Sex differences in clinical characteristics and outcomes in patients hospitalized with cellulitis in Spain (2016-2022)

Abstract

Purpose: To estimate hospitalization rates, analyze sex-specific clinical characteristics, assess in-hospital mortality and its risk factors, and measure the economic burden of cellulitis hospitalizations. Materials and methods: This retrospective population-based study included adults aged ≥15 years hospitalized for cellulitis in Spain from 2016 to 2022. Multivariable logistic regression was used to identify factors associated with in-hospital mortality (IHM). Results: A total of 194,673 cellulitis hospitalizations were recorded (90,828 women and 103,845 men). The mean hospitalization rates per 1000 admissions and per 100,000 inhabitants were lower in women than men (6.0 vs. 7.6 and 63 vs. 76, respectively). In women, cellulitis was more common in those aged 65-75 and ≥80 years and in those with hypertension, dyslipidemia, heart failure, or hypothyroidism. Women had a higher crude IHM (7.4%) than men (5.9%), but sex was not significantly associated with mortality after adjustment (AOR: 1.02; 95% CI: 0.93-1.07). The strongest predictors of mortality were similar in both women and men. These included leukemia (AOR: 4.45 vs. 3.15), age ≥80 years (AOR: 3.96 vs. 4.39), sepsis (AOR: 3.59 vs. 2.95), neoplasia (AOR: 3.44 vs. 3.47), and cirrhosis (AOR: 2.49 vs. 2.41). The total hospitalization cost for women was €451.8 million, with a median cost of €3,653 per admission. Conclusions: The clinical profile and outcomes of cellulitis differ by sex. In women, advanced age, comorbidities, and complications like sepsis significantly increased mortality risk.