Chest
Volume 156, Issue 4, October 2019, Pages 674-684
Journal home page for Chest

Original Research: COPD
Differences in COPD Exacerbation Risk Between Women and Men: Analysis From the UK Clinical Practice Research Datalink Data

A part of this work was given as a poster presentation at the 2017 winter meeting of the British Thoracic Society, December 6-8, 2017, London, England.
https://doi.org/10.1016/j.chest.2019.04.107Get rights and content

Background

Historically, COPD has been considered to affect mostly older men with a history of smoking; however, in recent times, its prevalence and mortality rates have steadily increased among women.

Objectives

The goal of this study was to systematically assess differences in COPD expression between women and men in UK primary care clinics who were newly diagnosed with COPD.

Methods

This retrospective cohort study compared women and men with an incident diagnosis of COPD by using electronic medical records data from the Clinical Practice Research Datalink and linked Hospital Episode Statistics data. The overall study period was between January 1, 2006, and February 28, 2016; patients with an incident diagnosis of COPD between January 1, 2010, and February 28, 2015, were analyzed.

Results

A cohort of 22,429 patients were identified as incident patients and included in the study; 48% of patients with COPD were women. The risk of first moderate or severe exacerbation was 17% greater in women than in men (hazard ratio, 1.17; 95% CI, 1.12-1.23), with a median time to first exacerbation of 504 days for women and 637 days for men. These differences were more prominent in the younger age group (≥ 40 years to < 65 years), as well as in Global Initiative for Chronic Obstructive Lung Disease 2016 groups B, C, and D and in individuals with moderate to severe airflow obstruction. The annual rate of moderate or severe exacerbations was higher in women compared with men in the first, second, and third year of follow-up.

Conclusions

These results highlight the unmet need for appropriate identification and management of women with COPD in clinical practice.

Section snippets

Data Sources

The current study used the electronic medical records data from the UK Clinical Practice Research Datalink (CPRD) and linked Hospital Episode Statistics (HES) data.

Patient Selection and Study Design

The overall study period was between January 1, 2006, and February 28, 2016; patients with an incident diagnosis of COPD between January 1, 2010, and February 28, 2015, were analyzed. A minimum of a 4-year washout period was applied to exclude prevalent patients. Patients with incident COPD, aged ≥ 40 years, were included. Patients

Demographic and Patient Characteristics

A total cohort of 49,169 patients with COPD were identified between January 1, 2010, and February 28, 2015, of whom 22,429 were identified as incident patients and included in the study (Fig 1). Overall, 48% of patients were women. At diagnosis, more women were either current smokers or had never smoked compared with men (Table 1). The proportion of patients using rescue medication at baseline was similar between both sexes. At baseline, there was no difference in GOLD combined assessment

Discussion

This retrospective study examined a large cohort of patients with incident COPD to identify and assess the differences in exacerbation risk and characteristics between women and men. We observed that despite the evidence of milder disease (as measured by lung function) at the time of COPD diagnosis, women were at a greater risk of moderate or severe exacerbation, with shorter time to first exacerbation and increased frequency of these events, compared with men. We found that the difference was

Conclusions

The current study found that women are at a higher risk of COPD exacerbations compared with men. The differences in COPD expression according to sex were more evident in the younger age group (≥ 40 years to < 65 years); in patients with preexisting asthma; in GOLD groups B, C, and D; and in individuals with moderate and severe airflow limitation. This trend was consistent across the first, second, and third years of follow-up. These results highlight the unmet need for appropriate

Acknowledgments

Author contributions: All authors contributed toward data analysis, drafting and revising the paper, and agree to be accountable for all aspects of the work.

Financial/nonfinancial disclosures: The authors have reported to CHEST the following: E. L., R. F., A. C., F. S. G., and H. C. are employees of Novartis. K. K. and V. C. were employees of Novartis at the time of the conduct of the study. None declared (D. S.).

Role of sponsors: The funding source Novartis is involved in the collection,

References (28)

  • N.J. Roberts et al.

    The diagnosis of COPD in primary care; gender differences and the role of spirometry

    Respir Med

    (2016)
  • J.P. de Torres et al.

    Gender and COPD in patients attending a pulmonary clinic

    Chest

    (2005)
  • L. Watson et al.

    Gender differences in the management and experience of chronic obstructive pulmonary disease

    Respir Med

    (2004)
  • Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and...
  • N. Snell et al.

    S32 epidemiology of chronic obstructive pulmonary disease (COPD) in the UK: findings from the British Lung Foundation’s ‘Respiratory Health of the Nation’ project

    Thorax

    (2016)
  • M. Raluy-Callado et al.

    Epidemiology, severity, and treatment of chronic obstructive pulmonary disease in the United Kingdom by GOLD 2013

    Int J Chron Obstruct Pulmon Dis

    (2015)
  • N. Roche et al.

    Impact of gender on COPD expression in a real-life cohort

    Respir Res

    (2014)
  • B. Celli et al.

    Sex differences in mortality and clinical expressions of patients with chronic obstructive pulmonary disease. The TORCH experience

    Am J Respir Crit Care Med

    (2011)
  • I. Tsiligianni et al.

    Response to indacaterol/glycopyrronium (IND/GLY) by sex in patients with COPD: a pooled analysis from the IGNITE Program

    COPD

    (2017)
  • S. Aryal et al.

    Influence of sex on chronic obstructive pulmonary disease risk and treatment outcomes

    Int J Chron Obstruct Pulmon Dis

    (2014)
  • Jenkins CR, Chapman KR, Donohue JF, Roche N, Tsiligianni I, Han MK. Improving the management of COPD in women. Chest....
  • R.K. Cydulka et al.

    Gender differences in emergency department patients with chronic obstructive pulmonary disease exacerbation

    Acad Emerg Med

    (2005)
  • Z. Cao et al.

    Frequent hospital readmissions for acute exacerbation of COPD and their associated factors

    Respirology

    (2006)
  • S.P. Patil et al.

    In-hospital mortality following acute exacerbations of chronic obstructive pulmonary disease

    Arch Intern Med

    (2003)
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    Drs Clemens and Cao contributed equally as senior authors to the manuscript.

    FUNDING/SUPPORT: The study was funded by Novartis Pharma AG, Basel, Switzerland.

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