Hannah Whittaker, Alexander Adamson, Philip Stone, Precious Olubori, James Calvert, James Dodd, Ian Sinha, Katherine Hickman, Sally Singh, Jennifer K Quint
{"title":"Sex differences in asthma and COPD hospital admission, readmission and mortality.","authors":"Hannah Whittaker, Alexander Adamson, Philip Stone, Precious Olubori, James Calvert, James Dodd, Ian Sinha, Katherine Hickman, Sally Singh, Jennifer K Quint","doi":"10.1136/bmjresp-2024-002808","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Asthma and chronic obstructive pulmonary disease (COPD) outcomes vary by sex. We investigated whether males and females with asthma or COPD are managed differently in-hospital when admitted for an exacerbation.</p><p><strong>Methods: </strong>Data from the National Asthma and COPD Audit Programme were used to determine three cohorts of people hospitalised for an exacerbation: (1) adults with asthma, (2) children and young people (CYP) with asthma, and (3) adults with COPD. Outcomes included the following in-hospital interventional measures: spirometry recording, respiratory specialist review, respiratory medication administration and discharge bundle recording. Linked hospital data were used to determine 30-day and 90-day readmissions and Office for National Statistics data for 90-day mortality. Random effects logistic regression was used to investigate the association between sex and in-hospital outcomes, readmission and mortality.</p><p><strong>Results: </strong>16 370 adults with asthma, 7156 CYP with asthma and 28 354 adults with COPD were included. Female adults with asthma had higher odds of being seen by a respiratory specialist (<sub>a</sub>OR 0.1.13, 1.02-1.26) and higher odds of readmission within 30 and 90 days (<sub>a</sub>OR 1.22, 1.10-1.37, <sub>a</sub>OR 1.34, 1.23-1.46) compared with males. Female adults with COPD had higher odds of being seen by a respiratory specialist, (<sub>a</sub>OR 1.10,1.02-1.19), being administered non-invasive ventilation (<sub>a</sub>OR 1.18, 1.09-1.29), and receiving a discharge bundle (<sub>a</sub>OR 1.07, 1.00-1.14), and lower odds of readmission within 90 days (<sub>a</sub>OR 0.95, 0.90-1.01), or mortality within 90 days (<sub>a</sub>OR 0.88, 0.81-0.96). Lastly, female CYP had higher odds of steroids administered within 1 hour (<sub>a</sub>OR 1.13, 1.00-1.28) and higher 30-day and 90-day readmission compared with males (<sub>a</sub>OR 1.21, 1.00-1.44 and 1.17, 1.03-1.34).</p><p><strong>Interpretation: </strong>Sex differences in in-hospital care exist in adults COPD, which may impact readmissions and mortality; however, little to no sex differences in in-hospital care were seen in people with asthma yet females were more likely to be readmitted to hospital.</p>","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMJ Open Respiratory Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bmjresp-2024-002808","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Asthma and chronic obstructive pulmonary disease (COPD) outcomes vary by sex. We investigated whether males and females with asthma or COPD are managed differently in-hospital when admitted for an exacerbation.
Methods: Data from the National Asthma and COPD Audit Programme were used to determine three cohorts of people hospitalised for an exacerbation: (1) adults with asthma, (2) children and young people (CYP) with asthma, and (3) adults with COPD. Outcomes included the following in-hospital interventional measures: spirometry recording, respiratory specialist review, respiratory medication administration and discharge bundle recording. Linked hospital data were used to determine 30-day and 90-day readmissions and Office for National Statistics data for 90-day mortality. Random effects logistic regression was used to investigate the association between sex and in-hospital outcomes, readmission and mortality.
Results: 16 370 adults with asthma, 7156 CYP with asthma and 28 354 adults with COPD were included. Female adults with asthma had higher odds of being seen by a respiratory specialist (aOR 0.1.13, 1.02-1.26) and higher odds of readmission within 30 and 90 days (aOR 1.22, 1.10-1.37, aOR 1.34, 1.23-1.46) compared with males. Female adults with COPD had higher odds of being seen by a respiratory specialist, (aOR 1.10,1.02-1.19), being administered non-invasive ventilation (aOR 1.18, 1.09-1.29), and receiving a discharge bundle (aOR 1.07, 1.00-1.14), and lower odds of readmission within 90 days (aOR 0.95, 0.90-1.01), or mortality within 90 days (aOR 0.88, 0.81-0.96). Lastly, female CYP had higher odds of steroids administered within 1 hour (aOR 1.13, 1.00-1.28) and higher 30-day and 90-day readmission compared with males (aOR 1.21, 1.00-1.44 and 1.17, 1.03-1.34).
Interpretation: Sex differences in in-hospital care exist in adults COPD, which may impact readmissions and mortality; however, little to no sex differences in in-hospital care were seen in people with asthma yet females were more likely to be readmitted to hospital.
期刊介绍：
BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.
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