Influence of patient gender on in-hospital mortality: A population-based cross-sectional study

1 of 12 Nursing Open, 2025; 12:e70132 https://doi.org/10.1002/nop2.70132 Nursing Open EMPIRICAL RESEARCH QUANTITATIVE OPEN ACCESS Influence of Patient Gender on InHospital Mortality: A PopulationBased CrossSectional Study NahikariVizueteAldave1 | MaiderUgartemendiaYerobi1 | BeatrizPeredaGoikoetxea1 | NagoreZinkunegiZubizarreta1 | JosuneZubeldiaEtxeberria1 | UdaneElordiGuenaga1 | HaritzArrieta1,2 | AinitzeLabaka1 1Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), DonostiaSan Sebastián, Gipuzkoa, Spain | 2Biogipuzkoa Health Research Institute, DonostiaSan Sebastián, Gipuzkoa, Spain Correspondence: Haritz Arrieta ([email protected]) Received: 2 February 2024 | Revised: 15 November 2024 | Accepted: 7 December 2024 Funding: This research received support from the University of the Basque Country (UPV/EHU) and Mujeres de Cuidado Association US21/16 joint Project Grant. ABSTRACT Aim: To analyse the association between gender and inhospital mortality odds ratios among patients in the Basque Country. Design: Crosssectional study. Methods: Admission data pertaining to the period between 1 January 2016 and 31 December 2018 were gathered for all registered acute care hospitals (both public and private) in the Basque Country. Odds ratios were calculated through binomial logistic regressions to determine the association between gender and mortality in each diagnostic category of the ICD10. Results: Women had a higher inhospital mortality odds ratio for diseases of the circulatory system (OR 1.07 [1.01–1.14], p < 0.05). In contrast, men were at greater risk of inhospital death from neoplasms (OR 0.86 [0.83–0.94], p < 0.05), diseases of the nervous system (OR 0.83 [0.70–0.97], p < 0.05), diseases of the genitourinary system (OR 0.83 [0.71–0.96], p < 0.05), endocrine diseases (OR 0.67 [0.54–0.84], p < 0.05), injury, poisoning and other consequences of external causes (OR 0.60 [0.54–0.67], p < 0.05) and diseases of the musculoskeletal system and connective tissue (OR 0.69 [0.50–0.93], p < 0.05). Patient or Public Contribution: No patient or public contributions. 1 | Introduction In the field of public health nursing, epidemiology is used to assess the interaction of health determinants within the healthillness continuum of both individuals and communities (Egry etal.2018; Melo etal. 2021). Currently, the critical examination of social determinants by the nursing sector and the subsequent measures taken constitute the driving force behind the effort both to improve health outcomes for the population and to develop and consolidate our profession (Jones, Edwards, and Alexander2022). One of the actions recommended by the Council of Public Health Nursing Organisations (CPHNO) is the operationalisation of health equity. In other words, it is necessary to identify and understand how social structures may affect clinical attendance, in order to enable the design of subsequent preventive interactions (Engle and Campbell 2019). Although the CPHNO presents this action in the framework of combating racism, public health nursing should also incorporate sex and gender as key health determinants, since they influence both the individual's selfcare and the way in which the health system responds to their needs (Malamou2015). In order to render the gender gap in health more visible, in 2019, for the first time, the World Health Organization (WHO) published its World Health Statistics disaggregated by sex, and called upon other institutions to follow its example, claiming that this would help health systems identify gender inequalities in health, understand how gender interacts with other factors to This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2025 The Author(s). Nursing Open published by John Wiley & Sons Ltd. 2 of 12 Nursing Open, 2025 influence health outcomes and assign the necessary resources accordingly (CabanillasMontferrer and GiménezBonafé2022). However, the gender differences present in the data have yet to be rendered completely visible in the field of health, and much the same can be said in terms of comparing health outcomes in accordance with sex (World Health Organization (WHO)2023). Inhospital mortality is an important indicator for clinical and epidemiological research, often used to monitor the quality of care (García Ortega, Barrios, and García Ortega 1997). Many studies have analysed inhospital mortality by sex in specific pathologies such as acute myocardial infarction (Ribera etal.2006; RodríguezPadial etal.2021; Roque etal.2020), certain types of cancer (AbdelFattah etal.2022; Bruno etal.2022; Lee etal.2020; SendraGutiérrez etal.2009; Taioli etal.2017) and Alzheimer's disease (Golüke etal.2019; Price etal.2021; Shayne etal.2013; Wang etal.2014), among others. However, we failed to find any statistical databases that systematically compare differences in this indicator by sex or gender. Such a comparison is necessary insofar as sex and gender clearly influence mortality: women have a greater life expectancy than men (LopezdeAndres etal.2023), but suffer from poorer health for most of their lives (Darbà and Marsà2021; Nakanishi, Yamasaki, and Nishida2018). The difference in life expectancy may be explained by biological sex differences and the different behaviours that confirm gender, with neither one alone being wholly responsible (CarrilloLarco and BernabéOrtiz 2018; ConcepciónZavaleta et al. 2015; Nakanishi, Yamasaki, and Nishida2018). From a physiological standpoint, the interaction between genetic differences, the role of sex hormones, the sexual dimorphism of the immune system and the distribution of body fat has an impact on morbidity and mortality (CarrilloLarco and BernabéOrtiz2018). For their part, gender differences linked to social functions and access to information, resources and preventive and curative measures also influence health and life expectancy (Moradabadi, Hannani, and Torkashvand2023). Overlooking the biological and social differences between men and women in terms of mortality may lead to biased clinical practice among nursing practitioners. In this line, Kuhn etal.(2017) found that emergency department nurses tended to allocate women with acute coronary syndrome a less priority triage category than men with the same symptoms, and that women waited longer for appropriate diagnostic tests, such as their first electrocardiograph. In addition, PregoJimenez etal.(2022) reported, in a sample mainly comprised by registered nurses and physicians, that gender stereotypes could undermine the legitimation of low back pain, the willingness to offer support and credibility for female patients, but not for male patients. Therefore, it is crucial to consider both nurses' gendersensitive clinical judgement and patients' health literacy when assessing how health status or disease impacts life expectancy. These factors are vital components of nurseled gendersensitive health education. Indeed, research indicates that inadequate health literacy correlates with a heightened risk of mortality and hospitalisation (FranchiAlfaro etal.2018; Salvador Marín etal.2021), and studies have shown that women generally possess lower levels of health literacy compared to men (Kuhn etal.2017). In light of the above, it is vital for public health nursing to adopt a gendersensitive perspective when interpreting epidemiological results. However, we failed to find any statistical indicator that simultaneously screens for gender differences in all registered diseases of a population. Consequently, the aim of the present study is to analyse the association between gender and inhospital mortality odds ratios among patients from the Basque Country for each of the diagnostic categories included in the International Classification of Diseases 10 (ICD10) (AppendixI). 2 | Methods 2.1 | Design and Data Collection A crosssectional retrospective study was carried out to analyse the association between gender, reason for hospital admission and inhospital mortality among patients in the Basque Country. Admission data pertaining to the period between 1 January 2016 and 31 December 2018 were gathered for all registered acute care hospitals (both public and private) in the Basque Country. The data were provided by Eustat, the Basque Statistics Institute (Eustat2020). The reason for admission was reflected through the principal diagnosis, which is established on the basis of the necessary examination and is identified as the cause of the patient's contact with the hospital (Ministerio de Sanidad Servicios Sociales e Igualdad2015). Principal diagnoses were categorised in accordance with ICD10 codes (AppendixI). 2.2 | Measures 2.2.1 | Independent Variable Gender was categorised as man or woman on the basis of the information contained in the Set of Basic Minimum Data for Specialist Care in the Basque Country register. 2.2.2 | Dependent Variable Mortality was categorised as a dichotomous variable: (a) discharged as deceased or (b) alive upon discharge. This latter group comprised patients who were discharged home, transferred to another hospital or socialhealth centre or another possible destination. 2.2.3 | Control Variables The variable province refers to the three provinces of the Basque Country: Araba, Gipuzkoa and Bizkaia. This variable indicates the location in which the patient received the corresponding medical attention. Age was categorised in accordance with five groups: (a) ≤ 14 years, (b) 15–44 years, (c) 45–64 years, (d) 65–84 years and (e) ≥ 85 years. 20541058, 2025, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/nop2.70132 by Universidad Del Pais Vasco, Wiley Online Library on [22/01/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 3 of 12 Hospitals were categorised as either public or private, depending on the legal organisation or entity to which they belonged. 2.3 | Statistical Analysis In terms of descriptive statistics, frequencies and percentages were used to summarise the characteristics of our sample. Odds ratios (OR) were calculated through binomial logistic regressions to determine the association between gender and inhospital mortality for each diagnostic category. The assumptions of linearity, independence of errors and multicollinearity have been respected (Field2013). We presented the corresponding OR and 95% confidence intervals adjusted by territory, hospital ownership and patient's age. Statistical significance was set at p < 0.05. The analyses were conducted using SPSS 29.0 (IBM Corp., Armonk, NY). 3 | Results As shown in Table1, 45.6% of inhospital deaths in the Basque Country during the 3 years covered by the study correspond to women (as opposed to 54.4% corresponding to men). It should be noted that according to the total values for the 2016–2018 period, in both types of hospital (public and private), in all three provinces (Araba, Gipuzkoa and Bizkaia) and for all ages under 84 years, more men than women died in hospital. In contrast, among those aged ≥ 85 years, women had a higher inhospital mortality rate. 3.1 | Risk of Death by Gender The coefficients obtained indicate that the odds ratio of dying in hospital were significantly higher for women than for men in relation to diseases of the circulatory system (OR 1.07 [1.01–1.14], p < 0.05), atherosclerosis (OR 1.57 [1.13–2.20], p < 0.05), acute myocardial infarction (OR 1.52 [1.21–1.91], p < 0.05) and cerebrovascular diseases (OR 1.14 [1.02–1.27], p < 0.05) (Figure1). For their part, men were more likely to die from neoplasms (OR 0.86 [0.83–0.94], p < 0.05), diseases of the nervous system (OR 0.83 [0.70–0.97], p < 0.05), diseases of the genitourinary system (OR 0.83 [0.71–0.96], p < 0.05), malignant neoplasms of the colon, rectum and anus (OR 0.77 [0.63–0.94], p < 0.05), cardiac conduction disorders and dysrhythmias (OR 0.72 [0.56–0.92], p < 0.05), diseases of the musculoskeletal system and connective tissue (OR 0.69 [0.50–0.93], p < 0.05), endocrine, nutritional and metabolic diseases (OR 0.67 [0.54–0.84], p < 0.05), intracranial trauma (OR 0.64 [0.50–0.82], p < 0.05), injury, poisoning and other consequences of external causes (OR 0.60 [0.54–0.67], p < 0.05), fracture of the femur (OR 0.57 [0.47–0.69], p < 0.05), intestinal diverticula (OR 0.57 [0.32–0.99], p < 0.05) and glomerular and tubulointerstitial diseases (OR 0.36 [0.14–0.97], p < 0.05) (Figure1). No statistically significant differences were found between genders in mortality for any of the other ICD10 diagnostic categories (AppendixII). 4 | Discussion The analysis of the association between gender and inhospital mortality for each ICD10 category for the 2016–2018 period in the Basque Country revealed several statistically significant differences. First, women were found to have a statistically higher inhospital mortality odds ratio than men in relation to diseases of the circulatory system. In contrast, for neoplasms, diseases of the nervous system, diseases of the genitourinary system, endocrine diseases, injury, poisoning and other consequences of external causes, diseases of the musculoskeletal system and connective tissue and intestinal diverticula, men were at a higher risk of death than women. Consistently with the results found here, several other studies have also reported a higher risk of inhospital mortality among women diagnosed with acute myocardial infarction (Bruno etal.2022; RodríguezPadial etal.2021; Roque etal.2020), stroke (AbdelFattah etal.2022; Arboix etal.2014) and atherosclerosis (Lee et al. 2020). Furthermore, despite the fact that only 30% of myocardial infarctions, including those with STsegment elevation, occur in women (RodríguezPadial et al. 2021), acute myocardial infarction remains a leading cause of mortality among females (DeFilippis et al. 2020; Ibanez etal.2018). This could be influenced by several factors, such as older age at the time of the event, a higher prevalence of atypical clinical presentation, a greater number of risk factors and differences in both the pathophysiology of the disease and the treatment received (Holtzman etal.2023; Ibanez etal.2018). In relation to cerebrovascular diseases, these differences have been associated with women's greater life expectancy (since the incidence rate for stroke increases with age), as well as with a greater prevalence of this disease among females (Arboix etal.2014). As for neoplasms, the higher likelihood of inhospital mortality due to colorectal cancer observed among men by Pucciarelli etal.(2017) in Italy between 2005 and 2014 seems to be consistent with the higher odds ratio found among the men in our sample for death owing to malignant neoplasms of the colon, rectum and anus. In relation to lung cancer, no gender differences were observed in our sample. This is consistent with that reported by Taioli etal.(2017), who also failed to find differences after analysing a sample of patients with lung cancer who underwent limited resection or lobectomy between 1995 and 2012 in the state of New York. However, another study conducted in Spain in 2005 found a high rate of inhospital mortality among men admitted for the first time as a result of this type of cancer (SendraGutiérrez etal.2009). The difference in the results found in our study and the one cited above may be due to the fact that the risk of inhospital mortality varies in accordance with time from diagnosis. A higher risk was found for men among newlyadmitted patients, whereas no gender differences were observed in our sample, which included both first time and recurrent admissions. Indeed, differences between men and women have been reported in relation to the course of lung cancer, since women receive more chemotherapy during their first hospital admission, have fewer adenocarcinomas and epidermoid tumours, smoke less and undergo 20541058, 2025, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/nop2.70132 by Universidad Del Pais Vasco, Wiley Online Library on [22/01/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 4 of 12 Nursing Open, 2025 TABLE 1 | Deaths in acute care hospitals of the Basque Country for the period 2016–2018. 2016 2017 2018 Total 2016–2018 Women Men Women Men Women Men Women Men Total, N (%)a3259 (2.80%) 3966 (3.44%) 3465 (3.00%) 4110 (3.51%) 3401 (2.93%) 4023 (3.37%) 10125 (2.91%) 12099 (3.44%) Territory Araba 577 (3.23%) 675 (3.61%) 612 (3.45%) 715 (3.76%) 557 (3.06%) 679 (3.49%) 1746 (3.25%) 2069 (3.62%) Gipuzkoa 1131 (2.87%) 1283 (3.30%) 1135 (2.96%) 1308 (3.40%) 1106 (2.92%) 1248 (3.23%) 3372 (2.92%) 3839 (3.31%) Bizkaia 1551 (2.61%) 2008 (3.47%) 1718 (2.89%) 2087 (3.49%) 1738 (2.89%) 2096 (3.41%) 5007 (2.80%) 6191 (3.46%) Hospital ownership Public 2867 (2.97%) 3608 (3.78%) 2927 (3.06%) 3539 (3.63%) 2849 (2.95%) 3414 (3.43%) 8643 (2.99%) 10561 (3.61%) Private 392 (1.96%) 358 (1.80%) 538 (2.71%) 571 (2.91%) 552 (2.84%) 609 (3.07%) 1482 (2.50%) 1538 (2.59%) Age ≤ 14 years 16 (0.32%) 29 (0.44%) 13 (0.29%) 24 (0.37%) 33 (0.69%) 26 (0.40%) 62 (0.44%) 79 (0.40%) 15–44 years 64 (0.18%) 65 (0.38%) 44 (0.13%) 72 (0.42%) 52 (0.16%) 66 (0.39%) 160 (0.16%) 203 (0.40%) 45–64 years 386 (1.58%) 692 (2.08%) 409 (1.67%) 632 (1.88%) 398 (1.59%) 619 (1.80%) 1193 (1.61%) 1943 (1.92%) 65–84 years 1302 (3.54%) 2084 (4.37%) 1318 (3.59%) 2192 (4.49%) 1244 (3.39%) 2083 (4.18%) 3864 (3.51%) 6359 (4.35%) ≥ 85 years 1491 (9.61%) 1096 (10.30%) 1681 (10.11%) 1190 (10.48%) 1674 (9.81%) 1229 (10.24%) 4846 (9.85%) 3515 (10.34%) aPercentages of deceased women and men, according to the number of admitted women and men to acute care hospitals. 20541058, 2025, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/nop2.70132 by Universidad Del Pais Vasco, Wiley Online Library on [22/01/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 5 of 12 fewer surgical procedures when readmitted than men (SendraGutiérrez et al. 2009). However, the differences between the samples in terms of inclusion criteria, location and year preclude any direct comparison of the results. In the case of diseases of the nervous system, in the Basque Country, the likelihood of inhospital death was higher among men. In relation to this, some authors have observed a greater likelihood of inhospital death among men for the diagnostic subgroups dementia and/or Alzheimer's disease (Golüke etal.2019; LopezdeAndres etal.2023; Nakanishi, Yamasaki, and Nishida2018). For example, in Japan, an observational study involving 960,423 people aged over 65 years who had died from Alzheimer's disease, vascular dementia or another kind of dementia, concluded that men were more at risk of dying in hospital than women (Nakanishi, Yamasaki, and Nishida2018). In contrast, in Spain, from 2011 to 2016, the inhospital mortality rate was higher among female than among male Alzheimer's patients (Darbà and Marsà2021). No statistically significant differences have been found between sexes for either epilepsy (Si etal.2018) or multiple sclerosis (Pirttisalo etal.2018). However, although some studies report a greater likelihood of inhospital death among men as a result of different types of dementia, a finding that is similar to that observed for diseases of the nervous system in our study, the results for other pathologies vary. In relation to diseases of the genitourinary system, men in the Basque Country had a higher inhospital mortality rate than women. Consistently with this finding, in the United States, female patients with endstage renal disease on dialysis who are hospitalised with heart failure were found to be 25% less likely to die in hospital than their male counterparts (Inampudi etal.2019). In contrast, CarrilloLarco and BernabéOrtiz(2018) observed that the mortality rate for chronic renal disease was higher for women than for men (2.2% and 1.8% respectively); and ConcepciónZavaleta etal.(2015) found no significant sex differences in relation to chronic endstage kidney disease. These inconsistencies between the results reported in the extant literature and those found here may be due to differences in the way diseases are categorised in the different studies. Furthermore, although in relation to glomerular and tubulointerstitial kidney diseases men in the Basque Country were found to be more likely to die in hospital than women, Beckwith, Lightstone, and McAdoo (2022) concluded that no statistically significant differences existed between men and women in terms of death from lupus nephritis and antineutrophil cytoplasmic antibodyassociated vasculitis (two glomerular diseases). Nevertheless, some authors have attempted to explain the greater prevalence of these diseases among men in terms of a combination of biological, social, cultural and occupational factors. For example, women with the same level of creatinine as men have poorer kidney function due to the fact that they have less muscle mass. Also, exposure to hydrocarbons (a frequent occurrence in masculinised industrial sectors such as the painting profession and chemical industries), greater delays in seeking medical attention and more frequent smoking and drug abuse among men may explain the greater prevalence of these diseases among this sex (Beckwith, Lightstone, and McAdoo2022). Moving on to another ICD10 category, in relation to endocrine, nutritional and metabolic diseases, the inhospital mortality rate among men in our study was higher than that of women. In contrast, in a longitudinal retrospective study carried out in Ghana (Papadopoulos et al. 2008), the authors concluded that there were no significant differences between men and women in terms of inhospital mortality due to diseases of the endocrine system. In Iran, however, it was observed that from 2006 to 2018, more women than men had died from endocrine, FIGURE 1 | Adjusted odds ratio for inhospital mortality (men vs. women) by diagnosis. LCI, lower confidence interval; OR, odds ratio; UCI, upper confidence interval. 20541058, 2025, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/nop2.70132 by Universidad Del Pais Vasco, Wiley Online Library on [22/01/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 6 of 12 Nursing Open, 2025 nutritional and metabolic diseases (Moradabadi, Hannani, and Torkashvand 2023); although since the authors did not specify whether or not these deaths had occurred in hospital, it is difficult to directly compare these results with those found in our study. For male patients in the Basque Country, the likelihood of dying in hospital from injury, poisoning or other consequences of external causes was higher than for women. Consistently with this finding, studies on severe trauma in men aged ≥ 60 years (MedinaMolina, BalcellsMartinez, and PratFabregat 2019) and vertebral fractures (Ong etal.2018) report that the male population is at greater risk of inhospital death than the female one. In the diagnostic subgroup fracture of the femur, men in the Basque Country also had a greater likelihood than women of dying in hospital. Consistently with this finding, in a study carried out in Lombardy, the authors (Viganò etal.2023) found a significantly higher risk of death among men one and 2 years after a hip fracture, and the same trend has been observed in the United States also, with the mortality rate among men with pelvic fractures being 10.2% higher than among women (Yoshihara and Yoneoka2014). Nevertheless, other authors have failed to find any association between sex and likelihood of inhospital death for these same diagnoses (Salvador Marín etal.2021) or have reported a greater risk among women (FranchiAlfaro etal.2018). The variation between findings may be due to the specific particularities of each study in terms of how they interpret the ICD category injury, poisoning and other consequences of external causes in comparison with the general interpretation used here. Finally, within this same ICD category, in relation to the specific diagnosis of intracranial trauma, inhospital mortality was higher among men in our study than among women. Consistently with this finding, in a study carried out in the USA between 2000 and 2017, the authors observed a statistically significant higher mortality rate among male than among female patients as a result of traumatic brain injury (Daugherty etal.2019). In contrast, in Australia, although most inhospital deaths following traumatic brain injury corresponded to men (69.2%), no statistically significant differences were observed between men and women admitted as a result of this kind of injury (O'Reilly etal.2023). In the diseases of the musculoskeletal system and connective tissue category, men in the Basque Country were at greater risk of inhospital death than women. A similar trend was observed in a Spanish study on osteomyelitis, in which the authors observed that being a woman was a protective factor for inhospital mortality among patients suffering from this disease (López del Pino and Guerrero Espejo2019). In Korea, although sex was not found to predict inhospital mortality among knee arthroplasty patients, it was found to predict postoperative mortality, with men being at greater risk than women (Choi etal.2021). Finally, for intestinal diverticula diagnoses, men from the Basque Country were at greater risk of inhospital death than women. In the United States also, women were found to have lower mortality rates in a study analysing a sample of 4 million hospital admissions for diverticulitis (Diamant etal.2015). However, it is worth noting that, in Italy, inhospital mortality due to this pathology increased significantly for women between 2008 and 2015 (Binda etal.2018). If we focus on the general ICD categories, we see that, in our study, the odds ratios for inhospital death were higher for men suffering from neoplasms, diseases of the nervous system, diseases of the genitourinary system, injury and poisoning and diseases of the musculoskeletal system; whereas among women, the odds ratio for inhospital death was higher among those with diagnoses listed under the general diseases of the circulatory system category. Interestingly, we found no other study analysing these general ICD categories per se in accordance with gender. We are therefore unable to directly compare results, and have opted instead to discuss the risk of inhospital mortality in these general categories with the results reported in studies focusing on similar diseases. There is an absence in the extant literature of comparisons between men and women for many of the specific pathologies outlined in the ICD. This serves to highlight the lack of any systematic method for comparing a very basic indicator (namely inhospital mortality) in accordance with gender. Given the territorial characteristics of the Basque Country, one of the strengths of the present study is the homogeneity of the community sample analysed, as well as its large size. Furthermore, the fact that all data were obtained from the same source (Eustat— the Basque Statistics Institute) guarantees a high degree of standardisation in their processing. However, the analysis may have benefited from the study of more factors influencing health outcomes that, unfortunately, were not available, such as socioeconomic status, ethnic origin and reason for hospital admission. 4.1 | Clinical Implications Comparing inhospital mortality odds ratios by gender has been shown to be a good indicator for identifying those diseases in which the differences between men and women are greatest. It is now important to compare these results with those found in other populations. The analysis conducted here should therefore be replicated in other hospitals and statistical observatories, etc. The present study highlights various biological specificities linked to gender that may influence mortality, including the pathogenesis of lung cancer and glomerular diseases. It is important for nursing practitioners to be aware of these physiopathological differences in order to avoid succumbing to type B gender bias, or in other words, assuming, when assessing a patient, that the physiopathologies of men and women are the same when, in fact, they are quite different (CabanillasMontferrer and GiménezBonafé2022). Following Henderson's model (Correa Argueta, Verde Flota, and Rivas Espinosa2016), several sources of difficulties have been detected in the vulnerable population that could be modified in order to enable people to reach their full health potential. For example, the lower awareness of the importance of acute myocardial infarction among women may be redressed through primary care nurseled health education. In this sense, it is worth noting that a nurseled phone followup education programme proved effective in increasing selfefficacy for disease management in a study involving 403 patients of both sexes suffering 20541058, 2025, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/nop2.70132 by Universidad Del Pais Vasco, Wiley Online Library on [22/01/2025]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License 7 of 12 from cardiovascular disease (Zhou etal.2018). Similarly, nurseled intervention initiatives such as the Protecting Healthy Hearts Program may be useful for improving the management of cardiovascular risk factors such as total cholesterol, weight and blood pressure (Carrington and Stewart2015). These initiatives were based on individual plans for developing selfcare skills, promoting healthy lifestyles and therapeutic adherence with followups scheduled in accordance with each patient's risks and needs. They managed to reduce systolic blood pressure by 4 mmHg, diastolic blood pressure by 1 mmHg and body mass index by 0.3 kg/m2, among others (Carrington and Stewart2015). Delays in seeking medical assistance among women constitute another factor linked to their higher inhospital mortality rate due to coronary disease (Holtzman etal.2023). This same factor is also associated with higher inhospital mortality rates among men due to glomerular diseases (Beckwith, Lightstone, and McAdoo2022). Promoting health at all ages and levels is the best possible tool for reducing the time that elapses before patients seek medical attention (MorenoMartínez etal.2016). This can be achieved through interventions targeting women's lifestyle and the principal cardiovascular risk factors, as well as through preventive pharmacological interventions. In all these actions, the active participation of the nursing profession is vital (Wood and Gordon2012). These same interventions could be adapted for glomerular diseases. Smoking has been linked to greater inhospital mortality due to lung cancer (SendraGutiérrez etal.2009) and glomerular diseases (Beckwith, Lightstone, and McAdoo 2022) among men. Nursing has a key role to play in both preventing smoking and helping people to give up once they have started. For example, an intensive nurseled intervention programme targeted at 163 patients, carried out from 2004 to 2012 at a health centre in Asturias, achieved a smoking abstinence rate of 45.1% 12 months later (Blanco Riopedre and Fernández Fernández2015). Finally, occupational exposure to hydrocarbons may be a risk factor for lupus nephritis and antineutrophil cytoplasmic antibodyassociated vasculitis (Beckwith, Lightstone, and McAdoo2022). In relation to this, it is important to highlight the role of occupational nursing, not only in the protection, prevention and promotion of health in the labour field, but also in terms of monitoring workers' health, working conditions and the risks present in the workplace (JuárezGarcía and HernándezMendoza2010). Across its entire scope of action and from the perspective of public health and occupational health, nursing therefore has the capacity to intervene to prevent those factors that may contribute to higher rates of inhospital mortality. 4.2 | Study Limitations Our study has certain limitations that should be considered when interpreting the findings. One of the main limitations of this study is the nature of the data set, which does not allow us to identify deceased patients or to obtain details on their comorbidities or medical history. The lack prevents an exhaustive analysis of the factors that could have influenced the prognosis and evolution of the patients, which could limit the generalisation of the results. In addition, the subjectivity and variability that may exist among clinicians when assigning an ICD10 diagnostic code to individuals upon admission or death must be considered. Finally, we recognise that the results obtained in this study should be interpreted with caution, as they include only inhospital mortality, and not outofhospital mortality. Despite these limitations, we believe that the results obtained provide valuable information on gender inequalities in inhospital mortality and provide a solid basis for future research. 5 | Conclusions Whereas in relation to diseases of the circulatory system women were more likely to die in hospital, for all the other diseases analysed, men had higher inhospital mortality rates. To the best of our knowledge, this is the first study to analyse the odds ratios of inhospital mortality by gender for each of the ICD10 categories. Having this overview of our health system will enable us to determine a starting point for working towards equality between men and women within the health service. There are many different factors (biology, gender roles in society, life expectancy, literacy, health actions, etc.) that may explain these inequalities. Being aware of the ICD10 categories in which these inequalities exist may help us better organise our resources in order to continue researching this issue, since remaining unaware of the factors that may be causing these differences does nothing but perpetuate a situation of inequality between men and women. Viewing prevention as the cornerstone of the public health system, and nursing practitioners as key professionals within that system, we hope this paper has served to highlight the importance of working, from within the nursing sector, on health promotion activities, with the aim of influencing those factors that may result in men and women having unequal health outcomes. Author Contributions All of the authors contributed intellectually to the work, meet the conditions of authorship and have approved the final version of it. A.L. devised the project, the main conceptual ideas and proof outline, N.Z.- Z., U.E.- G. and H.A. analysed the data, B.P.- G. and N.V.- A. developed the theoretical framework and N.V.- A., M.U.- Y. and J.Z.- E. discussed the results. I declare that the work is original, has not been previously published and is not under review by any other journal. Ethical principles have been consistently adhered to throughout the research process, and we would be willing to provide more information about our data and methods if necessary. Acknowledgements We express our gratitude to Eustat—the Basque Institute of Statistics for providing us with epidemiological data, and we extend special appreciation to the technician Marta De la Torre Fernández for her professionalism and efficiency. 20541058, 2025, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/nop2.70132 by Universidad Del Pais Vasco, Wiley Online Library on [22/01/2025]. 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