Sex-Specific Differences in Outcomes and Trends in Patients With Ulcerative Colitis

Sex-based differences in immune-mediated diseases are becoming more widely recognized, but there is very limited research exploring sex-based differences in ulcerative colitis (UC), particularly more severe forms of UC. Some recent studies have suggested lower colectomy rates in female patients with UC. The objective of this study is to assess the association between sex and outcomes of patients with UC, particularly those with more severe forms of the disease requiring hospitalization.

A propensity score matched retrospective cohort study was performed using TriNetX, a multi-institutional database, to compare risk of colectomy, hospitalization, and mortality between male and female patients with UC, including subgroup analyses of those who had been hospitalized, had received intravenous steroids within 2 weeks of hospitalization or had received infliximab within 1 month of hospitalization.

Males had a statistically significant increased risk of colectomy (odds ratio (OR) 1.50, 95% confidence interval (CI) 1.40-1.61; OR 1.47, 95% CI 1.38-1.57), hospitalization (OR 1.04, 95% CI 1.02-1.06; OR 1.02, 95% CI 1.00-1.04), and mortality (OR 1.28, 95% CI 1.21-1.34; OR 1.32, 95% CI 1.28-1.37) at 1 year and at 5 years after diagnosis. Similar results were found when focusing on hospitalized UC patients and males receiving intravenous steroids within 2 weeks of hospitalization. For patients receiving infliximab within 1 month of hospitalization only colectomy rates were significantly different between males and females at the 1-year timepoint.

Male patients with UC are at higher risk for colectomy, hospitalization, and mortality than females with UC.