title: Gender differences in outcomes of patients with cystic fibrosis.
abstract: BACKGROUND
  Cystic fibrosis (CF) is a common life-shortening genetic disease in which women have been described to have worse outcomes than males, particularly in response to respiratory infections with Pseudomonas aeruginosa. However, as advancements in therapies have improved life expectancy, this gender disparity has been challenged. The objective of this study is to examine whether a gender-based survival difference still exists in this population and determine the impact of common CF respiratory infections on outcomes in males versus females with CF.
  
  
  METHODS
  We conducted a retrospective cohort analysis of 32,766 patients from the United States Cystic Fibrosis Foundation Patient Registry over a 13-year period. Kaplan-Meier and Cox proportional hazards models were used to compare overall mortality and pathogen based survival rates in males and females.
  
  
  RESULTS
  Females demonstrated a decreased median life expectancy (36.0 years; 95% confidence interval [CI] 35.0-37.3) compared with men (38.7 years; 95% CI 37.8-39.6; p<0.001). Female gender proved to be a significant risk factor for death (hazard ratio 2.22, 95% CI 1.79-2.77), despite accounting for variables known to influence CF mortality. Women were also found to become colonized earlier with several bacteria and to have worse outcomes with common CF pathogens.
  
  
  CONCLUSIONS
  CF women continue to have a shortened life expectancy relative to men despite accounting for key CF-related comorbidities. Women also become colonized with certain common CF pathogens earlier than men and show a decreased life expectancy in the setting of respiratory infections. Explanations for this gender disparity are only beginning to be unraveled and further investigation into mechanisms is needed to help develop therapies that may narrow this gender gap.
authors.affiliation: 1 Department of Medicine, University of Texas Southwestern Medical Center , Dallas, Texas.
authors.forename: Cayce L
authors.initials: CL
authors.lastname: Harness-Brumley
authors.forename: Alan C
authors.initials: AC
authors.lastname: Elliott
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Rosenbluth
authors.forename: Deepa
authors.initials: D
authors.lastname: Raghavan
authors.forename: Raksha
authors.initials: R
authors.lastname: Jain
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001419:Bacteria / Q000302:isolation & purification / Q000472:pathogenicity*; D002648:Child; D003550:Cystic Fibrosis / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012141:Respiratory Tract Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult