé- O iz(2018)
obse ed ha he mo ali y a e o ch onic enal disease was
highe o women han o men (2.2% and 1.8% espec i ely); and
Concepción- Za ale a e al.(2015) ound no signi ican sex di -
e ences in ela ion o ch onic end- s age kidney disease. These
inconsis encies be ween he esul s epo ed in he ex an li e -
a u e and hose ound he e may be due o di e ences in he way
diseases a e ca ego ised in he di e en s udies. Fu he mo e,
al hough in ela ion o glome ula and ubuloin e s i ial kid-
ney diseases men in he Basque Coun y we e ound o be mo e
likely o die in hospi al han women, Beckwi h, Ligh s one,
and McAdoo (2022) concluded ha no s a is ically signi ican
di e ences exis ed be ween men and women in e ms o dea h
om lupus neph i is and an i- neu ophil cy oplasmic an ibody-
associa ed asculi is ( wo glome ula diseases). Ne e heless,
some au ho s ha e a emp ed o explain he g ea e p e alence
o hese diseases among men in e ms o a combina ion o bio-
logical, social, cul u al and occupa ional ac o s. Fo example,
women wi h he same le el o c ea inine as men ha e poo e
kidney unc ion due o he ac ha hey ha e less muscle mass.
Also, exposu e o hyd oca bons (a equen occu ence in mas-
culinised indus ial sec o s such as he pain ing p o ession and
chemical indus ies), g ea e delays in seeking medical a en ion
and mo e equen smoking and d ug abuse among men may
explain he g ea e p e alence o hese diseases among his sex
(Beckwi h, Ligh s one, and McAdoo2022).
Mo ing on o ano he ICD- 10 ca ego y, in ela ion o endoc ine,
nu i ional and me abolic diseases, he in- hospi al mo ali y
a e among men in ou s udy was highe han ha o women.
In con as , in a longi udinal e ospec i e s udy ca ied ou
in Ghana (Papadopoulos e al. 2008), he au ho s concluded
ha he e we e no signi ican di e ences be ween men and
women in e ms o in- hospi al mo ali y due o diseases o he
endoc ine sys em. In I an, howe e , i was obse ed ha om
2006 o 2018, mo e women han men had died om endoc ine,
FIGURE 1 | Adjus ed odds a io o in- hospi al mo ali y (men s. women) by diagnosis. LCI, lowe con idence in e al; OR, odds a io; UCI,
uppe con idence in e al.
20541058, 2025, 1, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1002/nop2.70132 by Uni e sidad Del Pais Vasco, Wiley Online Lib a y on [22/01/2025]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License
6 o 12 Nu sing Open, 2025
nu i ional and me abolic diseases (Mo adabadi, Hannani, and
To kash and 2023); al hough since he au ho s did no spec-
i y whe he o no hese dea hs had occu ed in hospi al, i is
di icul o di ec ly compa e hese esul s wi h hose ound in
ou s udy.
Fo male pa ien s in he Basque Coun y, he likelihood o dying
in hospi al om inju y, poisoning o o he consequences o ex-
e nal causes was highe han o women. Consis en ly wi h
his inding, s udies on se e e auma in men aged ≥ 60 yea s
(Medina- Molina, Balcells- Ma inez, and P a - Fab ega 2019)
and e eb al ac u es (Ong e al.2018) epo ha he male
popula ion is a g ea e isk o in- hospi al dea h han he emale
one. In he diagnos ic subg oup ac u e o he emu , men in
he Basque Coun y also had a g ea e likelihood han women
o dying in hospi al. Consis en ly wi h his inding, in a s udy
ca ied ou in Lomba dy, he au ho s (Viganò e al.2023) ound
a signi ican ly highe isk o dea h among men one and 2 yea s
a e a hip ac u e, and he same end has been obse ed in he
Uni ed S a es also, wi h he mo ali y a e among men wi h pel-
ic ac u es being 10.2% highe han among women (Yoshiha a
and Yoneoka2014). Ne e heless, o he au ho s ha e ailed o
ind any associa ion be ween sex and likelihood o in- hospi al
dea h o hese same diagnoses (Sal ado Ma ín e al.2021) o
ha e epo ed a g ea e isk among women (F anchi- Al a o
e al.2018). The a ia ion be ween indings may be due o he
speci ic pa icula i ies o each s udy in e ms o how hey in e -
p e he ICD ca ego y inju y, poisoning and o he consequences
o ex e nal causes in compa ison wi h he gene al in e p e a-
ion used he e.
Finally, wi hin his same ICD ca ego y, in ela ion o he spe-
ci ic diagnosis o in ac anial auma, in- hospi al mo al-
i y was highe among men in ou s udy han among women.
Consis en ly wi h his inding, in a s udy ca ied ou in he USA
be ween 2000 and 2017, he au ho s obse ed a s a is ically
signi ican highe mo ali y a e among male han among e-
male pa ien s as a esul o auma ic b ain inju y (Daughe y
e al.2019). In con as , in Aus alia, al hough mos in- hospi al
dea hs ollowing auma ic b ain inju y co esponded o men
(69.2%), no s a is ically signi ican di e ences we e obse ed
be ween men and women admi ed as a esul o his kind o
inju y (O'Reilly e al.2023).
In he diseases o he musculoskele al sys em and connec i e
issue ca ego y, men in he Basque Coun y we e a g ea e isk
o in- hospi al dea h han women. A simila end was obse ed
in a Spanish s udy on os eomyeli is, in which he au ho s ob-
se ed ha being a woman was a p o ec i e ac o o in- hospi al
mo ali y among pa ien s su e ing om his disease (López del
Pino and Gue e o Espejo2019). In Ko ea, al hough sex was no
ound o p edic in- hospi al mo ali y among knee a h oplas y
pa ien s, i was ound o p edic pos ope a i e mo ali y, wi h
men being a g ea e isk han women (Choi e al.2021).
Finally, o in es inal di e icula diagnoses, men om he
Basque Coun y we e a g ea e isk o in- hospi al dea h han
women. In he Uni ed S a es also, women we e ound o ha e
lowe mo ali y a es in a s udy analysing a sample o 4 mil-
lion hospi al admissions o di e iculi is (Diaman e al.2015).
Howe e , i is wo h no ing ha , in I aly, in- hospi al mo ali y
due o his pa hology inc eased signi ican ly o women be ween
2008 and 2015 (Binda e al.2018).
I we ocus on he gene al ICD ca ego ies, we see ha , in ou
s udy, he odds a ios o in- hospi al dea h we e highe o men
su e ing om neoplasms, diseases o he ne ous sys em, dis-
eases o he geni ou ina y sys em, inju y and poisoning and
diseases o he musculoskele al sys em; whe eas among women,
he odds a io o in- hospi al dea h was highe among hose wi h
diagnoses lis ed unde he gene al diseases o he ci cula o y sys-
em ca ego y. In e es ingly, we ound no o he s udy analysing
hese gene al ICD ca ego ies pe se in acco dance wi h gende .
We a e he e o e unable o di ec ly compa e esul s, and ha e
op ed ins ead o discuss he isk o in- hospi al mo ali y in hese
gene al ca ego ies wi h he esul s epo ed in s udies ocusing
on simila diseases. The e is an absence in he ex an li e a u e o
compa isons be ween men and women o many o he speci ic
pa hologies ou lined in he ICD. This se es o highligh he lack
o any sys ema ic me hod o compa ing a e y basic indica o
(namely in- hospi al mo ali y) in acco dance wi h gende . Gi en
he e i o ial cha ac e is ics o he Basque Coun y, one o he
s eng hs o he p esen s udy is he homogenei y o he commu-
ni y sample analysed, as well as i s la ge size. Fu he mo e, he
ac ha all da a we e ob ained om he same sou ce (Eus a —
he Basque S a is ics Ins i u e) gua an ees a high deg ee o s an-
da disa ion in hei p ocessing. Howe e , he analysis may ha e
bene i ed om he s udy o mo e ac o s in luencing heal h ou -
comes ha , un o una ely, we e no a ailable, such as socioeco-
nomic s a us, e hnic o igin and eason o hospi al admission.
4.1 | Clinical Implica ions
Compa ing in- hospi al mo ali y odds a ios by gende has
been shown o be a good indica o o iden i ying hose dis-
eases in which he di e ences be ween men and women a e
g ea es . I is now impo an o compa e hese esul s wi h
hose ound in o he popula ions. The analysis conduc ed he e
should he e o e be eplica ed in o he hospi als and s a is ical
obse a o ies, e c.
The p esen s udy highligh s a ious biological speci ici ies
linked o gende ha may in luence mo ali y, including he
pa hogenesis o lung cance and glome ula diseases. I is im-
po an o nu sing p ac i ione s o be awa e o hese physio-
pa hological di e ences in o de o a oid succumbing o ype
B gende bias, o in o he wo ds, assuming, when assessing a
pa ien , ha he physio- pa hologies o men and women a e
he same when, in ac , hey a e qui e di e en (Cabanillas-
Mon e e and Giménez- Bona é2022).
Following Hende son's model (Co ea A gue a, Ve de Flo a, and
Ri as Espinosa2016), se e al sou ces o di icul ies ha e been
de ec ed in he ulne able popula ion ha could be modi ied in
o de o enable people o each hei ull heal h po en ial. Fo
example, he lowe awa eness o he impo ance o acu e myo-
ca dial in a c ion among women may be ed essed h ough p i-
ma y ca e nu se- led heal h educa ion. In his sense, i is wo h
no ing ha a nu se- led phone ollow- up educa ion p og amme
p o ed e ec i e in inc easing sel - e icacy o disease manage-
men in a s udy in ol ing 403 pa ien s o bo h sexes su e ing
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7 o 12
om ca dio ascula disease (Zhou e al.2018). Simila ly, nu se-
led in e en ion ini ia i es such as he P o ec ing Heal hy
Hea s P og am may be use ul o imp o ing he managemen
o ca dio ascula isk ac o s such as o al choles e ol, weigh
and blood p essu e (Ca ing on and S ewa 2015). These ini-
ia i es we e based on indi idual plans o de eloping sel - ca e
skills, p omo ing heal hy li es yles and he apeu ic adhe ence
wi h ollow- ups scheduled in acco dance wi h each pa ien 's
isks and needs. They managed o educe sys olic blood p es-
su e by 4 mmHg, dias olic blood p essu e by 1 mmHg and
body mass index by 0.3 kg/m2, among o he s (Ca ing on and
S ewa 2015).
Delays in seeking medical assis ance among women cons i u e
ano he ac o linked o hei highe in- hospi al mo ali y a e
due o co ona y disease (Hol zman e al.2023). This same ac o
is also associa ed wi h highe in- hospi al mo ali y a es among
men due o glome ula diseases (Beckwi h, Ligh s one, and
McAdoo2022). P omo ing heal h a all ages and le els is he bes
possible ool o educing he ime ha elapses be o e pa ien s
seek medical a en ion (Mo eno- Ma ínez e al.2016). This can
be achie ed h ough in e en ions a ge ing women's li es yle
and he p incipal ca dio ascula isk ac o s, as well as h ough
p e en i e pha macological in e en ions. In all hese ac ions,
he ac i e pa icipa ion o he nu sing p o ession is i al (Wood
and Go don2012). These same in e en ions could be adap ed
o glome ula diseases.
Smoking has been linked o g ea e in- hospi al mo ali y due o
lung cance (Send a- Gu ié ez e al.2009) and glome ula dis-
eases (Beckwi h, Ligh s one, and McAdoo 2022) among men.
Nu sing has a key ole o play in bo h p e en ing smoking and
helping people o gi e up once hey ha e s a ed. Fo example,
an in ensi e nu se- led in e en ion p og amme a ge ed a 163
pa ien s, ca ied ou om 2004 o 2012 a a heal h cen e in
As u ias, achie ed a smoking abs inence a e o 45.1% 12 mon hs
la e (Blanco Rioped e and Fe nández Fe nández2015).
Finally, occupa ional exposu e o hyd oca bons may be a
isk ac o o lupus neph i is and an i- neu ophil cy oplas-
mic an ibody- associa ed asculi is (Beckwi h, Ligh s one, and
McAdoo2022). In ela ion o his, i is impo an o highligh
he ole o occupa ional nu sing, no only in he p o ec ion,
p e en ion and p omo ion o heal h in he labou ield, bu
also in e ms o moni o ing wo ke s' heal h, wo king condi-
ions and he isks p esen in he wo kplace (Juá ez- Ga cía and
He nández- Mendoza2010).
Ac oss i s en i e scope o ac ion and om he pe spec i e o pub-
lic heal h and occupa ional heal h, nu sing he e o e has he ca-
paci y o in e ene o p e en hose ac o s ha may con ibu e
o highe a es o in- hospi al mo ali y.
4.2 | S udy Limi a ions
Ou s udy has ce ain limi a ions ha should be conside ed
when in e p e ing he indings. One o he main limi a ions
o his s udy is he na u e o he da a se , which does no allow
us o iden i y deceased pa ien s o o ob ain de ails on hei co-
mo bidi ies o medical his o y. The lack p e en s an exhaus i e
analysis o he ac o s ha could ha e in luenced he p ognosis
and e olu ion o he pa ien s, which could limi he gene alisa-
ion o he esul s. In addi ion, he subjec i i y and a iabili y
ha may exis among clinicians when assigning an ICD- 10 diag-
nos ic code o indi iduals upon admission o dea h mus be con-
side ed. Finally, we ecognise ha he esul s ob ained in his
s udy should be in e p e ed wi h cau ion, as hey include only
in- hospi al mo ali y, and no ou - o - hospi al mo ali y. Despi e
hese limi a ions, we belie e ha he esul s ob ained p o ide
aluable in o ma ion on gende inequali ies in in- hospi al mo -
ali y and p o ide a solid basis o u u e esea ch.
5 | Conclusions
Whe eas in ela ion o diseases o he ci cula o y sys em women
we e mo e likely o die in hospi al, o all he o he diseases ana-
lysed, men had highe in- hospi al mo ali y a es.
To he bes o ou knowledge, his is he i s s udy o analyse
he odds a ios o in- hospi al mo ali y by gende o each o he
ICD- 10 ca ego ies.
Ha ing his o e iew o ou heal h sys em will enable us o de-
e mine a s a ing poin o wo king owa ds equali y be ween
men and women wi hin he heal h se ice.
The e a e many di e en ac o s (biology, gende oles in soci-
e y, li e expec ancy, li e acy, heal h ac ions, e c.) ha may ex-
plain hese inequali ies. Being awa e o he ICD- 10 ca ego ies
in which hese inequali ies exis may help us be e o ganise ou
esou ces in o de o con inue esea ching his issue, since e-
maining unawa e o he ac o s ha may be causing hese di -
e ences does no hing bu pe pe ua e a si ua ion o inequali y
be ween men and women.
Viewing p e en ion as he co ne s one o he public heal h sys-
em, and nu sing p ac i ione s as key p o essionals wi hin ha
sys em, we hope his pape has se ed o highligh he impo -
ance o wo king, om wi hin he nu sing sec o , on heal h p o-
mo ion ac i i ies, wi h he aim o in luencing hose ac o s ha
may esul in men and women ha ing unequal heal h ou comes.
Au ho Con ibu ions
All o he au ho s con ibu ed in ellec ually o he wo k, mee he con-
di ions o au ho ship and ha e app o ed he inal e sion o i . A.L. de-
ised he p ojec , he main concep ual ideas and p oo ou line, N.Z.- Z.,
U.E.- G. and H.A. analysed he da a, B.P.- G. and N.V.- A. de eloped he
heo e ical amewo k and N.V.- A., M.U.- Y. and J.Z.- E. discussed he
esul s. I decla e ha he wo k is o iginal, has no been p e iously pub-
lished and is no unde e iew by any o he jou nal. E hical p inciples
ha e been consis en ly adhe ed o h oughou he esea ch p ocess, and
we would be willing o p o ide mo e in o ma ion abou ou da a and
me hods i necessa y.
Acknowledgemen s
We exp ess ou g a i ude o Eus a — he Basque Ins i u e o S a is ics o
p o iding us wi h epidemiological da a, and we ex end special app eci-
a ion o he echnician Ma a De la To e Fe nández o he p o ession-
alism and e iciency.
20541058, 2025, 1, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1002/nop2.70132 by Uni e sidad Del Pais Vasco, Wiley Online Lib a y on [22/01/2025]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License
8 o 12 Nu sing Open, 2025
E hics S a emen
In compliance wi h he Spanish Biomedical Resea ch Law (14/2007),
his s udy was exemp om Ins i u ional Re iew Boa d app o al as i
solely encompasses he analysis o publicly a ailable non- nominal da a.
Con lic s o In e es
The au ho s decla e no con lic s o in e es .
Da a A ailabili y S a emen
The da a suppo ing he indings o his s udy a e a ailable a Eus a —
he Basque Ins i u e o S a is ics.
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