Abstract
Background. Gender medicine is a neglected dimension of medicine.
Objectives. We tested the hypothesis that long-term outcomes vary between genders in patients discharged after a COPD exacerbation.
Methods. A cohort of patients aged 45+ with first hospitalization for COPD in 2006-2009 and resident in Lazio and Emilia-Romagna regions was enrolled from administrative databases. Patients were followed from discharge until death or end of 2010 and were characterized on the basis of information at cohort entry. A Cox proportional hazard model was used to determine the effect of female gender on natural, cardiovascular and respiratory mortality adjusting for age, region of residence, calendar time, comorbidities and prior drug use.
Results. The cohort consisted of 33846 patients with 47.4% women and median age of 78 years. During the 5-year follow-up, natural mortality crude rate was 14.8 per 100 person-years with 15.6 for men and 13.9 for women. Cardiovascular mortality rate was 6.6 (6.4 men, 6.8 women) and respiratory mortality rate 3.9 (4.4 men, 3.3 women). Mortality risk factors were: increasing age, psychiatric disorders, cardiovascular and respiratory comorbidities, while hypertension and statin use were protective. Natural mortality risk was significantly lower in women than in men, also after adjusting (HR=0.81; IC95%=0.78-0.84), and Kaplan-Meier curves showed a major reduction of female mortality for respiratory causes.
Conclusions. Our study confirms better long-term prognosis of women with COPD. These results suggest that different pathophysiology and risk factors may contribute to gender differences, which might be of potential relevance for prevention, diagnostics, and therapy.
- © 2014 ERS