Gender versus sex in predicting outcomes of traumatic brain injury: A cohort study utilizing large administrative databases

Understanding the factors associated with elevated risks and adverse consequences of traumatic brain injury (TBI) is an integral part of developing preventive measures for TBI. Brain injury outcomes differ based on one’s sex (biological characteristics) and gender (social characteristics reflecting norms and relationships), however, whether it is sex or gender that drives differences in early (30-day) mortality and discharge location post-TBI event are unknown. In the absence of gender variable in existing data, we developed a method for “measuring gender” in 276,812 residents of Ontario, Canada who entered the emergency department and acute care hospitals with a TBI diagnostic code between April 1(st), 2002 and March 31(st), 2020. We analysed differences in diagnostic codes between the sexes to derive gender score that reflected social dimensions. Sex had a significant effect on early mortality after severe TBI with a rate ratio (95% confidence interval (CI)) of 1.54 (1.24-1.91). Gender had a more significant effect than sex on discharge location. A person expressing more female-like characteristics have lower odds of being discharged to rehabilitation versus home with odds ratio (95% CI) of 0.54 (0.32-0.88). The method we propose offers an opportunity to measure gender effect independently of sex on TBI outcomes.