Sex Differences and Survival Among COPD Patients in France: The Palomb Cohort

Previous studies suggest that the clinical presentation of chronic obstructive pulmonary disease (COPD) is different between men and women. The aim of this study was to investigate sex-related differences and survival among COPD patients.

Multicentric prospective real-life cohort. COPD patients (post-bronchodilator FEV₁/FVC <0.7) of any stages of airway obstruction recruited since January 2014 by pulmonologists. Stratified logistic regression models assessed to identify the determinants of dyspnea, exacerbations, ABE classification and all-cause mortality by sex. Kaplan-Meier curves and Cox proportional-hazards models were also performed.

A total of 3265 patients included, with 36.7% women. Women had an increased risk of ≥2 exacerbations (aOR=1.79; _95%CI[1.46-2.19]), mMRC grade 1 (aOR=1.46; _95%CI[1.14-1.89]) and grade 2 (aOR=1.41; _95%CI[1.07-1.87]) and a higher risk of severity E of the ABE classification (aOR=1.56; _95%CI[1.27-1.93]). In stratified models, the determinants of these outcomes were different. Men had a lower survival rate at GOLD airway obstruction I-II (Log-rank: p<0.0001) and III-IV (Log-rank: p<0.0001) and a higher risk of mortality (HR=1.62; _95%CI[1.40-1.87]). Common factors characterizing mortality were: age, BMI <18.5, mMRC ≥ 2, airway obstruction, diabetes and lung cancer. Additional factors related to mortality in men were asthma, left heart failure and tobacco-related cancers.

COPD is more severe in women however men have a higher risk of mortality. Clinical features and mortality in men and women with COPD are different in our cohort. Further studies are needed to elucidate sex-related differences among COPD patients.