Sex-based Disparities in In-Hospital Outcomes Among Patients Hospitalized with Hyperthyroidism: A National Inpatient Sample Analysis (2016-2022).

Objective

Hyperthyroidism is more common in women, but hospitalized men may have worse outcomes. National U.S. data are limited. we aimed to compare in-hospital mortality, length of stay, and total charges by sex among adults hospitalized with hyperthyroidism.

Methods

We analyzed 2016-2022 NIS adult hospitalizations with a principal hyperthyroidism diagnosis (E05.xx), excluding thyroid cancer. Multivariable regression and propensity-score IPTW sensitivity analysis compared outcomes by recorded sex, with females as the reference.

Results

Among 58,150 weighted eligible hospitalizations, sex was recorded for 58,130; 74.4% were female and 25.6% male. Men had a higher comorbidity burden (Charlson index ≥5: 16.8% vs. 10.4%) and higher prevalences of atrial fibrillation and coronary artery disease (all p < 0.001). After multivariable adjustment, male sex was independently associated with higher in-hospital mortality (adjusted odds ratio [aOR] 1.82, 95% CI 1.16-2.86), higher total charges (+$5,121), and greater odds of atrial fibrillation (aOR 2.08), acute kidney injury (1.67), respiratory failure (1.25), mechanical ventilation (1.40), cardiac arrest (1.72), and pericardial tamponade (2.87), but lower odds of thyroid storm (0.89). Propensity-score analysis confirmed higher mortality (aOR 1.95, 95% CI 1.23-3.11). Male excess mortality persisted across all years from 2016 to 2022, with progressively widening disparities in total charges and acute kidney injury.

Conclusion

In this nationally representative cohort, men with hyperthyroidism had twofold higher in-hospital mortality and a greater burden of severe cardiovascular, renal, and respiratory complications despite lower odds of thyroid storm. These findings support sex-specific monitoring and risk stratification at admission.