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

Nolwenn Jestin-Guyon,1,* El Hassane Ouaalaya,2,3,* Alain Bernady,4,* Emilie Berteaud,1,* Zamira Betancourt-Rial,1,* Jean Moinard,5,* Laurent Falque,6,* Frédéric Le Guillou,7,* Mathieu Molimard,8,* Laurent Nguyen,9,* Cécilia Nocent,10,* Annaig Ozier,9,* Mohammed Staali,11,* Chantal Raherison-Semjen1,12,* 1UMR1219 Bordeaux Population Health, Bordeaux School of Public Health (ISPED), Bordeaux, France; 2High Institute of Nursing Professions and Health Techniques (ISPITS), Agadir University, Agadir, Morocco; 3Department of Biology, Laboratory of Cell Biology and Molecular Genetics, Ibnou Zohr University, Agadir, Morocco; 4Department of Pulmonology, Cardio-Respiratory Medical Center Toki Eder, Combo-les-Bains, France; 5Department of Pulmonology, Polyclinic Bordeaux Nord, Bordeaux, France; 6Department of Pulmonology, Polyclinic Bordeaux Rive Droite, Lormont, France; 7Pulmonology Clinic, La Rochelle, France; 8Department of Clinical Pharmacology, Pellegrin University Hospital, Bordeaux, France; 9Department of Pulmonology, Saint Augustin Clinic, Bordeaux, France; 10Department of Pulmonology, Hospital Center Côte Basque, Bayonne, France; 11Department of Pulmonology, Avicenne Rehabilitation Center, Libourne, France; 12Department of Pulmonology, Guadeloupe University Hospital, Pointe-à-Pitre, West French Indies, France*These authors contributed equally to this workCorrespondence: Nolwenn Jestin-Guyon, UMR1219 Bordeaux Population Health, Bordeaux School of Public Health (ISPED), Bordeaux, France, Email nolwenn.jestin-guyon@u-bordeaux.frPurpose: 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.Patients and Methods: 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.Results: 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.Conclusion: 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.Keywords: COPD, women, exacerbations, mortality