Gender bias in the diagnosis of COPD
Gender bias in the diagnosis of COPD
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DOI：
10.1378/chest.119.6.1691
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发表时间：
2001-06-01
期刊：
影响因子：
9.6
通讯作者：
Pye, DJ
中科院分区：
文献类型：
--
作者：
Chapman, KR;Tashkin, DP;Pye, DJ
背景：认为COPD在男性中比女性更为普遍，这一发现通常归因于更高的吸烟率和更频繁的男性职业暴露。但是，女性的吸烟率增加了，有证据表明，女性可能比男性更容易受吸烟的不良肺功能影响。在两性中，由于肺功能的客观措施未使用，目的：我们进行了本研究，以确定COPD的诊断是否存在性别偏见，因此两性的COPD也可能存在诊断不足和误诊。接受COPD的诊断，我们还试图确定I; ng功能测量是否不足是任何检测到的偏差的一个因素。方法：我们调查了192位初级保健医师的随机样本（96名美国和96名加拿大人； 154名男性和154名男性和38妇女）使用假设的案例表现和结构化访谈。吸烟者中咳嗽和呼吸困难的情况仅在六个版本中，仅在患者的年龄和性别上有所不同。在介绍了病史和身体发现后，要求医生陈述最可能的诊断并选择所需的诊断研究，然后向医生提供了中度或重度梗阻的肺活量测定结果，而没有明显的支气管扩张剂反应，并且问题重复。最后，描述了口服类固醇试验的负面结果。结果：最初，COPD作为男性的最可能诊断要大得多（58％vs 42％； P <0,05），这是一种可能性随着客观信息，COPD诊断显着增加，性别之间的初始差异减少。肺活量测定后，男性和女性的COPD诊断率为74％vs 66％（p =不显着）；在类固醇试验之后，85％vs 79％（p =不显着）。最初的结论结论：在北美，初级保健医师诊断不足的COPD，特别是在女性中，只有22％的医生会要求进行肺活量测定法。肺活量测定法降低了诊断不足和性别偏见的风险，但没有使用。
Background: COPD is thought to be more prevalent among men than women, a finding usually attributed to higher smoking rates and more frequent occupational exposures of significance for men. However, smoking prevalence has increased among women and there is evidence that women may be more susceptible to the adverse pulmonary function effects of smoking than men. There may also be underdiagnosis and misdiagnosis of COPD in both sexes because objective measures of lung function are underused,Objectives: We undertook the present study to determine if there is gender bias in the diagnosis of COPD, such that women are less likely than men to receive a diagnosis of COPD, We also attempted to determine if underuse of I;ng function measurements was a factor in any bias detected.Methods: We surveyed a random sample of 192 primary-care physicians (96 American and 96 Canadian; 154 men and 38 women) using a hypothetical case presentation and a structured interview. The case of cough and dyspnea in a smoker was presented in six versions differing only in the age and sex of the patient. After presentation of the history and physical findings, physicians were asked to state the most probable diagnosis and to choose the diagnostic studies needed, Physicians were then presented with spirometric findings of moderate or severe obstruction without significant bronchodilator response, and the questions repeated. Finally, the negative outcome of an oral steroid trial was described.Results: Initially, COPD was given as the most probable diagnosis significantly more often for men than women (58% vs 42%; p < 0,05), The likelihood of a COPD diagnosis increased significantly and initial differences between sexes decreased as objective information was provided. After spirometry, COPD diagnosis rates for men and women were 74% vs 66% (p = not significant); after the steroid trial 85% vs 79% (p = not significant). Only 22% of physicians would have requested spirometry after the initial presentation,Conclusions: In North America, primary-care physicians underdiagnose COPD, particularly in women. Spirometry reduces the risk of underdiagnosis and gender bias but is underused.