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No gender-related bias in COPD diagnosis and treatment in Sweden: a randomised, controlled, case-based trial

Hamid Akbarshahi, Zainab Ahmadi, David C. Currow, Jacob Sandberg, Zac Vandersman, Aaron Shanon-Honson, Magnus Ekström
ERJ Open Research 2020 6: 00342-2020; DOI: 10.1183/23120541.00342-2020
Hamid Akbarshahi
1Dept of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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  • ORCID record for Hamid Akbarshahi
  • For correspondence: hamid.akbarshahi@med.lu
Zainab Ahmadi
1Dept of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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David C. Currow
2IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Australia
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Jacob Sandberg
1Dept of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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Zac Vandersman
2IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Australia
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Aaron Shanon-Honson
2IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Australia
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Magnus Ekström
1Dept of Clinical Sciences, Division of Respiratory Medicine and Allergology, Lund University, Lund, Sweden
2IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Australia
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Tables

  • Supplementary Materials
  • TABLE 1

    Characteristics of the participating physicians

    CharacteristicAllMale caseFemale case
    Physicians n1346272
    Female63 (47)24 (38)39 (62)
    Professional seniority
     Resident43 (32)20 (15)23 (17)
     Specialist52 (39)24 (18)28 (21)
     Senior specialist38 (28)18 (13)20 (15)
    Present location of practice#
     Hospital69 (51)33 (25)36 (27)
     Primary healthcare62 (46)27 (20)35 (26)
     Other6 (4)3(2)3 (2)
    Specialty licence(s)#
     Internal medicine50 (37)26 (19)24 (18)
     Family medicine62 (46)27 (20)35 (26)
     Respiratory medicine32 (24)13 (10)19 (14)
     Other31 (23)19 (14)12 (9)
    Current specialty area(s) of practice#
     Internal medicine36 (27)19 (14)17 (13)
     Primary care61 (46)26 (19)35 (26)
     Respiratory medicine32 (24)13 (10)19 (14)
     Other24 (18)14 (10)10 (7)

    Data are presented as n (%). #: percentages may exceed 100% due to overlap.

    • TABLE 2

      Diagnosis and evaluation of a male versus female patient with COPD

      Male patientFemale patientp-value
      Cases n6272 
      COPD diagnosis61 (98)70 (97)0.649
      Spirometry62 (100)72 (100)>0.999
      Blood test45 (73)52 (72)0.963
      ECG42 (68)50 (69)0.832
      Exercise testing7 (11)8 (11)0.974
      Echocardiography5 (8)11 (15)0.199
      O2 saturation levels41 (66)49 (68)0.813
      Sputum culture0 (0)2 (3)0.186

      Data are presented as n (%), unless otherwise stated.

      • TABLE 3

        Management of a male versus female patient with COPD

        Male patientFemale patientp-value
        Cases n6272
        Short-acting bronchodilator62 (100)72 (100)>0.999
        Long-acting anti-cholinergic inhaler62 (100)72 (100)>0.999
        Long-acting β2-agonist inhaler14 (23)27 (38)0.062
        Both long-acting anti-cholinergic and β2-agonist inhalers32 (52)40 (56)0.648
        ICS14 (23)17 (24)0.888
        Triple therapy19 (31)26 (36)0.504
        OCS10 (16)9 (13)0.548
        Respiratory rehabilitation treatment46 (74)54 (75)0.915
        Consultation with a dietitian45 (73)48 (67)0.459
        Oxygen therapy0 (0)0 (0)1.0
        Changing the inhaler#4 (6)5 (7)0.910
        Intensifying respiratory rehabilitation treatment#4 (6)12 (17)0.069
        Benzodiazepines#1 (2)0 (0)0.279
        Opioids#6 (10)9 (13)0.605
        Oral steroids#5 (8)3 (4)0.342
        Roflumilast (Daxas)#4 (6)2 (3)0.305
        Oxygen therapy#2 (3)0 (0)0.125

        Data are presented as n (%), unless otherwise stated. ICS: inhaled corticosteroids; OCS: oral corticosteroids. #: follow-up management.

        • TABLE 4

          Diagnostic management of a patient with COPD by a male versus female physician

          Male physicianFemale physicianp-value
          Cases n7163 
          COPD diagnosis69 (97)62 (98)0.631
          Spirometry71 (100)63 (100)1.0
          Blood test47(66)50(79)0.089
          ECG45(63)47(74)0.162
          Exercise ECG6(8)9(14)0.285
          Echocardiography8(11)8(12)0.799
          O2 saturation levels45(63)45(71)0.322
          Sputum culture0 (0)2 (3)0.130

          Data are presented as n (%), unless otherwise stated.

          Supplementary Materials

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            Supplementary material 00342-2020.SUPPLEMENT

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          No gender-related bias in COPD diagnosis and treatment in Sweden: a randomised, controlled, case-based trial
          Hamid Akbarshahi, Zainab Ahmadi, David C. Currow, Jacob Sandberg, Zac Vandersman, Aaron Shanon-Honson, Magnus Ekström
          ERJ Open Research Oct 2020, 6 (4) 00342-2020; DOI: 10.1183/23120541.00342-2020

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          No gender-related bias in COPD diagnosis and treatment in Sweden: a randomised, controlled, case-based trial
          Hamid Akbarshahi, Zainab Ahmadi, David C. Currow, Jacob Sandberg, Zac Vandersman, Aaron Shanon-Honson, Magnus Ekström
          ERJ Open Research Oct 2020, 6 (4) 00342-2020; DOI: 10.1183/23120541.00342-2020
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