Sex disparities among persons receiving operative care during armed conflicts
Background Armed conflict increasingly involves civilian populations, and health care needs may be immense. We hypothesized that sex disparities may exist among persons receiving operative care in conflict zones and sought to describe predictors of disparity. Methods We performed a retrospective ana...
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| Veröffentlicht in: | Surgery 2017-08, Vol.162 (2), p.366-376 |
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| creator | Forrester, Joseph D., MD, MSc Forrester, Jared A., MD Basimouneye, Jean-Paul, MD Tahir, Mohammad-Zahir, MD Trelles, Miguel, MD, PhD Kushner, Adam L., MD, MPH Wren, Sherry M., MD |
| description | Background Armed conflict increasingly involves civilian populations, and health care needs may be immense. We hypothesized that sex disparities may exist among persons receiving operative care in conflict zones and sought to describe predictors of disparity. Methods We performed a retrospective analysis of operative interventions performed between 2008 and 2014 at Médecins Sans Frontières Operation Center Brussels conflict projects. A Médecins Sans Frontières Operation Center Brussels conflict project was defined as a program established in response to human conflict, war, or social unrest. Intervention- and country-level variables were evaluated. For multivariate analysis, multilevel mixed-effects logistic regression was used with random-effect modeling to account for clustering and population differences in conflict zones. Results Between 2008 and 2014, 49,715 interventions were performed in conflict zones by Médecins Sans Frontières Operation Center Brussels. Median patient age was 24 years (range: 1–105 years), and 34,436 (69%) were men. Patient-level variables associated with decreased interventions on women included: American Society of Anesthesiologists score ( P = .003), degree of urgency ( P = .02), mechanism ( P |
| doi_str_mv | 10.1016/j.surg.2017.03.001 |
| format | Article |
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We hypothesized that sex disparities may exist among persons receiving operative care in conflict zones and sought to describe predictors of disparity. Methods We performed a retrospective analysis of operative interventions performed between 2008 and 2014 at Médecins Sans Frontières Operation Center Brussels conflict projects. A Médecins Sans Frontières Operation Center Brussels conflict project was defined as a program established in response to human conflict, war, or social unrest. Intervention- and country-level variables were evaluated. For multivariate analysis, multilevel mixed-effects logistic regression was used with random-effect modeling to account for clustering and population differences in conflict zones. Results Between 2008 and 2014, 49,715 interventions were performed in conflict zones by Médecins Sans Frontières Operation Center Brussels. Median patient age was 24 years (range: 1–105 years), and 34,436 (69%) were men. Patient-level variables associated with decreased interventions on women included: American Society of Anesthesiologists score ( P = .003), degree of urgency ( P = .02), mechanism ( P < .0001), and a country's predominant religion ( P = .006). Men were 1.7 times more likely to have an operative intervention in a predominantly Muslim country ( P = .006). Conclusion Conflict is an unfortunate consequence of humanity in a world with limited resources. For most operative interventions performed in conflict zones, men were more commonly represented. Predominant religion was the greatest predictor of increased disparity between sexes, irrespective of the number of patients presenting as a result of traumatic injury. It is critical to understand what factors may underlie this disparity to ensure equitable and appropriate care for all patients in an already tragic situation.</description><identifier>ISSN: 0039-6060</identifier><identifier>EISSN: 1532-7361</identifier><identifier>DOI: 10.1016/j.surg.2017.03.001</identifier><identifier>PMID: 28400124</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Armed Conflicts ; Child ; Child, Preschool ; Female ; Healthcare Disparities - statistics & numerical data ; Humans ; Infant ; Logistic Models ; Male ; Middle Aged ; Patient Selection ; Retrospective Studies ; Sex Factors ; Surgery ; Surgical Procedures, Operative - statistics & numerical data ; Young Adult</subject><ispartof>Surgery, 2017-08, Vol.162 (2), p.366-376</ispartof><rights>Elsevier Inc.</rights><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-e25826b4eb1d2c85efdd6b0bfdde0e7fd9d30e065d267fbe1570f5adfe11d0ad3</citedby><cites>FETCH-LOGICAL-c411t-e25826b4eb1d2c85efdd6b0bfdde0e7fd9d30e065d267fbe1570f5adfe11d0ad3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.surg.2017.03.001$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28400124$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Forrester, Joseph D., MD, MSc</creatorcontrib><creatorcontrib>Forrester, Jared A., MD</creatorcontrib><creatorcontrib>Basimouneye, Jean-Paul, MD</creatorcontrib><creatorcontrib>Tahir, Mohammad-Zahir, MD</creatorcontrib><creatorcontrib>Trelles, Miguel, MD, PhD</creatorcontrib><creatorcontrib>Kushner, Adam L., MD, MPH</creatorcontrib><creatorcontrib>Wren, Sherry M., MD</creatorcontrib><title>Sex disparities among persons receiving operative care during armed conflicts</title><title>Surgery</title><addtitle>Surgery</addtitle><description>Background Armed conflict increasingly involves civilian populations, and health care needs may be immense. We hypothesized that sex disparities may exist among persons receiving operative care in conflict zones and sought to describe predictors of disparity. Methods We performed a retrospective analysis of operative interventions performed between 2008 and 2014 at Médecins Sans Frontières Operation Center Brussels conflict projects. A Médecins Sans Frontières Operation Center Brussels conflict project was defined as a program established in response to human conflict, war, or social unrest. Intervention- and country-level variables were evaluated. For multivariate analysis, multilevel mixed-effects logistic regression was used with random-effect modeling to account for clustering and population differences in conflict zones. Results Between 2008 and 2014, 49,715 interventions were performed in conflict zones by Médecins Sans Frontières Operation Center Brussels. Median patient age was 24 years (range: 1–105 years), and 34,436 (69%) were men. Patient-level variables associated with decreased interventions on women included: American Society of Anesthesiologists score ( P = .003), degree of urgency ( P = .02), mechanism ( P < .0001), and a country's predominant religion ( P = .006). Men were 1.7 times more likely to have an operative intervention in a predominantly Muslim country ( P = .006). Conclusion Conflict is an unfortunate consequence of humanity in a world with limited resources. For most operative interventions performed in conflict zones, men were more commonly represented. Predominant religion was the greatest predictor of increased disparity between sexes, irrespective of the number of patients presenting as a result of traumatic injury. It is critical to understand what factors may underlie this disparity to ensure equitable and appropriate care for all patients in an already tragic situation.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Armed Conflicts</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Healthcare Disparities - statistics & numerical data</subject><subject>Humans</subject><subject>Infant</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Patient Selection</subject><subject>Retrospective Studies</subject><subject>Sex Factors</subject><subject>Surgery</subject><subject>Surgical Procedures, Operative - statistics & numerical data</subject><subject>Young Adult</subject><issn>0039-6060</issn><issn>1532-7361</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU-L1EAQxRtR3HH1C3iQHL0kVnUnnQREkMV_sOJh9dx0uitLj5n02JUMu9_eDrN68OCp4PHeg_o9IV4iVAio3-wrXtNtJQHbClQFgI_EDhsly1ZpfCx2AKovNWi4EM-Y9wDQ19g9FReyq7Nb1jvx9YbuCh_4aFNYAnFhD3G-LY6UOM5cJHIUTiErMUt2CScqnE1U-DVtqk0H8oWL8zgFt_Bz8WS0E9OLh3spfnz88P3qc3n97dOXq_fXpasRl5Jk00k91DSgl65raPReDzDkQ0Dt6HuvgEA3Xup2HAibFsbG-pEQPVivLsXrc-8xxV8r8WIOgR1Nk50prmyw61poEPo-W-XZ6lJkTjSaYwoHm-4Ngtkwmr3ZMJoNowFlMpgcevXQvw75wb-RP9yy4e3ZQPnLU6Bk2AWaHfmQkS3Gx_D__nf_xN0U5uDs9JPuifdxTXPmZ9CwNGButiG3HbFVgI3U6jfg15qW</recordid><startdate>20170801</startdate><enddate>20170801</enddate><creator>Forrester, Joseph D., MD, MSc</creator><creator>Forrester, Jared A., MD</creator><creator>Basimouneye, Jean-Paul, MD</creator><creator>Tahir, Mohammad-Zahir, MD</creator><creator>Trelles, Miguel, MD, PhD</creator><creator>Kushner, Adam L., MD, MPH</creator><creator>Wren, Sherry M., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170801</creationdate><title>Sex disparities among persons receiving operative care during armed conflicts</title><author>Forrester, Joseph D., MD, MSc ; Forrester, Jared A., MD ; Basimouneye, Jean-Paul, MD ; Tahir, Mohammad-Zahir, MD ; Trelles, Miguel, MD, PhD ; Kushner, Adam L., MD, MPH ; Wren, Sherry M., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-e25826b4eb1d2c85efdd6b0bfdde0e7fd9d30e065d267fbe1570f5adfe11d0ad3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Armed Conflicts</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Female</topic><topic>Healthcare Disparities - statistics & numerical data</topic><topic>Humans</topic><topic>Infant</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Patient Selection</topic><topic>Retrospective Studies</topic><topic>Sex Factors</topic><topic>Surgery</topic><topic>Surgical Procedures, Operative - statistics & numerical data</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Forrester, Joseph D., MD, MSc</creatorcontrib><creatorcontrib>Forrester, Jared A., MD</creatorcontrib><creatorcontrib>Basimouneye, Jean-Paul, MD</creatorcontrib><creatorcontrib>Tahir, Mohammad-Zahir, MD</creatorcontrib><creatorcontrib>Trelles, Miguel, MD, PhD</creatorcontrib><creatorcontrib>Kushner, Adam L., MD, MPH</creatorcontrib><creatorcontrib>Wren, Sherry M., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Forrester, Joseph D., MD, MSc</au><au>Forrester, Jared A., MD</au><au>Basimouneye, Jean-Paul, MD</au><au>Tahir, Mohammad-Zahir, MD</au><au>Trelles, Miguel, MD, PhD</au><au>Kushner, Adam L., MD, MPH</au><au>Wren, Sherry M., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sex disparities among persons receiving operative care during armed conflicts</atitle><jtitle>Surgery</jtitle><addtitle>Surgery</addtitle><date>2017-08-01</date><risdate>2017</risdate><volume>162</volume><issue>2</issue><spage>366</spage><epage>376</epage><pages>366-376</pages><issn>0039-6060</issn><eissn>1532-7361</eissn><abstract>Background Armed conflict increasingly involves civilian populations, and health care needs may be immense. We hypothesized that sex disparities may exist among persons receiving operative care in conflict zones and sought to describe predictors of disparity. Methods We performed a retrospective analysis of operative interventions performed between 2008 and 2014 at Médecins Sans Frontières Operation Center Brussels conflict projects. A Médecins Sans Frontières Operation Center Brussels conflict project was defined as a program established in response to human conflict, war, or social unrest. Intervention- and country-level variables were evaluated. For multivariate analysis, multilevel mixed-effects logistic regression was used with random-effect modeling to account for clustering and population differences in conflict zones. Results Between 2008 and 2014, 49,715 interventions were performed in conflict zones by Médecins Sans Frontières Operation Center Brussels. Median patient age was 24 years (range: 1–105 years), and 34,436 (69%) were men. Patient-level variables associated with decreased interventions on women included: American Society of Anesthesiologists score ( P = .003), degree of urgency ( P = .02), mechanism ( P < .0001), and a country's predominant religion ( P = .006). Men were 1.7 times more likely to have an operative intervention in a predominantly Muslim country ( P = .006). Conclusion Conflict is an unfortunate consequence of humanity in a world with limited resources. For most operative interventions performed in conflict zones, men were more commonly represented. Predominant religion was the greatest predictor of increased disparity between sexes, irrespective of the number of patients presenting as a result of traumatic injury. It is critical to understand what factors may underlie this disparity to ensure equitable and appropriate care for all patients in an already tragic situation.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28400124</pmid><doi>10.1016/j.surg.2017.03.001</doi><tpages>11</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Armed Conflicts Child Child, Preschool Female Healthcare Disparities - statistics & numerical data Humans Infant Logistic Models Male Middle Aged Patient Selection Retrospective Studies Sex Factors Surgery Surgical Procedures, Operative - statistics & numerical data Young Adult |
| title | Sex disparities among persons receiving operative care during armed conflicts |
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