Sex differences in hospitalisation and healthcare utilisation for patients with atrial fibrillation

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Abstract Background There is a paucity of data assessing the relation of sex differences in healthcare utilisation in patients with atrial fibrillation (AF). Purpose We therefore sought to examine the association of age and sex with healthcare utilization in patients with AF. Methods We conducted a retrospective analysis of electronic health records from three hospitals in the Netherlands which included all patients ≥18 years who had at least one healthcare encounter (outpatient or emergency visit and inpatient days). Diagnosis of AF was determined using the International Classification of Diseases and Related Health Problems 10 codes and linked with the Dutch Hospital Data Clinical Classification Software. Logistic regression analysis was performed to determine the association between age and healthcare utilization in females and males separately; we performed an unadjusted model and also adjusted for number of comorbidities. To assess the interaction between female sex and age, we also examined logistic regression models including an interaction term (female x age) in the model. Results Of 226991 patients, 5126 (2.3%) had an AF diagnosis (2274 (44%) were female, mean age 68±12 years). There were no statistically significant differences detected for the number of outpatient, emergency department visits or inpatient days between sexes. Females compared to males with AF aged 18-59 years had a significantly greater number of outpatient visits (6.1±7.9 vs 4.8±5.2, p=0.001). Females compared to males with AF aged ≥75 years, had fewer outpatient visits (7.2 vs 8.4, p<0.001) and inpatient days (4.8 vs 5.8, p=0.03). After multivariable adjustment, both sexes aged ≥75 years had an increased risk of inpatient days (Female: OR 2.53, 95% CI: 2.30-2.78; Male: OR 1.49, 95% CI: 1.6-1.62) and emergency department visits (Female: OR 2.14, 95% CI: 1.94-2.35; Male: OR 1.13, 95% CI: 1.03-1.24).(Figure) An interaction was detected between sex and age, as females were observed to have 1.99 times higher odds of inpatient days (pinteraction<0.001) and 1.23 times higher odds of emergency department visits compared to males (pinteraction<0.001). Conclusion Whilst there was no overall difference between sexes in hospital healthcare utilisation, sex differences did exist within age categories. Females compared to males aged 18-59 years had more outpatient visits, whilst females compared to males aged ≥75 years had less outpatient visits and inpatient days. Following adjustment for interaction between sex and age, females had an increased risk of both inpatient days and emergency visits compared to males, highlighting that independent of age, females had higher hospital healthcare utilisation rates.Figure

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