Gender Differences Found in COPD Hospitalizations and In-Hospital Deaths

Alison Rodriguez

A recent report, published by the Annals of the American Thoracic Society, assessed trends in chronic obstructive pulmonary disease (COPD) hospitalizations and in-hospital deaths in the United States and found that the number of in-hospital deaths for COPD has decreased; however, women account for a higher proportion of the hospitalizations and in-hospital deaths.

The researchers used the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) and conducted a retrospective analysis from 2005 to 2014 by collecting data of selected hospitalizations with a primary discharge diagnosis of COPD, which represents a prominent and prevalent public health burden.

“Once considered a disease occurring predominately in men, the global prevalence of COPD has shifted such that more women are now diagnosed with COPD,” the authors explained. “Gender differences in the clinical presentation of COPD are being increasingly recognized. Women are often younger than men at the time of diagnosis and are underdiagnosed due to a lack of formal evaluation with spirometry. Thus, the true prevalence and incidence of COPD in women might be underestimated.”

Of the total 8,575,820 hospitalizations for COPD that were identified, 2% (160,552) had resulted in death. However, the number of in-hospital deaths had decreased by 62% from 2005 to 2014. Also, the overall length of stay decreased from 5.25 days in 2005 to 4.23 days in 2014.

Women represented a higher proportion of COPD hospitalizations and in-hospital deaths during all of the time points examined, according to the results. Additionally, a greater proportion of women were characterized with minor to moderate loss of function compared to men, whereas a larger proportion of men had major to extreme loss of function.

“In this report, we show that while the number of COPD hospitalizations has remained relatively stable (834,788 in 2005 versus 764,710 in 2014), the number of in-hospital deaths has decreased dramatically by 62%. This is in stark contrast to the fact that from 1980 to 2000, the overall death rate for COPD increased by 67%,” noted the authors. “Certainly, we can attribute some of this decrease to overall improvements in patient care, including caring for conditions associated with COPD exacerbations, such as pneumonia, sepsis, and thromboembolic diseases, in addition to the use of non-invasive positive pressure ventilation.”

The study concluded that there is a need for more targeted studies that investigate the factors associated with readmissions for COPD in order to shed light on the gender disparities that exist.

Goel K, Bailey M, Borgstrom M, et al. Trends in COPD hospitalization and in-hospital deaths in the United States by sex: 2005-2014
[published online November 5, 2018]. Ann Am Thorac Soc.  doi: 10.1513/AnnalsATS.201807-488RL.   

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