Women With ILD Fare Better After ICU Care

Medscape

12-06-2025

Women admitted to ICU for interstitial lung disease (ILD) had shorter hospital stays and a lower risk for death than men, based on a new analysis of more than 800,000 individuals.
Although previous studies have shown gender-based disparities in disease progression and severity for ILD based on subtype, data on the effect of gender on ICU outcomes in these patients are limited, according to Matthew Viggiano, MD, an internal medicine resident at Temple University Hospital, Philadelphia, and colleagues.
In a study presented at the American Thoracic Society (ATS) 2025 International Conference, the researchers analyzed data from the National Inpatient Sample (NIS), part of the Healthcare Cost and Utilization Project for the period from 2016 to 2018. They identified 810,295 adults aged 18 years or older hospitalized with ILD, of whom 42,080 received ICU care. Of these, 46.7% were women.
Female patients were significantly younger than male patients (mean age, 66.9 vs 69.1 years), more likely to be African American (17.0% vs 10.9%), and less likely to be Caucasian (63.7% vs 69.2%; P < .001 for all).
Mortality was significantly lower in women than in men (40.5% vs 48.1%) even after adjusting for confounders including age, race, and comorbidities, and this difference was the most striking finding, Viggiano said in an interview.
'It also surprised us that these women tended to have a shorter length of hospital stay, given many came from lower-income areas,' he said.
ICU stays were defined using International Classification of Diseases (ICD) codes for central line placement and mechanical ventilation. Overall, hospital stays for female patients lasted 1.15 days less than hospital stays for male patients.
Female patients also were significantly more likely than male patients to come from lower-income ZIP codes (38.3% vs 33.2%) and less likely to have a history of tobacco use disorder (35.0% vs 43.9%; P < .001 for both).
The reasons for the disparities remain unclear, but new studies suggest that hormones may play a role in disease progression and severity, Viggiano told Medscape Medical News . 'For example, estrogen has been implicated in modulating immune responses and fibrotic processes in the lungs via downregulating profibrotic pathways,' he said. 'Additionally, women may have lower threshold to seek medical attention or follow-up, leading to earlier intervention and management of ILD,' he noted. Other comorbidities unrelated to ILD also may contribute to morbidity and hospital length of stay, he added.
'Overall, recognizing these disparities is a key step toward more personalized treatment strategies, and our hope is that this research will prompt further studies to fully understand and address the underlying causes,' said Viggiano.
Not Time for Gender Neutral Treatments
Although the results suggest that clinicians should be aware that gender could influence ILD prognosis, the data do not suggest a need to advocate for entirely separate protocols as yet, Viggiano said. 'Instead, we encourage clinicians to recognize that men may have unique risk factors and might require more aggressive monitoring or early interventions; further studies will help refine specific management strategies,' he said.
'We believe evaluating for mortality and hospital stay in different subtypes of ILD would be an immediate future direction for the project,' said Viggiano. The investigation of specific biological, immunologic, and social factors also must be an area of focus, he said. 'Understanding why women fare better could lead to targeted therapies, especially for men who are at higher risk of poor outcomes, and ultimately to more personalized approaches to ILD care,' he added.
To that end, Viggiano and colleagues intend to conduct prospective studies to explore specific biological markers and social determinants in men and women with ILD. 'We'll also look at the influence of treatment interventions, medication use, and rehabilitation services on outcomes. Ultimately, we'd like to identify targeted strategies to reduce the mortality gap and enhance care for both genders,' he told Medscape Medical News .
Data Reinforce Differences
'As more treatments for interstitial lung diseases emerge, it is important that we now start focusing on which populations get the greatest benefit for specific treatments,' said Anthony Faugno, MD, a pulmonologist at Tufts Medicine, Boston, in an interview.
To that end, the authors of the current study used data from the NIS to ask important questions about how sex, demographics, and socioeconomic factors affect patient outcomes, said Faugno, who was not involved in the study.
Were You Surprised by Any of the Findings? Why or Why Not?
Biologically important differences in hormones between men and women are known to affect the way a given disease behaves; therefore, it is important to have representative samples of diverse sex and race in clinical trials to ensure the generalizability of therapy, Faugno told Medscape Medical News . The current study findings were not surprisingbut reinforce the value of a diverse population using a large, nationally representative sample, he said.
The current study findings may not directly affect clinical practice, as the results were based on ICD codes that cover many different diagnoses, Faugno noted. However, as the authors suggest, 'I do think it informs additional research directions, such as doing a similar analysis in specific interstitial diseases,' he said.
The current study addresses a global catch-all term of ILD, which may include many different pathologies that respond to different treatments, said Faugno. 'A future analysis that addressed the gender disparities in more specific diagnoses would add to our understanding and help patients better understand how they may respond to a specific therapy,' he said.