Ozga Jenny E, Steinberg Alexander W, Sargent James D, Tang Zhiqun, Stanton Cassandra A, Paulin Laura M
Behavioral Health and Health Policy, Westat, 1600 Research Boulevard, Rockville, MD, 20850, USA.
Division of Pulmonary and Critical Care, Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA.
Nicotine Tob Res. 2025 Aug 5. doi: 10.1093/ntr/ntaf162.
This study examined the main and interactive effects of sex, cigarette smoking status, cigarette pack-years, and second-hand smoke exposure on COPD prevalence and incidence.
COPD prevalence was estimated for US adults aged 40+ years from Wave 1 of the Population Assessment of Tobacco and Health Study (n = 12 296). Incidence analyses included adults from the initial sample without a COPD diagnosis (n = 6611). Multivariable Poisson regressions assessed prevalence and incidence based on self-reported sex and cigarette smoking, adjusted for covariates.
COPD prevalence was 7.4% and 9.4% and incident COPD was 5.0% and 8.7% for males and females, respectively. The adjusted prevalence ratio (aPR) for COPD for females was 1.26 [95% CI = 1.11, 1.44], and the adjusted risk ratio (aRR) for incident COPD was 1.73 [1.41, 2.12]. Stratified by smoking status, female (vs. male) sex was associated with aPRs of 1.26 [1.10, 1.44] and 1.35 [0.98, 1.84] and aRRs of 1.32 [1.00, 1.75] and 2.58 [1.79, 3.72] for adults who ever or never smoked, respectively. Smoking status (p = .003) and pack-years (p = .006) increased risk of COPD incidence for both males and females, but to a greater extent for males.
Female sex was associated with significantly higher COPD incidence, which was not explained by cigarette smoking, second-hand smoke exposure, e-cigarette use, or other covariates. Cigarette-related COPD risk factors increased risk of COPD incidence for both males and females but to a greater extent for males. Future research can include examining alternative risk factors or diagnostic biases contributing to higher incident COPD among females.
Prior studies show that COPD prevalence has been increasing for women in the United States, but the basis for this change remains unclear. This study shows how female (vs. male) sex is associated with significantly increased risk for COPD prevalence and incidence among a nationally representative sample of older (aged ≥40 years) US adults using data from 2013 to 2019, which was not accounted for by cigarette smoking, second-hand smoke exposure, e-cigarette use, or other covariates. Work is needed on alternative COPD risk factors or diagnostic biases contributing to higher incident COPD among females.
本研究考察了性别、吸烟状况、吸烟包年数和二手烟暴露对慢性阻塞性肺疾病（COPD）患病率和发病率的主要影响及交互作用。
根据烟草与健康人口评估研究第1波数据，对40岁及以上美国成年人的COPD患病率进行了估计（n = 12296）。发病率分析纳入了初始样本中未被诊断为COPD的成年人（n = 6611）。多变量泊松回归基于自我报告的性别和吸烟情况评估患病率和发病率，并对协变量进行了调整。
男性和女性的COPD患病率分别为7.4%和9.4%，COPD发病率分别为5.0%和8.7%。女性COPD的调整患病率比（aPR）为1.26 [95%置信区间（CI）= 1.11, 1.44]，COPD发病的调整风险比（aRR）为1.73 [1.41, 2.12]。按吸烟状况分层，对于曾经吸烟或从不吸烟的成年人，女性（与男性相比）的aPR分别为1.26 [1.10, 1.44]和1.35 [0.98, 1.84]，aRR分别为1.32 [1.00, 1.75]和2.58 [1.79, 3.72]。吸烟状况（p = 0.003）和吸烟包年数（p = 0.006）均增加了男性和女性COPD发病的风险，但对男性的影响更大。
女性性别与显著更高的COPD发病率相关，这无法通过吸烟、二手烟暴露、电子烟使用或其他协变量来解释。与香烟相关的COPD危险因素增加了男性和女性COPD发病的风险，但对男性的影响更大。未来的研究可以包括考察导致女性中更高COPD发病率的其他危险因素或诊断偏倚。
先前的研究表明，美国女性的COPD患病率一直在上升，但这种变化的原因尚不清楚。本研究利用2013年至2019年的数据，展示了在一个具有全国代表性的美国老年（年龄≥40岁）成年人样本中，女性（与男性相比）性别如何与COPD患病率和发病率的显著增加风险相关，而吸烟、二手烟暴露、电子烟使用或其他协变量并不能解释这一现象。需要针对导致女性中更高COPD发病率的其他COPD危险因素或诊断偏倚展开研究。
