Moffett Alexander T, Halpern Scott D, Weissman Gary E
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA, USA.
medRxiv. 2024 Jul 19:2024.07.18.24310648. doi: 10.1101/2024.07.18.24310648.
Women are more likely than men to report delays in the diagnosis of chronic obstructive pulmonary disease (COPD), though the etiology of these delays is unknown. We sought to test whether delays in COPD diagnosis persist after the performance of spirometry.
We used the Optum Labs Data Warehouse to identify patients 18 years of age and older without a prior diagnosis of COPD, with a post-bronchodilator forced expiratory volume in 1 second (FEV) to forced vital capacity (FVC) ratio of less than 0.7 on spirometry. We used a Cox proportional hazards model to compare the time to diagnosis after spirometry in men and women, adjusting for age, race, ethnicity, tobacco use, and post-bronchodilator FEV/FVC.
The probability of receiving a COPD diagnosis after the performance of spirometry was lower among women than men (adjusted hazard ratio [aHR] 0.66, 95% confidence interval [CI] 0.50 to 0.88).
In this retrospective cohort study of patients with spirometric evidence of obstruction, the time to diagnosis of COPD was greater among women than men. While previous vignette-based studies have found that gender differences in the diagnosis of COPD resolve with the performance of spirometry, we found that gender differences persist after spirometry has been performed. Clinicians were less likely to diagnose COPD in women even when spirometry supported this diagnosis.
女性比男性更有可能报告慢性阻塞性肺疾病（COPD）诊断延迟，尽管这些延迟的病因尚不清楚。我们试图测试在进行肺量计检查后COPD诊断延迟是否仍然存在。
我们使用Optum Labs数据仓库识别18岁及以上且先前未诊断出COPD的患者，这些患者在肺量计检查中支气管扩张剂后1秒用力呼气量（FEV）与用力肺活量（FVC）之比小于0.7。我们使用Cox比例风险模型比较男性和女性在肺量计检查后至诊断的时间，并对年龄、种族、族裔、吸烟情况和支气管扩张剂后FEV/FVC进行调整。
女性在进行肺量计检查后被诊断为COPD的概率低于男性（调整后的风险比[aHR]为0.66，95%置信区间[CI]为0.50至0.88）。
在这项对有肺量计检查显示存在阻塞证据患者的回顾性队列研究中，女性COPD诊断时间比男性更长。虽然先前基于病例摘要的研究发现，COPD诊断中的性别差异在进行肺量计检查后会消除，但我们发现，在进行肺量计检查后性别差异仍然存在。即使肺量计检查支持诊断，临床医生诊断女性COPD的可能性也较小。
