Comorbidity and gender-related differences in patients hospitalized for COPD. The ECCO study
Received 9 May 2009; accepted 28 September 2009. published online 02 November 2009.
Summary
Rationale
Patients hospitalized for a COPD exacerbation are usually of advanced age, with functional deterioration, and suffering an increased number of associated conditions, but little is known about gender differences. Our hypothesis is that the frequency and type of comorbidities differ in male and female COPD patients.
Material and methods
A cross-sectional, multicentre study of patients hospitalized for a COPD exacerbation. All of them had COPD confirmed by baseline forced spirometry with a bronchodilator test. Comorbidity information was collected using the Charlson index, and an ad hoc questionnaire that included other common conditions not included in the Charlson index.
Results
We studied 398 patients, 353 men (89%) and 45 women (11%), with a mean (S.D.) age of 73.7 (8.9) years and a percent predicted FEV1 of 43.2 (12.5). The mean score of the Charlson index was 2.7 (2.0), with no differences by gender; in contrast, the mean number of all comorbid conditions assessed was 3.7 (1.7) in men and 1.8 (1.8) in women (p < 0.05). Overall, 55% of the patients had arterial hypertension, 26% diabetes mellitus, 27% chronic heart failure, and 17% ischemic heart disease. Female COPD patients had a lower prevalence of ischemic heart disease (p = 0.008) and alcoholism (p = 0.03), but presented more frequently with chronic heart failure (p = 0.03), osteoporosis (p = 0.007) and diabetes mellitus without complications (p = 0.02).
Conclusions
Comorbidities are common in patients hospitalized for a COPD exacerbation, but their relative distribution varies by gender. The exclusive use of the Charlson index underestimates comorbidities in COPD patients.
aInternal Medicine Service, Hospital Mútua de Terrassa, Plaza Dr. Robert 5, 08221 Terrassa, Barcelona, Spain
bInternal Medicine Service, Hospital Vega Baja-Orihuela, Alicante, Spain
cInternal Medicine Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
dInternal Medicine Service, Hospital Comarcal Axarquía. Vélez Málaga, Málaga, Spain
eInternal Medicine Service, Hospital Universitario del Rio Hortega, Valladolid, Spain
fInternal Medicine Service, Hospital Royo Villanova, Zaragoza, Spain
gPrograma de Epidemiología e Investigación Clínica, Fundación Caubet-CIMERA, Centro Internacional de Medicina Respiratoria Avanzada, Baleares, Spain
Corresponding author. Internal Medicine Service, Hospital Mútua de Terrassa. Plaza Dr. Robert 5, 08221 Terrassa, Barcelona, Spain. Tel.: +34 937365050.
ABSTRACT