Sex differences in long-term outcomes after traumatic injury: A mediation analysis

Background: We sought to examine the association and potential mediators between sex and long-term trauma outcomes. Methods: Moderately-to-severely injured patients admitted to 3 level-1 trauma centers were contacted between 6 and 12-months post-injury to assess for functional limitations, use of pain medications, and posttraumatic stress disorder (PTSD). Multivariable adjusted regression analyses were used to compare long-term outcomes by sex. Potential mediators of the relationship between sex and outcomes was explored using mediation analysis. Results: 2607 patients were followed, of which 45% were female. Compared to male, female patients were more likely to have functional limitations (OR: 1.45; 95% CI: 1.31–1.60), take pain medications (OR: 1.17; 95% CI: 1.02–1.38), and screen positive for PTSD (OR: 1.60; 95% CI: 1.46–1.76) post-injury. Age, extremity injury, previous psychiatric illness, and pre-injury unemployment, partially mediated the effect of female sex on long-term outcomes. Conclusions: There are significant sex differences in long-term trauma outcomes, which are partially driven by patient and injury-related factors.