Study Identifies Gender Differences in Evaluation, Treatment, Outcomes Among Veterans With COPD

Analyzing chronic obstructive pulmonary disease (COPD) evaluation, treatment, and outcomes among veterans, researchers have found that women who are admitted to the hospital with the disease are evaluated and treated differently than men prior to hospitalization and have better hospital-associated outcomes.

While COPD has traditionally been associated with older men, recent years have brought a shift in prevalence of the disease, with COPD mortality having decreased among men while it has increased among women. As the demographics of the disease continue to evolve, understanding sex differences in behaviors, comorbidities, and treatment of patients are crucial.

The researchers collected data on nearly 50,000 veterans admitted to Veterans Health Affairs facilities for a COPD exacerbation between 2012 and 2015 who survived discharge. Prior to hospitalization, women were more likely to receive nicotine-replacement therapy (24% vs 15%) but were less likely to receive anti-muscarinic (43% vs 48%) or combined long-acting beta-agonists and inhaled corticosteroids (ICS) (61% vs 64%). They were also less likely to undergo pulmonary function testing (76% vs 78%).

Looking at intensive care unit admission rates and the need for mechanical ventilation, rates were comparable between both sexes. The median length of stay was shorter for women (2 days vs 3 days), as was the 30-day readmission rate (20% vs 22%).

However, in adjusted models, sex was not a factor for readmission, which may suggest that comorbidities that differ by sex are the driving force for readmissions, noted the researchers, who added that individualized case management may reduce readmission risk for both men and women with the disease.

Compared with men, the women were younger, more likely to be non-white, and were more likely to have asthma, drug use disorder, and psychiatric comorbidities. They were less likely to have hypertension, diabetes, congestive heart failure, and alcohol use disorder.

Smoking status also varied by sex, with women more frequently being either current smokers (71% vs 62%) or never smokers (13% vs 10%).

“Since women’s lung functions may be more susceptible to tobacco smoke, and women veterans in our cohort were more likely to be current smokers, our findings support that smoking cessation must remain a primary focus of COPD management for women,” wrote the researchers.”

Older age, white race, inhaler use, and multiple comorbidities were associated with an increased risk of 30-day readmissions, specifically congestive heart failure, alcohol use disorder, drug use disorder, and anxiety. Meanwhile, smoking status and prior pulmonary function testing were not associated with readmission risk. Veterans who were prescribed anti-muscarinics before being hospitalized were 13% more likely to be readmitted.

When stratified by sex, older age, congestive heart failure, anxiety, and the presence of drug use were associated with 30-day readmission, while white race, diabetes, major depressive disorder, and anti-muscarinic use were only significant among men.

Reference:

Bade B, DeRycke E, Ramsey C, et al. Sex differences in veterans admitted to the hospital for COPD exacerbation published online March 1, 2019]. Ann Am Thorac Soc. doi: 10.1513/AnnalsATS.201809-615OC.