Sex differences in asthma and COPD hospital admission, readmission and mortality.

IF 3.4 3区医学 Q1 RESPIRATORY SYSTEM

BMJ Open Respiratory Research Pub Date : 2025-03-17 DOI:10.1136/bmjresp-2024-002808

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":"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.","PeriodicalId":9048,"journal":{"name":"BMJ Open Respiratory Research","volume":"12 1","pages":""},"PeriodicalIF":3.4000,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927479/pdf/","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.

查看原文本刊更多论文

哮喘和慢性阻塞性肺病入院、再入院和死亡率的性别差异。

背景：哮喘和慢性阻塞性肺疾病（COPD）的结局因性别而异。我们调查了患有哮喘或慢性阻塞性肺病的男性和女性在入院时是否有不同的治疗方法。方法：使用来自国家哮喘和慢性阻塞性肺病审计计划的数据来确定因急性发作住院的三组患者：(1)患有哮喘的成人，(2)患有哮喘的儿童和青少年（CYP），以及(3)患有慢性阻塞性肺病的成人。结果包括以下院内干预措施：肺活量测量记录、呼吸专科医生复查、呼吸药物管理和出院束记录。相关的医院数据用于确定30天和90天的再入院率，以及国家统计局90天死亡率的数据。采用随机效应logistic回归研究性别与住院结局、再入院和死亡率之间的关系。结果：纳入成人哮喘16 370例，哮喘CYP 7156例，慢性阻塞性肺病28 354例。与男性相比，女性哮喘患者接受呼吸专科医生诊治的几率更高（aOR 0.1.13, 1.02-1.26），在30天和90天内再入院的几率更高（aOR 1.22, 1.10-1.37, aOR 1.34, 1.23-1.46）。成年女性COPD患者接受呼吸专科医生治疗的几率较高（aOR 1.10,1.02-1.19），接受无创通气治疗的几率较高（aOR 1.18, 1.09-1.29），接受出院治疗的几率较高（aOR 1.07, 1.00-1.14）， 90天内再入院的几率较低（aOR 0.95, 0.90-1.01）， 90天内死亡的几率较低（aOR 0.88, 0.81-0.96）。最后，与男性相比，女性CYP在1小时内使用类固醇的几率更高（aOR 1.13, 1.00-1.28）， 30天和90天再入院率更高（aOR 1.21, 1.00-1.44和1.17,1.03-1.34）。解释：成人慢性阻塞性肺病住院治疗存在性别差异，这可能影响再入院率和死亡率；然而，在哮喘患者的住院治疗中，几乎没有性别差异，但女性更有可能再次入院。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

BMJ Open Respiratory Research RESPIRATORY SYSTEM-

CiteScore

6.60

自引率

2.40%

发文量

审稿时长

12 weeks

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.