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

[PURPOSE] 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 FEV/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; CI[1.46-2.19]), mMRC grade 1 (aOR=1.46; CI[1.14-1.89]) and grade 2 (aOR=1.41; CI[1.07-1.87]) and a higher risk of severity E of the ABE classification (aOR=1.56; 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; 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.