Association of alcohol use with olfactory function among older adults.

BACKGROUND/PURPOSE: Olfactory dysfunction (OD) has been recognized as an early biomarker for neurodegenerative diseases. Identifying behaviors that increase the risk of OD is crucial for early recognition of neurogenerative diseases. Alcohol consumption can potentially impact olfaction through its neurotoxic effects. This study aims to examine the relationship between alcohol consumption and OD, using data from the National Social Life, Health, and Aging Project (NSHAP). METHODS: This cross-sectional study was conducted on data for 2757 adults from Round 1 of NSHAP. OD was defined as correctly identifying 0-3 odors in the 5-item Sniffin' Sticks test while normal olfactory function was defined as correctly identifying 4-5 odors. Multivariable logistic regression was utilized to examine the association between alcohol consumption and OD, controlling for age, race, and comorbidities. Analyses were weighted to account for the sampling design. RESULTS: OD was present in 23.1 % of adults. The average age among those with OD was 71.2 ± 7.8 years, compared to 66.9 ± 7.2 years in those with normal olfaction. In terms of alcohol consumption, 31.1 % of adults with OD were light-to-moderate drinkers and 7.7 % were heavy drinkers, compared to 35.6 % light-to-moderate and 7.7 % heavy drinkers in the normal olfaction group. After adjusting for age, gender, race, and education, neither light-to-moderate drinking (aOR: 0.99; 95 % CI: 0.76-1.29) nor heavy drinking (aOR: 1.24; 95 % CI: 0.83-1.85) were significantly associated with OD. CONCLUSION: Alcohol consumption was not associated with OD after controlling for covariates. While this study provides insight into the relationship between alcohol consumption and OD, further research is needed due to conflicting results in previous studies.

Associations of community-level particulate matter with high-acuity visit presentation for sinusitis.

BACKGROUND: Exposure to particulate matter <2.5 µm in diameter (PM2.5) has been linked to increased sinusitis prevalence and morbidity. However, studies analyzing environmental exposures and sinusitis have not explored the effect of PM2.5 on healthcare presentation patterns. OBJECTIVE: This study aims to characterize the relationship of community-level PM2.5 with high-acuity visits in sinusitis patients. METHODS: A retrospective analysis based on medical records of 2092 adults presenting with chronic rhinosinusitis, acute rhinosinusitis, or sinus/nasal polyps to an urban academic medical center from 2010 to 2019 was conducted. We linked medical records (individual-level) with data on PM2.5 exposure at the community level, using residential zip-code data from the Chicago Health Atlas covering the years 2015-2019. Multivariable binary logistic regression with Generalized Estimating Equations examined adjusted associations between PM2.5 and high-acuity visits - including emergency department and inpatient settings. RESULTS: Our sample was 69 % female, with a mean age of 46.9 years. From 2015 to 2019, the average PM2.5 exposure in zip-codes examined was 11.66 µg/m3 with a range of 11.14-11.79 µg/m3. In adjusted models, odds of a high-acuity visit were significantly higher in patients residing in zip-codes in the top tertile of PM2.5 exposure compared to the bottom tertile (OR: 1.74; CI: 1.20-2.51). CONCLUSION: Community-level PM2.5 exposure was associated with high-acuity visits among sinusitis patients. These associations need to be studied through more rigorous, prospective investigations, as they may have potential public health implications and underscore a need to mitigate PM2.5 exposures at a community-level.

Perceived Adequacy of Tangible Social Support and Associations with Health Outcomes Among Older Primary Care Patients.

BACKGROUND: The availability and adequacy of tangible social support may be critical to older adults managing multiple chronic conditions, yet few studies have evaluated the perceived adequacy of needed tangible support and its relation to health outcomes. OBJECTIVE: We investigated the association between unmet, tangible social support needs, health status, and urgent healthcare use among community-dwelling older adults. DESIGN: Cross-sectional analysis. PARTICIPANTS: English-speaking older adults (n = 469) who participated in the Health Literacy and Cognitive Function cohort study. MAIN MEASURES: Perceived adequacy of tangible social support was measured using a brief, validated scale that determined (1) if an individual needed assistance managing his or her health, and (2) if yes, whether this need was met. Health status was measured using physical function, depression, and anxiety PROMIS short-form instruments. Urgent healthcare utilization (emergency department and hospitalization) was self-reported for the past 12 months. KEY RESULTS: Participants' mean age was 69 years; 73% were women and 31% were African American, and 16% identified unmet support needs. Unmet support needs were associated with worse physical (ß - 6.32; 95% CI - 8.31, - 4.34) and mental health (anxiety: ß 3.84; 95% CI 1.51, 6.17; depression: ß 2.45; 95% CI 0.32, 4.59) and greater urgent healthcare utilization (ED: OR 2.86; 95% CI 1.51, 5.41; hospitalization: OR 3.75; 95% CI 1.88, 7.50). CONCLUSIONS: Perceived unmet support needs were associated with worse health status and greater urgent healthcare use. Primary care practices might consider screening older patients for unmet tangible support needs, although appropriate responses should first be established if unmet needs are identified.

Associations of urban greenness with asthma and respiratory symptoms in Mexican American children.

BACKGROUND: Evidence on the association between residential surrounding greenness (RSG) in urban areas with asthma and asthma symptoms is inconsistent. OBJECTIVE: To examine the association of RSG with respiratory outcomes in a sample of Mexican American children living in inner-city Chicago, Illinois. METHODS: This study is based on parent-reported data on 1915 Mexican American children. We calculated RSG using the normalized difference vegetation index based on satellite imagery within buffers of 100, 250, and 500 m of each child's residence. Multivariable multilevel mixed-effect logistic regression was used to estimate adjusted odds ratios (aORs) for the effect of a 1-interquartile range increase in greenness. RESULTS: In adjusted analyses, a protective effect of greenness within 100 m was observed for lifetime wheezing (aOR, 0.82; 95% CI, 0.69-0.96). Environmental tobacco smoke (ETS) exposure modified the association of RSG with lifetime asthma and current dry cough at night. For all buffer distances, increased greenness was associated with lower odds of lifetime asthma among children with current ETS exposure (100 m: aOR, 0.43; 95% CI, 0.22-0.87; 250 m: aOR, 0.39; 95% CI, 0.18-0.84; 500 m: aOR, 0.48; 95% CI, 0.26-0.90) and lower odds of current dry cough at night among children with perinatal ETS exposure (100 m: aOR, 0.53; 95% CI, 0.31-0.92; 250 m: aOR, 0.55; 95% CI, 0.31-0.98; 500 m: aOR, 0.55; 95% CI, 0.35-0.87). CONCLUSION: Our results suggest inverse associations of urban greenness with respiratory outcomes, especially in children exposed to ETS. Further research is needed to examine the mechanisms through which RSG may be associated with the risk of asthma and contribute to health.

Systemic Inflammation and Viral Exposure among Young Mexican American Women: Nativity-Related Differences.

BACKGROUND: Factors contributing to elevated inflammation in racial/ethnic minority populations are not well understood. We examined the association of viral exposure with C-reactive protein (CRP) in young Mexican American women. METHODS AND RESULTS: Participants (N=1,141) were currently non-pregnant women of Mexican background, aged 18-39 years, from the cross-sectional National Health and Nutrition Examination Survey (NHANES) 1999-2010. Viral exposure was defined as seropositive status for hepatitis B, and herpes simplex types 1 and 2, and classified as seronegative, seropositive for any one agent, and seropositive for 2 or 3 agents. The association of viral exposure with elevated CRP (3.01-10.00 mg/L) varied by country of birth (P=.001). Among Mexico-born women, those seropositive for 2 or 3 agents had 3.79 times (95% CI: 1.28-11.27) and those seropositive for any one agent 2.56 times (95% CI: 1.12-5.86) the odds of elevated CRP compared with seronegative women, after adjustment for age, country of birth, household density, waist circumference, glycated hemoglobin, and total cholesterol. Among US-born women, the corresponding odds were OR: .32, 95% CI: .12-.86 and OR: .71, 95% CI .43-1.17. CONCLUSIONS: In Mexico-born Mexican American women, viral exposure is associated with higher odds of elevated CRP.

Association of neighborhood crime with asthma and asthma morbidity among Mexican American children in Chicago, Illinois.

BACKGROUND: There is increasing evidence that neighborhood-level factors, in addition to individual-level factors, may contribute directly or indirectly to childhood asthma by affecting environmental and lifestyle factors. Exposure to neighborhood crime and violence has been associated with poor health outcomes, especially among underserved and minority populations, and its effect on respiratory health is an area of active research. OBJECTIVE: To examine the association of residential neighborhood crime with asthma and asthma-related outcomes among Mexican American children. METHODS: This cross-sectional study was conducted with parents of 2,023 Mexican American children. We derived measures of neighborhood (census tract) violent, property, and drug abuse crime and used multilevel generalized estimating equations to test associations of neighborhood crime counts with respiratory conditions. RESULTS: In multiple regression models, a 1-SD increase in neighborhood property crimes significantly increased the odds of lifetime asthma, lifetime wheezing, lifetime emergency department (ED) visits attributable to asthma or wheezing, and lifetime hospitalization attributable to asthma or wheezing by 25%, 18%, 44%, and 62%, respectively. A 1-SD elevation in neighborhood violent crime was positively and significantly associated with 21% and 57% higher odds of lifetime wheezing and ED visits, respectively. We also observed 13% and 44% significantly increased odds of lifetime wheezing and ED visits, respectively, for a 1-SD increase in drug abuse crime. These findings were not explained or modified by individual- and neighborhood-level covariates. CONCLUSION: Higher neighborhood crime was associated with greater odds of asthma and asthma morbidity in Mexican American children.

In utero exposure to pets is associated with asthma and wheezing in Mexican American children.

OBJECTIVE: To examine the associations of in utero and early life exposure to cats/dogs and birds with the risk of lifetime doctor-diagnosed asthma and other respiratory conditions in a sample of Mexican American (MA) children 4-18 years of age. METHODS: This study is a population-based cross-sectional investigation of 1816 MA children. We conducted multiple logistic models examining the relationship of asthma and wheezing with exposures to cats/dogs and birds in utero, infancy and at the time of the survey adjusted for country of birth, family history of asthma/allergies, antibiotics use in infancy and other covariates. RESULTS: In adjusted analyses, in utero exposure to cats/dogs and birds jointly was associated with increased odds of asthma (adjusted odds ratio (aOR): 2.89; 95% confidence interval (CI): 1.34-6.23), ever wheezing (aOR: 1.96; 95% CI: 1.11-3.46) and current exercise-induced wheezing (aOR: 3.16; 95% CI: 1.27-7.85) compared to children not exposed to these pets in utero. Children who were exposed to both cats/dogs and birds in utero had an elevated, albeit statistically non-significant, odds of current wheezing. Exposures in infancy and at the time of the survey to cats/dogs and birds were not associated with asthma or wheezing. CONCLUSIONS: In utero exposure to pets might be associated with an increased risk of asthma and respiratory conditions in a sample of non-affluent MA children.

Antibiotic use in infancy and the risk of asthma in Mexican American children.

OBJECTIVE: This study examined the associations of antibiotic use in infancy with lifetime doctor-diagnosed asthma and current wheeze among Mexican American children. METHODS: In a population-based, cross-sectional investigation, parents of 2023 children 4-18 years of age completed a questionnaire/interview addressing respiratory conditions, antibiotic use, and covariates. RESULTS: In adjusted analyses, among children without history of ear infections in infancy, children who used antibiotics ≥3 times and 1-2 times were more likely to report doctor-diagnosed asthma compared with their peers who did not use antibiotics in infancy [adjusted odds ratio (aOR) = 5.14, 95% confidence interval (CI): 2.88-9.17, and aOR = 2.15, 95% CI: 1.26-3.69, respectively, p trend < 0.0001]. The respective aORs for current wheeze were 3.67 (95% CI: 1.95-6.89) and 1.63 (95% CI: 0.91-2.95). Antibiotic use in infancy was not associated with asthma or current wheeze in children who had ear infections in infancy. In additional analyses, antibiotic use in infancy was associated with asthma in children without parental history of asthma or allergies (aOR = 2.73, 95% CI: 1.70-4.39) but not in those with parental history of asthma or allergies. Among Mexico-born participants born in rural areas, antibiotic use in infancy was associated with a seven-fold increase in risk of asthma (aOR = 7.21, 95% CI: 1.46-35.65), while the association was non-significant in Mexico-born children born in urban areas in Mexico. CONCLUSIONS: Antibiotic use in infancy may increase the risk of asthma and wheezing, but these associations were limited to subgroups of children.

Relationship of serum carotenoid concentrations with allostatic load as a measure of chronic stress among middle-aged adults in the USA.

OBJECTIVE: Chronic stress and repeated physiological attempts at stress adaptation may result in 'fatigue' and suboptimal performance of multiple physiological systems, i.e. allostatic load (AL). Although carotenoids have been linked with individual cardiovascular, metabolic and inflammatory biomarkers, little is known about the relationship of carotenoids with the multi-system biomarker measure of stress, AL. The present study examined the association of serum concentrations of carotenoids with AL among middle-aged adults. DESIGN: Cross-sectional. AL score was calculated based on nine risk-rated indicators (systolic and diastolic blood pressure, pulse rate, total and HDL-cholesterol, glycosylated Hb, sex-specific waist-to-hip ratio, albumin and C-reactive protein). SUBJECTS: Middle-aged (45-64 years, n 3387) men and women participants in the Third National Health and Nutrition Examination Survey, NHANES III (1988-1994). RESULTS: Serum ß-carotene concentration was inversely associated with high AL after adjusting for age, education, race/ethnicity, serum cotinine, alcohol consumption, physical activity and other carotenoids (α-carotene, ß-cryptoxanthin, lycopene, lutein/zeaxanthin). Females in the lowest ß-carotene quartile were 2·94 (95 % CI 1·74, 4·94) times and males 2·90 (95 % CI 1·43, 5·89) times as likely to have high AL, compared with peers in the highest quartile (P for linear trend 0·001 and 0·018 for females and males, respectively). Mean serum ß-carotene concentrations were also inversely associated with the number of 'high-risk' AL components (P for linear trend <0·001 and 0·004 for females and males, respectively). CONCLUSIONS: Our study adds to evidence linking low ß-carotene levels with unfavourable health outcomes.

Postpartum depression in mothers of infants in neonatal intensive care unit: risk factors and management strategies.

OBJECTIVE: The aim of this study is to assess incidence, risk factors, and management strategies for Postpartum depression (PPD) in mothers of neonatal intensive care unit (NICU) infants. STUDY DESIGN: A total of 131 mothers completed the study assessment tool (Edinburgh Postnatal Depression Scale with additional questions). Score of 10 or above was considered to indicate risk for PPD (subclinical depression). Risk factors were examined with particular emphasis on length of stay (LOS). RESULTS: Approximately 19.1% of mothers experienced (subclinical) PPD. Depression during current and previous pregnancy, and problems with current delivery were strong predicting risk factors for PPD. As the LOS increased beyond 2 weeks, the odds of PPD risks initially increased, then leveled off, and then decreased after 31 days. CONCLUSION: We recommend that the mothers of NICU infants be routinely screened for PPD and aggressively treated.

Urinary incontinence among adult women with diabetes in Jordan: epidemiology, correlates and perceived impact on emotional and social well-being.

AIMS AND OBJECTIVES: To assess the epidemiology and correlates of urinary incontinence and its perceived impact on the emotional and social well-being of Jordanian women. BACKGROUND: Diabetes is a chronic disease with rising prevalence in women worldwide. Although urinary incontinence is a complication of diabetes, it is not commonly assessed with limited nurses' knowledge available on its prevalence, correlates and its perceived impact on lives of women. DESIGN: A cross-sectional survey design using probability sampling approach was used to collect information on incontinence. METHODS: A total of 1011 adult women, 20-65 years old, attending primary healthcare centres in Jordan were interviewed using a standardised incontinence questionnaire. Questionnaire included items to assess the perceived impact of incontinence on social and emotional well-being of women. The study outcome included weekly or more any, stress and urge incontinence. RESULTS: Of 435 (43%) diabetic and 576 (57%) nondiabetic women, a total of 676 (66·8%) women reported incontinence. The prevalence of weekly or more any, urge and stress incontinence was significantly higher in diabetic than in nondiabetic women, 31·5, 13·8 and 20% versus 18·2, 5·9 and 14·2%, respectively. After adjusting for age, body mass index, parity and history of urinary tract infections, in multiple logistic regression analyses, diabetes was significantly associated with any (OR: 1·99; 95% CI: 1·44-2·74) urge (OR: 2·23; 95% CI: 1·38-3·61) and stress incontinence (OR: 1·54; CI: 1·07-2·22). Obesity and age were found to be significant correlates for urge incontinence in diabetics. Women with incontinence perceived incontinence as bothersome condition with negative impact on social well-being. CONCLUSIONS: Incontinence is a common and distressing problem in diabetic women, especially for those who are older and obese. Prospective cohort studies are needed to assess how nurse-led interventions may impact the negative consequences of incontinence on women well-being. RELEVANCE TO CLINICAL PRACTICE: Nurses are in the right position to assess urinary incontinence in diabetic women. Proper communications, culturally sensitive screening and tailored interventions may assist nurses in providing care and support to alleviate the impact of incontinence on women well-being.

Economic, Psychological, and Emotional Well-Being of Pregnant Women During the COVID-19 Pandemic.

INTRODUCTION: The intersection between perinatal mental health and the coronavirus disease 2019 (COVID-19) pandemic remains of significant public health importance. The current study examined the emotional and financial well-being and predictors of elevated depressive symptoms among pregnant women during the COVID-19 pandemic. METHODS: This online survey was conducted with 2118 women ≥18 years old who were pregnant at the time of the survey and living in the United States or Puerto Rico. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale, with scores ≥10 indicative of elevated depressive symptoms. The final logistic regression model included housing insecurity, financial distress, COVID-19 diagnosis, exposure to COVID-19, and demographic covariates. RESULTS: More than half the sample (53.8%) had elevated depressive symptoms. In logistic regression analyses, the odds of having elevated depressive symptoms were significantly higher for participants reporting housing insecurity (adjusted odds ratio [aOR], 1.56; 95% CI, 1.22-2.01), financial distress (aOR, 1.57; 95% CI, 1.17-2.12), COVID-19 diagnosis (aOR, 2.53; 95% CI, 1.53-4.17), and COVID-19 exposure (aOR, 1.41; 95% CI, 1.07-1.86), after adjusting for covariates. The association of elevated depressive symptoms with housing insecurity was especially strong among those who experienced COVID-19 (aOR, 6.04; 95% CI, 2.15-17.0). DISCUSSION: Our findings are consistent with previous literature revealing that diagnosis, exposure, concerns about family, and effects on financial stability were related to depressive symptoms during the pandemic. The relationships between financial and housing concerns with elevated depressive symptoms, independent of concerns about infection in family members, suggest that there may be direct and indirect effects of the pandemic on mental health.

Associations of Allostatic Load with Level of and Change in Cognitive Function Among Middle-Aged and Older Hispanic/Latino Adults: The Study of Latinos-Investigation of Neurocognitive Aging (SOL-INCA).

Background: Higher allostatic load (AL), a multi-system measure of physiological dysregulation considered a proxy for chronic stress exposure, is associated with poorer global cognition (GC) in older non-Hispanic white adults. However, evidence of these associations in middle-aged and older US-based Hispanic/Latino adults is limited. Objective: To examine associations of AL with level of cognition, performance in cognition 7 years later, and change in cognition over 7 years among middle-aged and older US-based Hispanic/Latino adults. Methods: We used data (n = 5,799, 45-74 years at baseline) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and SOL-Investigation of Neurocognitive Aging (SOL-INCA). The AL score comprised 16 biomarkers representing cardiometabolic, glucose, cardiopulmonary, parasympathetic, and inflammatory systems (higher scores = greater dysregulation). Cognitive outcomes included GC and individual tests of verbal learning and memory, world fluency (WF), Digit Symbol Substitution (DSS), and Trail Making (Parts A & B). Survey-linear regressions assessed associations of AL with performance in cognition at baseline, 7 years later, and via 7-year cognitive change scores adjusting for sociodemographic characteristics, lifestyle factors, and depressive symptoms. Results: Higher AL was associated with lower baseline performance in GC and WF; and lower 7-year follow-up performance in these same measures plus DSS and Trail Making Parts A & B. Higher AL was associated with more pronounced 7-year change (reduction) in GC and on WF and DSS tests. Conclusions: Findings extend previous evidence in predominantly older non-Hispanic white cohorts to show that AL is related to level of and change in GC (as well as WF and DSS) among middle-aged and older US-based Hispanic/Latino adults.

Prevalence of tobacco smoking between 2009 and 2015 among students and the general population in the Kingdom of Saudi Arabia.

INTRODUCTION: Tobacco smoking is a major risk factor for morbidity and mortality. Studies on smoking in the Kingdom of Saudi Arabia (KSA) have shown inconsistent results. The purpose of this study was to provide a literature review on the prevalence of tobacco smoking among school students, university students, and the general population of KSA during 2009-2015, before the implementation of new tobacco control measures. METHODS: We searched PubMed and Google for articles published in English from 2009 to 2015, focused on overall tobacco smoking and/or any form of tobacco smoking (e.g. tobacco, cigarette, and waterpipe) and conducted with a sample of ≥300 participants. Only the prevalence of current smoking was assessed. A narrative synthesis of the prevalence results was conducted. RESULTS: Of the 360 studies found in the primary search, 91 were selected for further examination for eligibility, and 20 studies were included in the review. Among school students, the prevalence of smoking any form of tobacco (cigarettes, waterpipes, or both) ranged 10.0-21.7%. The prevalence of cigarette smoking ranged 8.9-19.5% and for waterpipe smoking it was 9.5%. Among university students, the prevalence of smoking any form of tobacco ranged 11.1-25.3%, cigarette smoking 7.8-17.5%, and waterpipe 4.3-18.0%. In the general population, the prevalence of cigarette smoking ranged 19.6-23.5% and for waterpipe smoking it was 4.3%. CONCLUSIONS: Our study shows smoking levels were high in the KSA between 2009 and 2015. Studies utilizing standardized methodology with nationally representative samples are needed to better characterize the prevalence of different types of tobacco smoking. More research on national representative samples is needed, including studies on the same populations/groups/areas over time using standardized tools and definitions.

Embracing midcareer in the tenure system.

Midcareer faculty are the "keystone" of academia. Faculty in midcareer experience an increase or change in responsibilities and expectations as well as reduced support and mentorship usually extended to junior faculty. Nonetheless, midcareer can be an ideal time for re-evaluating and defining one's career path and taking advantage of leadership and service opportunities. Successful navigation of midcareer is essential to ensure nursing faculty remain in the academic setting, contribute to nursing science, and have a satisfying career. In this paper, we present strategies midcareer nurse faculty can consider to maintain balance and advance their careers even during challenging times. These strategies include appraising career goals, maintaining and expanding mentoring relationships, seeking and utilizing opportunities for leadership development, selecting service strategically to advance career goals, preparing for the unexpected, maintaining/expanding scholarly productivity, learning when to say yes or no, embracing lifelong learning, and improving visibility of one's work.

The Association of Food Insecurity With Asthma Control in Adults During COVID-19.

BACKGROUND: Food insecurity has been associated with poorer asthma control in children, but research lacks in adults. OBJECTIVE: To assess the frequency of food insecurity and its association with asthma control in adults during the coronavirus disease 2019 pandemic. METHODS: An online cross-sectional survey study was conducted in US adults with asthma. Survey questions included how worried or concerned participants were about food security since the pandemic. Asthma control was assessed using the Asthma Control Test, with uncontrolled asthma defined as Asthma Control Test score less than or equal to 19. Self-report of food insecurity since the pandemic was assessed. Food insecurity variables were dichotomized into high insecurity (≥3) or low insecurity (<3). Descriptive statistics and bivariate analyses were performed. RESULTS: Of the total participants (N = 866), 82.79% were female; mean age of participants was 44 ± 15.05 years, their mean Asthma Control Test score was 19.25 ± 4.54, and 18.48% had high food insecurity. Participants with high food insecurity were more likely to have uncontrolled asthma (74.38%) compared with those with lower food insecurity (34.99%; P < .01). The relationship between asthma control and food insecurity remained significant after adjusting for age, education, sex, race, anxiety, and living stability concerns due to the pandemic. CONCLUSIONS: Food insecurity exists in adults with asthma and is associated with uncontrolled asthma. Providers should consider screening their patients for food insecurity when treating individuals with uncontrolled asthma.

Association of gender with outcomes in critically ill patients.

INTRODUCTION: The influence of gender on mortality and other outcomes of critically ill patients is not clear. Different studies have been performed in various settings and patient populations often yielding conflicting results. We wanted to assess the relationship of gender and intensive care unit (ICU) outcomes in the patients included in the Acute Physiology and Chronic Health Evaluation (APACHE) IV database (Cerner Corporation, USA). METHODS: We performed a retrospective review of the data available in the APACHE IV database. A total of 261,255 consecutive patients admitted to adult ICUs in United States from 1 January 2004 to 31 December 2008 were included. Readmissions were excluded from the analysis. The primary objective of the study was to assess the relationship of gender with ICU mortality. The secondary objective was to evaluate the association of gender with active therapy, mechanical ventilation, length of stay in the ICU, readmission rate and hospital mortality. The gender-related outcomes for disease subgroups including acute coronary syndrome, coronary artery bypass graft (CABG) surgery, sepsis, trauma and chronic obstructive pulmonary disease (COPD) exacerbation were assessed as well. RESULTS: ICU mortality was 7.2% for men and 7.9% for women, odds ratio (OR) for death for women was 1.07 (95% confidence interval (CI): 1.04 to 1.1). There was a statistically significant interaction between gender and age. In patients <50 years of age, women had a reduced ICU mortality compared with men, after adjustment for acute physiology score, ethnicity, co-morbid conditions, pre-ICU length of stay, pre-ICU location and hospital teaching status (adjusted OR 0.83, 95% CI: 0.76 to 0.91). But among patients ≥ 50 years of age, there was no significant difference in ICU mortality between men and women (adjusted OR 1.02, 95% CI: 0.98 to 1.06). CONCLUSIONS: Among the critically ill patients, women less than 50 years of age had a lower ICU mortality compared to men, while 50 years of age or older women did not have a significant difference compared to men. Women had a higher mortality compared to men after CABG surgery and lower mortality with COPD exacerbation. There was no difference in mortality in acute coronary syndrome, sepsis or trauma.