Sex-related differences in management of Swedish patients with a clinical diagnosis of chronic obstructive pulmonary disease
Received 3 November 2018
Accepted for publication 25 February 2019
Published 7 May 2019 Volume 2019:14 Pages 961—969
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 4
Editor who approved publication: Dr Richard Russell
Joakim Åberg,1 Mikael Hasselgren,1 Scott Montgomery,2–4 Karin Lisspers,5 Björn Ställberg,5 Christer Janson,6 Josefin Sundh7
1School of Medical Sciences, Örebro University, Örebro 70185, Sweden; 2Clinical Epidemiology and Biostatistics, Örebro University, Örebro 70182, Sweden; 3Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; 4Department of Epidemiology and Public Health, University College, London, UK; 5Department of Public Health and Caring Sciences, Family Medicine and Preventive medicine, Uppsala University, Uppsala 75122, Sweden; 6Department of Medical Sciences, Respiratory, Allergy & Sleep Research, Uppsala University, Uppsala 75105, Sweden; 7Department of Respiratory Medicine, School of Medical Sciences, Örebro University, Örebro 70185, Sweden
Purpose: Women with chronic obstructive pulmonary disease (COPD) have more symptoms, more exacerbations, lower health status scores, and more comorbidity. However, it is unclear whether management of COPD differs by sex. The aim of the study was to investigate differences by sex in the care of patients with COPD.
Patients and methods: The population included 1329 primary and secondary care patients with a doctor´s diagnosis of COPD in central Sweden. Data were obtained from patient questionnaires and included patient characteristics and data on achieved COPD care. Analyses included cross-tabulations, chi-squared test and multiple logistic regression using several measures in COPD management as dependent variables, female sex as independent variable, and with adjustment for age groups, previous exacerbations, COPD Assessment Test, level of dyspnea assessed by the modified Medical Research Council scale, comorbid conditions, self-rated moderate/severe disease, level of education and body mass index.
Results: Women were more likely to receive triple therapy (OR 1.86 (95% CI 1.38–2.51)), to have any maintenance treatment (OR 1.82 (95% CI 1.31–2.55)), to be on sick leave (OR 2.16 (95% CI 1.19–3.93)), to have received smoking cessation support (OR 1.80 (95% CI 1.18–2.75)) and to have had pneumococcal vaccination (OR 1.82 (95% CI 1.37–2.43)), all independently of age, severity of disease or other potential confounders.
Conclusion: Management of COPD differs by sex, with women being more actively managed than men. It is unclear whether this is due to patient- or care-related factors.
Keywords: gender, triple inhaled therapy, maintenance treatment, sick leave, smoking support, pneumococcal vaccination