Men had longer hospital stays, greater mortality
by Salynn Boyles, Contributing Writer October 31, 2017

Action Points
• Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
• Women hospitalized for chronic obstructive pulmonary disease (COPD) exacerbations in the U.S. had shorter hospital stays than men, and they also had a lower death rate.
• Note that total hospitalization charges, use of bronchoscopy, and need for ICU admission did not differ significantly by gender.

TORONTO — Women hospitalized for chronic obstructive pulmonary disease (COPD) exacerbations in the U.S. had shorter hospital stays than men, and they also had a lower death rate, according to researchers here.
In a nationwide, retrospective analysis, female COPD patients showed a reduced adjusted in-hospital mortality versus males (odds ratio 0.88; P=0.02). Women also had a lower mean length of stay (4.16 versus 4.38 days, P<0.01), and lower rates of thoracentesis (OR 0.74, P<0.01), and incidence of shock of any type (OR 0.78, P=0.02) throughout the examined time period, reported Navid Gholitabar of the Mayo Clinic in Scottsdale, Arizona, and colleagues.
However, total hospitalization charges, use of bronchoscopy, and need for ICU admission did not differ significantly by gender, they reported at CHEST, the American College of Chest Physicians annual meeting.
Female gender has been associated with greater lung function reduction and more severe disease in early onset COPD with lower exposure to cigarettes, suggesting that women may be more susceptible to the lung damaging effects of smoking.
Gender also appears to influence COPD presentation, with men experiencing more emphysema than women, and women experiencing more chronic bronchitis.
The prevalence of COPD and deaths attributed to the disease have increased significantly in women, but not men, in the last 2 decades.
“Women have been felt to be at greater risk for developing COPD with less smoking burden,” commented James K. Stoller, MD, of the Cleveland Clinic, who was not involved in the study.
While research suggests that women with COPD are less likely to be diagnosed than men and tend to be diagnosed later in the course of the disease, the impact of gender on hospitalizations for COPD exacerbations has not been widely studied.
Gholitabar told MedPage Today that women hospitalized for COPD exacerbations may have shorter hospital stays and better survival than men because they tend to be more proactive about seeking treatment.
“The study did not address this, but we know that females are more health conscious, and they tend to be less risk averse,” he said. “They may be getting to the hospital sooner when they experience COPD exacerbations.”
Gholitabar’s group sought to determine whether gender plays a role in outcomes associated with hospitalization for COPD exacerbations by examining data from the 2013 National Inpatient Sample (NIS), which is the largest publicly available hospital inpatient database in the U.S.
The primary outcome was inhospital mortality. Secondary outcomes included morbidity, as measured by ICU admission, shock, and acute respiratory failure, and resource utilization, as measured by mean length of hospital stay, total hospitalization charges, and utilization of bronchoscopy and thoracentesis.
Patients were classified as either having a diagnosis of COPD or not having a diagnosis of COPD using ICD-9 CM codes. Analyses were performed using Stata (version 13.0). ORs and means were adjusted for the following confounders using multivariate regression analysis models: age, race, Charlson Comorbidity Index, primary insurance, hospital location, and hospital teaching status.
The study included 631,664 patients with a primary diagnosis of COPD. The mean patient age was 68 and 56% of the patients were female.
The data analysis revealed that no difference between male and female COPD patients with regard to mean hospital charges ($28,871 versus $28,487, P=0.12), utilization of bronchoscopy (OR 0.90; P=0.29), ICU admission (OR 0.93, P=0.08), and acute respiratory failure (OR 1.00, P=0.91).
Stoller called the finding that women appear to have better outcomes than men when hospitalized for COPD exacerbations “surprising and provocative. It is gratifying to know that this might be the case, but determining whether this is actually true will require validation through prospective studies,” he told MedPage Today.
The authors agreed, noting that “Barriers to healthcare utilization vary by gender. Research will need to continue documenting such variation in order to better inform policy makers and health practitioners of potential solutions for improving health outcomes.”

Gholitabar and co-authors disclosed no relevant relationships with industry.
• Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner
• Primary Source
CHEST
Source Reference: Gholitabar N, et al “Gender differences in the outcomes of patients hospitalized for COPD: a nationwide analysis” CHEST 2017; Abstract 2746484.