Gender differences in survival following hospitalisation for COPD

Gender differences in survival following hospitalisation for COPD
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DOI：
10.1136/thx.2010.141978
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发表时间：
2011-01-01
期刊：
THORAX
影响因子：
10
通讯作者：
Ernst, Pierre
Ernst, Pierre
中科院分区：
医学1区
文献类型：
--
作者：
Gonzalez, Anne V.;Suissa, Samy;Ernst, Pierre

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慢性阻塞性肺疾病（COPD）是世界范围内发病率和死亡率最高的疾病之一. COPD临床表现的性别差异越来越多地被认识到，但结果差异尚未得到系统的研究。性别差异的生存率和再住院率进行了调查，在一个大型队列的慢性气流阻塞住院COPD.Methods从魁北克省健康保险计划的数据库。研究人群包括1990年1月1日至2001年12月31日期间任何1年内接受≥ 3次呼吸系统药物处方的年龄>66岁的受试者。研究队列包括入选研究人群后首次因COPD住院的患者。随访患者直至死亡或2003年12月31日。Kaplan-Meier方法用于估计至死亡时间和至首次因阻塞性气道疾病（COPD或哮喘）住院的时间。考克斯比例风险模型被用来确定男性性别对全因死亡率和再hospitalis.Results队列包括19 260名女性和23 893名男性，平均年龄为77岁。11 245名女性（58.4%）和16 754名男性（70.1%）在进入队列后死亡。男性与死亡的风险显著增加（调整后的HR 1.45，95%CI 1.42至1.49），并与阻塞性气道疾病再住院的风险显著增加（调整后的HR 1.12，95%CI 1.09至1.15）。
Background Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Gender differences in the clinical expression of COPD are increasingly recognised, but outcome differences have not been systematically examined. Gender differences in survival and rate of rehospitalisation were investigated in a large cohort of elderly patients with chronic airflow obstruction hospitalised for COPD.Methods The databases from the Quebec provincial health insurance plan were used. The study population included subjects aged >66 years who received >= 3 prescriptions for respiratory medications in any 1-year period between 1 January 1990 and 31 December 2001. The study cohort consisted of patients with a first hospitalisation for COPD, after selection into the study population. Patients were followed until death or 31 December 2003. The Kaplan-Meier method was used to estimate time to death and time to first hospitalisation for obstructive airways disease (COPD or asthma). The Cox proportional hazards model was used to determine the effect of male gender on all-cause mortality and rehospitalisation.Results The cohort consisted of 19 260 women and 23 893 men with a mean age of 77 years. 11 245 (58.4%) women and 16 754 (70.1%) men died after cohort entry. Male sex was associated with a significantly increased risk of death (adjusted HR 1.45, 95% CI 1.42 to 1.49) and with a significantly increased risk of rehospitalisation for obstructive airways disease (adjusted HR 1.12, 95% CI 1.09 to 1.15).Conclusion Mean survival and time to rehospitalisation for obstructive airways disease are significantly better for female patients.