Korean J Intern Med. 2020;35(5):1154-1163.

Impact of gender on chronic obstructive pulmonary disease outcomes: a propensity score-matched analysis of a prospective cohort study.

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제1저자 조재영 · 교신저자 이창훈

PMID 32098456 PMC7487291 DOI 10.3904/kjim.2019.111 IF 2.2 호흡기내과

소속 (9)

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
Division of Respiratory, Department of Internal Medicine, Soonchunhyang University Gumi Hospital, Gumi, Korea.
Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea.
Division of Pulmonology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea.
Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

BACKGROUND/AIMS Despite increasing awareness of the burden of chronic obstructive pulmonary disease (COPD) in women, knowledge regarding gender differences in COPD outcomes is limited. Therefore, we aimed to evaluate whether COPD outcomes, including exacerbations, lung function, and symptoms differ by gender.

METHODS We recruited patients with COPD from two Korean multicenter prospective cohorts. After propensity score matching, the main outcome, the incidence of moderate or severe exacerbations was analyzed using a negative binomial regression model. We also assessed changes in lung function and symptom scores including the St. George's respiratory questionnaire for COPD (SGRQ-C), COPD assessment test (CAT), and the modified Medical Research Council (mMRC) dyspnea score.

RESULTS After propensity score matching, 74 women and 74 men with COPD were included. The incidence rates of exacerbations in women and men were not significantly different (incidence rate ratio, 1.49; 95% confidence interval [CI], 0.88 to 2.54). There was no significant difference in the incidence rates adjusted for medication possession ratios of long-acting muscarinic antagonists, long-acting β-agonists, and inhaled corticosteroids during the follow-up period (incidence rate ratio, 1.47; 95% CI, 0.86 to 2.52). Rates of decline in post-bronchodilator forced expiratory volume in 1 second and forced vital capacity did not differ between women and men during 48 months of follow-up. The changes in scores on the SGRQ-C, CAT, and mMRC Questionnaire in women were also similar to those in men.

CONCLUSION We observed no gender differences in the rate of exacerbations of COPD in a prospective longitudinal study. Further studies are needed to confirm these findings in the general COPD population.

Keywords

Chronic obstructive pulmonary diseaseMenProspective studiesWomen

Figures

**Figure 1.** Flowchart of patient selection. COPD, chronic obstructive pulmonary disease; KOCOSS, Korean COPD Subgroup Study; KOLD, Korean Obstructive Lung Disease. ^a% predicted post-bronchodilator forced expiratory volume in 1 second and forced vital capacity, and body mass index.

**Figure 2.** Kaplan-Meier curves of the time to the first moderate or severe exacerbation in the propensity score-matched cohort.

**Figure 3.** Subgroup analyses of moderate or severe exacerbations in the propensity score-matched cohort. CI, confidence interval; SGRQ-C, St. George’s Respiratory Questionnaire for COPD; CAT, chronic obstructive pulmonary disease assessment test; mMRC, modified Medical Research Council; FEV₁, forced expiratory volume in 1 second. ^aAdjusted for medication possession ratios of long-acting muscarinic antagonist, long-acting β-agonist, and inhaled corticosteroids during the follow-up period as continuous variables. ^bUsable data regarding the SGRQ-C total score at baseline were missing for nine patients. ^cUsable data regarding the CAT score at baseline were missing for 35 patients. ^dUsable data regarding the mMRC dyspnea score at baseline were missing for six patients. ^eUsable data regarding the exacerbation history during the previous year were missing for two patients at baseline.

**Figure 4.** Mean post-bronchodilator forced expiratory volume in 1 second (FEV₁) and forced vital capacity (FVC), and symptom scores over 48 months. (A) Post-bronchodilator FEV₁. A p values were 0.764 at 12 months, 0.680 at 24 months, 0.595 at 36 months, 0.809 at 48 months. (B) Post-bronchodilator FVC. A p values were 0.981 at 12 months, 0.854 at 24 months, 0.574 at 36 months, 0.871 at 48 months. (C) St. George’s Respiratory Questionnaire for COPD (SGRQ-C) total score. A p values were 0.953 at 6 months, 0.117 at 12 months, 0.222 at 24 months, 0.706 at 36 months, 0.522 at 48 months. (D) COPD assessment test (CAT) score. A p values were 0.365 at 6 months, 0.750 at 12 months, 0.965 at 24 months, 0.204 at 36 months, 0.156 at 48 months. (E) Modified Medical Research Council (mMRC) dyspnea score. A p values were 0.832 at 6 months, 0.057 at 12 months, 0.176 at 24 months, 0.804 at 36 months, 0.563 at 48 months. COPD, chronic obstructive pulmonary disease.

그림 출처: PubMed Central 공개 논문 (PMC7487291)

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

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