Sex discrepancies in COPD patients and burden of the disease in females: a nationwide study in Greece (Greek Obstructive Lung Disease Epidemiology and health ecoNomics: GOLDEN study)

Abstract

Background

The prevalence of chronic obstructive pulmonary disease (COPD) in females appears to be increasing. Recent studies have revealed that the percentage of women with COPD in Greece is approximately 12.5%.

Aims

To evaluate the burden of COPD among males and females in Greece through a nationwide cross-sectional survey and to explore sex differences regarding functional characteristics and exacerbation frequency.

Methods

Data collection was completed in a 6-month period. The present study followed a nationwide sampling approach of respiratory medicine physicians. The sampling approach included three steps: 1) estimation of expected incidence and prevalence of COPD cases in each prefecture of Greece and in total; 2) estimation of expected incidence of COPD cases per physician in each prefecture; and 3) creation of a frame of three different sampling zones. Following this sampling, data were provided by 199 respiratory physicians.

Results

The participating physicians provided data from 6,125 COPD patients. Female patients represented 28.7% of the study participants. Female COPD patients were, on average, 5 years younger than male COPD patients. Never smokers accounted for 9.4% within female patients, compared to 2.7% of males (P<0.001). Female patients were characterized by milder forms of the disease. Comorbidities were more prevalent in men, with the exception of gastroesophageal reflux (14.6% versus 17.1% for men and women, respectively, P=0.013). Female COPD patients had a higher expected number of outpatient visits per year (by 8.9%) than males (P<0.001), although hospital admissions did not differ significantly between sexes (P=0.116). Females had fewer absences from work due to COPD per year, by 19.0% (P<0.001), compared to males.

Conclusion

The differences observed between male and female COPD patients provide valuable information which could aid the prevention and management of COPD in Greece.

Keywords:

• chronic obstructive pulmonary disease
• exacerbations
• comorbidities

Acknowledgments

The authors would like to thank the following pulmonary medicine physicians for their contribution to the study.

Author contributions

Eleni Bania, Eirini Mitsiki, Evangelos C Alexopoulos, and Konstantinos I Gourgoulianis were involved in the study conception and design. Andriana I Papaioannou contributed to study design and conception. Konstantinos I Gourgoulianis is the guarantor. Eleni Bania, Eirini Mitsiki and Foteini Malli collected the data. Evangelos C Alexopoulos performed the statistical analysis of the data. Andriana I Papaioannou, Eirini Mitsiki, Foteini Malli, and Evangelos C Alexopoulos prepared the manuscript. All authors revised the manuscript, and read and approved the final version.

Disclosure

Andriana I Papaioannou and Foteini Malli have no conflicts of interest in relation to this article. Eleni Bania has worked for Novartis. Evangelos C Alexopoulos held a contract with Novartis for participating in the study design and performing the statistical analysis. Eirini Mitsiki is currently working for Novartis. Konstantinos I Gourgoulianis has received an investigator’s fee for the GOLDEN study by Novartis. The study was funded by Novartis Hellas. The authors report no further conflicts of interest in this work.