title: Sex discrepancies in COPD patients and burden of the disease in females: a nationwide study in Greece (Greek Obstructive Lung Disease Epidemiology and health ecoNomics: GOLDEN study).
abstract: BACKGROUND
  The prevalence of chronic obstructive pulmonary disease (COPD) in females appears to be increasing. Recent studies have revealed that the percentage of women with COPD in Greece is approximately 12.5%.
  
  
  OBJECTIVE
  To evaluate the burden of COPD among males and females in Greece through a nationwide cross-sectional survey and to explore sex differences regarding functional characteristics and exacerbation frequency.
  
  
  METHODS
  Data collection was completed in a 6-month period. The present study followed a nationwide sampling approach of respiratory medicine physicians. The sampling approach included three steps: 1) estimation of expected incidence and prevalence of COPD cases in each prefecture of Greece and in total; 2) estimation of expected incidence of COPD cases per physician in each prefecture; and 3) creation of a frame of three different sampling zones. Following this sampling, data were provided by 199 respiratory physicians.
  
  
  RESULTS
  The participating physicians provided data from 6,125 COPD patients. Female patients represented 28.7% of the study participants. Female COPD patients were, on average, 5 years younger than male COPD patients. Never smokers accounted for 9.4% within female patients, compared to 2.7% of males (P<0.001). Female patients were characterized by milder forms of the disease. Comorbidities were more prevalent in men, with the exception of gastroesophageal reflux (14.6% versus 17.1% for men and women, respectively, P=0.013). Female COPD patients had a higher expected number of outpatient visits per year (by 8.9%) than males (P<0.001), although hospital admissions did not differ significantly between sexes (P=0.116). Females had fewer absences from work due to COPD per year, by 19.0% (P<0.001), compared to males.
  
  
  CONCLUSIONS
  The differences observed between male and female COPD patients provide valuable information which could aid the prevention and management of COPD in Greece.
authors.affiliation: 3rd Respiratory Medicine Department, Sismanoglio General Hospital, Marousi, Athens, Greece ; Respiratory Medicine Department, University of Thessaly Medical School University Hospital of Larissa, Larissa, Greece.
authors.forename: Andriana I
authors.initials: AI
authors.lastname: Papaioannou
authors.affiliation: Respiratory Medicine Department, University of Thessaly Medical School University Hospital of Larissa, Larissa, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Bania
authors.affiliation: Occupational Health Department, Onassis Cardiac Surgery Center, Athens, Greece.
authors.forename: Evangelos C
authors.initials: EC
authors.lastname: Alexopoulos
authors.affiliation: Medical Department, Novartis Hellas, Athens, Greece.
authors.forename: Eirini
authors.initials: E
authors.lastname: Mitsiki
authors.affiliation: Respiratory Medicine Department, University of Thessaly Medical School University Hospital of Larissa, Larissa, Greece.
authors.forename: Foteini
authors.initials: F
authors.lastname: Malli
authors.affiliation: Respiratory Medicine Department, University of Thessaly Medical School University Hospital of Larissa, Larissa, Greece.
authors.forename: Konstantinos I
authors.initials: KI
authors.lastname: Gourgoulianis
mesh_terms: D000041:Absenteeism; D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006115:Greece / Q000453:epidemiology; D017048:Health Care Costs; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D018582:Sick Leave; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D013997:Time Factors
keywords: chronic obstructive pulmonary disease; comorbidities; exacerbations