Sex differences in mortality among COPD patients: the French Palomb Cohort

Abstract

Background: Projections of Chronic Obstructive Pulmonary Disease (COPD) prevalence in men and women in France for 2025 are approximately 11.5% and 8.3% respectively. Women diagnosed with and dying of COPD is increasing. This study investigates differences in mortality according to sex in a real-life cohort of patients with COPD. Methods: Prospective multi-centered study. Patients recruited between 2013 and 2022 by pulmonologists in 2 French regions. Results are based on data collected at inclusion (smoking status, symptoms, FEV1, comorbidities) and the vital status updated in 2022. Multiple logistic regression models were used to analyze determinants of mortality and stratified by sex. Survival analyses were also used. Results: 3,228 patients were included in February 2022 with 36.5% women. 26.6% of patients died during study period with significantly more men (31.2%) than women (18.6%). In multivariate analysis (performed on the entire sample of included patients) male sex was significantly associated with a higher risk of death (aOR=2.05;CI95%=[1.67–2.51]) after adjustment for confounders. In stratified models, we found similar determinants of death according to sex: age, BMI<18.5, mMRC scale ⩾2, GOLD stage III-IV, diabetes, left heart failure and lung cancer. However, current smoking, gastroesophageal reflux disease and other tobacco-related cancers were associated to death in men but not for women. Anxiety and atherosclerosis were associated with death for women but not considered as a higher risk of death in men. Conclusion: The determinants of mortality are found to be different between men and women.