Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands.
Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center of Groningen, Groningen, The Netherlands.
Fam Pract. 2020 Oct 19;37(5):631-636. doi: 10.1093/fampra/cmaa040.
Differences between women and men play an important role in lung physiology and epidemiology of respiratory diseases, but also in the health care processes.
To analyse sex differences in patients encountering their general practitioner (GP) with respiratory symptoms with regard to incidence, GP's management and final diagnoses.
Retrospective cohort study, using data of the Dutch Practice Based Research Network. All patients who encountered their GP from 01-07-2013 until 30-06-2018 with a new episode of care starting with a reason for encounter in the respiratory category (R) of the ICPC-2 classification were included (n = 16 773). Multi-level logistic regression was used to analyse influence of patients' sex on management of GPs with adjustment for possible confounders.
We found a significant higher incidence of respiratory symptoms in women than in men: 230/1000 patient years [95% confidence interval (CI) 227-232] and 186/1000 patient years (95% CI 183-189), respectively. When presenting with cough, GPs are more likely to perform physical examination [odds ratio (OR) 1.22; 95% CI 1.11-1.35] and diagnostic radiology (OR 1.25; 95% CI 1.08-1.44), but less likely to prescribe medication (OR 0.88; 95% CI 0.82-0.95) in men. When visiting the GP with dyspnoea, men more often undergo diagnostic imaging (OR 1.32; 95% CI 1.05-1.66) and are more often referred to a specialist (OR 1.35; 95% CI 1.13-1.62).
Women encounter their GP more frequently with respiratory symptoms than men and GPs perform more diagnostic investigations in men. We suggest more research in general practice focussing on sex differences and possible confounders.
女性和男性之间的差异在肺部生理学和呼吸系统疾病的流行病学中起着重要作用，但也在医疗保健过程中起着重要作用。
分析因呼吸系统症状就诊的患者中，性别差异在发病率、全科医生的处理方式和最终诊断方面的表现。
这是一项回顾性队列研究，使用荷兰实践基础研究网络的数据。所有在 2013 年 7 月 1 日至 2018 年 6 月 30 日期间因呼吸系统症状就诊的患者，其新的护理疗程起始原因均为 ICPC-2 分类中的 R 类（n=16773），都被纳入本研究。采用多水平逻辑回归分析患者性别对全科医生处理方式的影响，并对可能的混杂因素进行调整。
我们发现女性呼吸系统症状的发生率明显高于男性：230/1000患者年（95%置信区间[CI]227-232）和 186/1000患者年（95%CI 183-189）。当因咳嗽就诊时，医生更倾向于进行体格检查（比值比[OR]1.22；95%CI 1.11-1.35）和诊断性影像学检查（OR 1.25；95%CI 1.08-1.44），但更倾向于开具更少的药物（OR 0.88；95%CI 0.82-0.95）。当因呼吸困难就诊时，男性更常接受诊断性影像学检查（OR 1.32；95%CI 1.05-1.66），也更常被转诊至专科医生（OR 1.35；95%CI 1.13-1.62）。
女性因呼吸系统症状就诊的频率高于男性，且男性接受的诊断性检查更多。我们建议在普通实践中开展更多关注性别差异和可能混杂因素的研究。
