Women Die of Diverticulitis Disproportionately More Often Than Men

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Diverticulitis is the leading reason for gastrointestinal-related hospital admissions, which have been continually increasing for two decades. It's well established that women are more likely than men to be diagnosed with diverticulitis. This difference has been attributed to the fact that women outlive men, on average, and therefore represent a larger proportion of the older population, which is at greater risk of diverticulitis.

Naomi M. Sell, MD, MHS, general surgery resident, Rocco Ricciardi, MD, MPH, chief of the Section of Colon and Rectal Surgery at Massachusetts General Hospital, and colleagues thought the sex-based variance need closer scrutiny.

In Diseases of the Colon & Rectum, they report that women are disproportionately more likely than men to have diverticulitis as their underlying cause of death or to have a secondary cause of death related to infection, obstruction or fistulae. Women with diverticulitis might have a more variable presentation of diverticulitis or more chronic disease compared with their male counterparts.

Study Methods

The researchers harnessed a CDC database that captures 99% of deaths of U.S. citizens. For the study period from January 1999 through December 2016, they collected data on the underlying cause of death and the secondary (additional) causes of death listed on death certificates.

Underlying Cause

During the study period, 55,096 of 44,915,066 deaths (0.12%) were reported to be caused by diverticulitis. Approximately 68% of diverticulitis deaths were in women vs. 32% in men. Deaths from diverticulitis comprised 0.017% of all deaths in women and 0.08% in men (P<0.001).

Secondary Causes

Women were more likely than men to have nonsurgical infections listed, the most common being:

• Intestinal infections including sepsis (OR, 1.04; 95% CI, 1.01–1.05; P<0.03)
• Chronic pelvic fistulizing disease (OR, 1.43; 95% CI, 1.23–1.66; P<0.001)

Women were more likely than men to have a nonsurgical gastrointestinal complication listed, such as abscess, perforation or obstruction (OR, 1.16; 95% CI, 1.09–1.24; P<0.001). They were also less likely than men to have their death related to procedural or surgical complications (OR, 0.72; 95% CI, 0.66–0.78; P<0.001).

Yentl Syndrome

Bernadine Healy, MD, a cardiologist who became the first female director of the National Institutes of Health, coined the term "Yentl syndrome" in 1991 to describe sex-based discrepancy in the evaluation and treatment of women with coronary artery disease. In an editorial, she suggested that only when female patients present like men are they likely to be diagnosed and treated for coronary artery disease appropriately (as published in The New England Journal of Medicine). Since then, Yentl syndrome has been identified in patients with sepsis, asthma and acute appendicitis.

The progression of diverticulitis, too, may differ in women and men. Nonprocedural complications such as infections, obstructions and pelvic fistulae indicate women may have more subtle symptoms and less acute complaints. These differences may lead to fewer hospitalizations and less invasive procedures, which may lead to more chronic disease and higher overall diverticulitis mortality. Female patients thus represent a particularly vulnerable population that may benefit from more intensive diverticulitis evaluation.

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