Assessment of Sex-Dependent Medical Outcomes During Spaceflight.

Background: In this study sex-differences in medical outcomes during spaceflight are reviewed and probabilistic risk assessment (PRA) is used to assess the impact on spaceflight missions of varying lengths. Materials and Methods: We use PRA to simulate missions of 42 days, 6 months, and 2.5 years. We model medical outcomes using three crews: two men and two women, four women, or four men. Total medical events (TME), crew health index (CHI), probability (0-1) of medical evacuation (pEVAC), probability of loss of crew life (pLOCL), and influential medical conditions were determined. Results: No differences were seen in any metric for the 42-day mission. There were no differences seen for any mission length, in any crew, for TME, CHI, pLOCL, or environmental causes of pEVAC. Sex-dependent differences are seen for rates of nonemergent pEVAC during the 6 month and 2.5-year missions, where women have a higher pEVAC in the 182-day (0.0388 vs. 0.0354) and 2.5-year missions (0.350 vs. 0.228). These differences were driven by higher incidence of partially treated urinary tract infection (UTI). In the 2.5 year mission, with resupply of medical resources, the influence of UTI in women on pEVAC decreases (0.35-0.11). Conclusion: Although resupply is unlikely for deep space missions, modeled results suggest that sex-specific medical needs can be readily managed through preventive measures and inclusion of appropriate medical capabilities. Within its many limitations, PRA is a useful tool to estimate medical risks in unique environments where only expert opinion was previously available.