Sex differences in mortality among critically ill children in Pakistan

I read with interest the article on the outcomes of critically ill children in Pakistan.1 There are two surprising findings that the authors did not discuss. First, only 37% of the attending children were female. Second, 59% of all deaths were female. One can calculate the male death rate (8.2%) and the female death rate (20.1%). This means that the relative risk of dying for girls presenting as triage category 1 is 2.44 (2.23–2.76, p<0.0001). I find it perplexing that the authors' analysis of sex differences was limited to reporting a simple sex ratio.

An excess male population does not account for this huge difference in attendance between the sexes. The sex ratio in Pakistan is 1.05 males-to-females,2 equal to the natural sex ratio at birth.3 The male-to-female ratio among children aged 0–14 years is 1.06.2 If the attendance difference is because...

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