Published ahead of print on June 15, 2006, doi:10.1164/rccm.200507-1057OC
Am. J. Respir. Crit. Care Med., Volume 174, Number 5, September 2006, 524-529
A more recent version of this article appeared on September 1, 2006
Submitted on July 8, 2005
Accepted on June 14, 2006
Gender Differences on Survival in Oxygen-dependent Chronic Obstructive Pulmonary Disease Patients
Maria-Christina L Machado1*, Jerry A Krishnan2, Sonia A Buist3, Andrew L Bilderback2, Guilherme P Fazolo4, Michelle G Santarosa5, Fernando Queiroga-Jr5, and William M Vollmer6
1 State Public Hospital of Sao Paulo, Sao Paulo, Sao Paulo, Brazil; Respiratory Division, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil,
2 Johns Hopkins University, Baltimore, Maryland, USA,
3 Oregon Health and Science University, Portland, Oregon, USA,
4 State Public Hospital of Sao Paulo, Sao Paulo, Sao Paulo, Brazil,
5 Respiratory Division, Federal University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil,
6 Center for Health Research, Portland, Oregon, USA
* To whom correspondence should be addressed. E-mail: mchrismachado{at}pneumo.epm.br.
Rationale: Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. The prevalence of COPD is rising among women and is approaching that of men, but it is not known if gender affects survival.
Objectives: To measure the survival differences between men and women with oxygen-dependent COPD.
Methods: We conducted a 7-year prospective cohort study of 435 COPD outpatients (184 women, 251 men) referred for long-term oxygen therapy at two respiratory clinics in Sao Paulo, Brazil. Baseline data were collected on enrollment into oxygen therapy, when patients were clinically stable.
Measurements: We examined the effect of gender on survival using Kaplan-Meier survival curves and then used Cox proportional hazards models to control for potential confounders.
Main Results: In unadjusted analyses, we observed a non-significant trend toward increased mortality for women (Hazard Ratio = 1.28; 95% CI 0.98 - 1.68, p=0.07). After accounting for potential confounders (age, pack-years smoked, PaO2, FEV1, body-mass index), females were at a significantly higher risk of death (HR 1.54, 95% CI 1.15 -2.07, p=0.004). Other independent predictors of death were lower PaO2 (p <0.001) and lower body-mass index (p<0.05).
Conclusions: Among patients with oxygen-dependent COPD women were more likely to die than men.
Key words: Oxygen-dependent chronic obstructive pulmonary disease patients, gender differences, survival
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