DOI QR코드

DOI QR Code

Sex differences in chronic obstructive pulmonary disease characteristics: the Korea National Health and Nutrition Examination Survey 2007-2018

  • Moon Seong Baek (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Haegwang Shin (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Kang-Mo Gu (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Hae In Jung (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Won Young Kim (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Jae-Woo Jung (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Jong-Wook Shin (Department of Internal Medicine, Chung-Ang University College of Medicine) ;
  • Sun-Young Jung (College of Pharmacy, Chung-Ang University) ;
  • Jae-Yeol Kim (Department of Internal Medicine, Chung-Ang University College of Medicine)
  • Received : 2023.01.25
  • Accepted : 2023.10.19
  • Published : 2024.01.01

Abstract

Background/Aims: Chronic obstructive pulmonary disease (COPD) is less prevalent in females than males, but it affects mortality in females. There may be sex differences in the clinical characteristics of COPD. Methods: We analyzed the Korea National Health and Nutrition Examination Survey dataset from 2007 to 2018. We compared the clinical characteristics and comorbidities in subjects with COPD according to sex. We adjusted the multivariate logistic regression of lung cancer prevalence according to COPD and sex by age and smoking amount. Results: Females with COPD tended to be older than males with COPD (64.1 ± 0.4 yr vs. 62.3 ± 0.2 yr, respectively, p < 0.001). Approximately 89% of males with COPD had a smoking history, while 86% of females with COPD were non-smokers (p < 0.001). Household income was lower (p < 0.001) and asthma and overall malignancy were more prevalent in females with COPD than males with COPD (25.5 vs. 11.6%, respectively, p < 0.001; (6.3 vs. 5.4%, respectively, p < 0.001). However, lung cancer was more common in males with COPD than females with COPD (0.9 vs. 0.1%, respectively, p < 0.001). Lung cancer prevalence increased in males with moderate COPD compared to subjects without COPD (OR, 4.409; 95% CI, 1.741-9.419). Conclusions: Females with COPD had a lower smoking rate, household income, and lung cancer prevalence than males with COPD. More active COPD screening is needed for women of low socioeconomic status, even if they do not smoke.

Keywords

References

  1. Christenson SA, Smith BM, Bafadhel M, Putcha N. Chronic obstructive pulmonary disease. Lancet 2022;399:2227-2242. 
  2. GBD 2015 Chronic Respiratory Disease Collaborators. Global, regional, and national deaths, prevalence, disability-adjusted life years, and years lived with disability for chronic obstructive pulmonary disease and asthma, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Respir Med 2017;5:691-706. 
  3. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: 2020 report [Internet]. GOLD, c2020 [cited Dec 16, 2022]. Available from: https://goldcopd.org/wp-content/uploads/2019/12/GOLD-2020-FINAL-ver1.2-03Dec19_WMV.pdf. 
  4. Oh YM, Bhome AB, Boonsawat W, et al. Characteristics of stable chronic obstructive pulmonary disease patients in the pulmonology clinics of seven Asian cities. Int J Chron Obstruct Pulmon Dis 2013;8:31-39. 
  5. Tan WC, Sin DD, Bourbeau J, et al.; CanCOLD Collaborative Research Group. Characteristics of COPD in never-smokers and ever-smokers in the general population: results from the CanCOLD study. Thorax 2015;70:822-829. 
  6. Dai X, Gil GF, Reitsma MB, et al. Health effects associated with smoking: a Burden of Proof study. Nat Med 2022;28:2045-2055. 
  7. Leem AY, Park B, Kim YS, Chang J, Won S, Jung JY. Longitudinal decline in lung function: a community-based cohort study in Korea. Sci Rep 2019;9:13614. 
  8. Lamprecht B, McBurnie MA, Vollmer WM, et al.; BOLD Collaborative Research Group. COPD in never smokers: results from the population-based burden of obstructive lung disease study. Chest 2011;139:752-763. 
  9. Rennard SI, Vestbo J. COPD: the dangerous underestimate of 15%. Lancet 2006;367:1216-1219. 
  10. Ntritsos G, Franek J, Belbasis L, et al. Gender-specific estimates of COPD prevalence: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis 2018;13:1507-1514. 
  11. Gut-Gobert C, Cavailles A, Dixmier A, et al. Women and COPD: do we need more evidence? Eur Respir Rev 2019;28:180055. 
  12. Kim JY. Directions and challenges in smoking cessation treatment. Tuberc Respir Dis (Seoul) 2020;83(Supple 1):S1-S5. 
  13. Jeon J, Holford TR, Levy DT, et al. Smoking and lung cancer mortality in the United States from 2015 to 2065: a comparative modeling approach. Ann Intern Med 2018;169:684-693. 
  14. Sorheim IC, Johannessen A, Gulsvik A, Bakke PS, Silverman EK, DeMeo DL. Gender differences in COPD: are women more susceptible to smoking effects than men? Thorax 2010;65:480-485. 
  15. Kweon S, Kim Y, Jang MJ, et al. Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol 2014;43:69-77. 
  16. Graham BL, Steenbruggen I, Miller MR, et al. Standardization of spirometry 2019 update. An official American Thoracic Society and European Respiratory Society technical statement. Am J Respir Crit Care Med 2019;200:e70-e88. 
  17. Korea Disease Control and Prevention Agency. Quality control program of spirometry at the seventh KNHANES [Internet]. Osong: Korea Disease Control and Prevention Agency, c2017 [cited Aug 18, 2023]. Available from: https://www.prism.go.kr/homepage/entire/researchDetail.do?researchId=1351000-201700231&menuNo=I0000002. 
  18. Jia G, Lu M, Wu R, Chen Y, Yao W. Gender difference on the knowledge, attitude, and practice of COPD diagnosis and treatment: a national, multicenter, cross-sectional survey in China. Int J Chron Obstruct Pulmon Dis 2018;13:3269-3280. 
  19. Lopez Varela MV, Montes de Oca M, Halbert RJ, et al.; PLATINO Team. Sex-related differences in COPD in five Latin American cities: the PLATINO study. Eur Respir J 2010;36:1034-1041. 
  20. Kanervisto M, Vasankari T, Laitinen T, Heliovaara M, Jousilahti P, Saarelainen S. Low socioeconomic status is associated with chronic obstructive airway diseases. Respir Med 2011;105:1140-1146. 
  21. Yin P, Zhang M, Li Y, Jiang Y, Zhao W. Prevalence of COPD and its association with socioeconomic status in China: findings from China Chronic Disease Risk Factor Surveillance 2007. BMC Public Health 2011;11:586. 
  22. Bardach A, Perdomo HA, Gandara RA, Ciapponi A. [Income and smoking prevalence in Latin America: a systematic review and meta-analysis]. Rev Panam Salud Publica 2016;40:263-271. Spanish. 
  23. Kim JD, Seo JH, Shin YJ, Kim CY. The factors associated with smoking behavior of low-income people. Health Soc Welfare Rev 2013;33:577-602. 
  24. Zysman M, Raherison-Semjen C. Women's COPD. Front Med (Lausanne) 2022;8:600107. 
  25. Hagstad S, Bjerg A, Ekerljung L, et al. Passive smoking exposure is associated with increased risk of COPD in never smokers. Chest 2014;145:1298-1304. 
  26. Kurmi OP, Semple S, Simkhada P, Smith WC, Ayres JG. COPD and chronic bronchitis risk of indoor air pollution from solid fuel: a systematic review and meta-analysis. Thorax 2010;65:221-228. 
  27. Hu G, Zhou Y, Tian J, et al. Risk of COPD from exposure to biomass smoke: a metaanalysis. Chest 2010;138:20-31. 
  28. Hong Y, Lim MN, Kim WJ, et al. Influence of environmental exposures on patients with chronic obstructive pulmonary disease in Korea. Tuberc Respir Dis (Seoul) 2014;76:226-232. 
  29. Malhotra J, Malvezzi M, Negri E, La Vecchia C, Boffetta P. Risk factors for lung cancer worldwide. Eur Respir J 2016;48:889-902. 
  30. Rodriguez-Lara V, Avila-Costa MR. An overview of lung cancer in women and the impact of estrogen in lung carcinogenesis and lung cancer treatment. Front Med (Lausanne) 2021;8:600121. 
  31. de-Torres JP, Wilson DO, Sanchez-Salcedo P, et al. Lung cancer in patients with chronic obstructive pulmonary disease. Development and validation of the COPD Lung Cancer Screening Score. Am J Respir Crit Care Med 2015;191:285-291. 
  32. Park HY, Kang D, Shin SH, et al. Chronic obstructive pulmonary disease and lung cancer incidence in never smokers: a cohort study. Thorax 2020;75:506-509. 
  33. Nagasaka M, Lehman A, Chlebowski R, et al. COPD and lung cancer incidence in the Women's Health Initiative Observational Study: a brief report. Lung Cancer 2020;141:78-81. 
  34. Bade BC, Dela Cruz CS. Lung cancer 2020: epidemiology, etiology, and prevention. Clin Chest Med 2020;41:1-24. 
  35. Ortega-Gomez A, Rangel-Escareno C, Molina-Romero C, et al. Gene-expression profiles in lung adenocarcinomas related to chronic wood smoke or tobacco exposure. Respir Res 2016;17:42. 
  36. Mannino DM, Aguayo SM, Petty TL, Redd SC. Low lung function and incident lung cancer in the United States: data From the First National Health and Nutrition Examination Survey follow-up. Arch Intern Med 2003;163:1475-1480. 
  37. de Torres JP, Marin JM, Casanova C, et al. Lung cancer in patients with chronic obstructive pulmonary disease-- incidence and predicting factors. Am J Respir Crit Care Med 2011;184:913-919. 
  38. Kang HS, Park YM, Ko SH, et al. Impaired lung function and lung cancer incidence: a nationwide population-based cohort study. J Clin Med 2022;11:1077. 
  39. Schottenfeld D, Beebe-Dimmer JL. Advances in cancer epidemiology: understanding causal mechanisms and the evidence for implementing interventions. Annu Rev Public Health 2005;26:37-60.