Sex Differences in Documented Multimorbidity and Selected Healthcare-Use Indicators Among Deceased Patients Meeting...

Advanced chronic obstructive pulmonary disease (COPD) is associated with multimorbidity and substantial healthcare use. However, sex differences in documented multimorbidity and healthcare use near the end of life remain insufficiently understood.

This retrospective population-based cohort study used routinely collected administrative and clinical data from Clalit Health Services, Israel. The study included deceased patients with advanced COPD during 2016-2020 and 2022-2023. The year 2021 was excluded a priori as the period designated in the study protocol to minimize distortion in healthcare utilization, and mortality patterns; 2020 remained part of the prespecified observation window. The cohort comprised 2261 patients aged ≥55 years who met an operational definition requiring documented COPD, FEV1/FVC <0.70, FEV1 <50% predicted, and at least two opioid prescriptions or dispensations during the final year of life. The opioid criterion was not considered a stand-alone diagnostic criterion or evidence of refractory dyspnea. Women and men were compared regarding demographic characteristics, multimorbidity, selected healthcare-use indicators, coded palliative care encounters, and time from first documented COPD diagnosis to death.

The cohort included 547 women and 1714 men. Women were older and more frequently had dementia and rheumatic/connective tissue disease. Men more frequently had myocardial infarction, renal disease, peripheral vascular disease, and diabetes. Men had more documented procedures, although the effect size was small. The mean Charlson Comorbidity Index differed by 0.44 points, of uncertain clinical importance. Coded palliative care encounters were rare and available only for small subsamples. Median time from first documented COPD diagnosis to death was 33 months among women and 29 months among men, without a statistically significant difference (log-rank p=0.328).

Sex differences were observed primarily in documented multimorbidity. Healthcare-use and palliative-care findings were partial and descriptive and should not be interpreted as complete end-of-life trajectories or causal effects of sex.