Sex disparities among persons receiving operative care during armed conflicts

• Published in: Surgery 2017-08, Vol.162 (2), p.366-376
• Main Authors: 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
• Format: Article
• Language: English
• 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
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2017.03.001

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