Gender difference in smoking effects on lung function and risk of hospitalization for COPD: results from a Danish longitudinal population study

Recent findings suggest that females may be more susceptible than males to the deleterious influence of tobacco smoking in developing chronic obstructive pulmonary disease (COPD). This paper studies the interaction of gender and smoking on development of COPD as assessed by lung function and hospital admission. A total of 13,897 subjects, born after 1920, from two population studies, 9,083 from the Copenhagen City Heart Study (CCHS) and 4,814 from the Glostrup Population Studies (GPS), were followed for 7-16 yrs. Data were linked with information on hospital admissions caused by COPD. Based on cross-sectional data, in the CCHS the estimated excess loss of forced expiratory volume in one second (FEV1) per pack-year of smoking was 7.4 mL in female smokers who inhaled and 6.3 mL in male smokers who inhaled. In the GPS, the corresponding excess loss of FEV1 was 10.5 and 8.4 mL in females and males, respectively. Two hundred and eighteen subjects in the CCHS and 23 in the GPS were hospitalized during follow-up. Risk associated with pack-years was higher in females than in males (relative risks (RRs) for 1-20, 20-40 and >40 pack-years were 7.0 (3.5-14.1), 9.8 (4.9-19.6) and 23.3 (10.7-50.9) in females, and 3.2 (1.1-9.1), 5.7 (2.2-14.3) and 8.4 (3.3-21.6) in males) but the interaction term gender x pack-years did not reach significance (p=0.08). Results were similar in the GPS. After adjusting for smoking in more detail, females in both cohorts had an increased risk of hospitalization for COPD compared to males with a RR of 1.5 (1.2-2.1) in the CCHS and 3.6 (1.4-9.0) in the GPS. This was not likely to be caused by a generally increased rate of hospital admission for females. Results were similar when including deaths from COPD as endpoint. In two independent population samples, smoking had greater impact on the lung function of females than males, and after adjusting for smoking females subsequently suffered a higher risk of being admitted to hospital for COPD. Results suggest that adverse effects of smoking on lung function may be greater in females than in males.

This article has been cited by other articles:

				O. A. Minai, J. Benditt, and F. J. Martinez Natural History of Emphysema Proceedings of the ATS, May 1, 2008; 5(4): 468 - 474. [Abstract] [Full Text] [PDF]

				J. Hallberg, A. Dominicus, U. K. Eriksson, M. Gerhardsson de Verdier, N. L. Pedersen, M. Dahlback, U. Nihlen, T. Higenbottam, and M. Svartengren Interaction between Smoking and Genetic Factors in the Development of Chronic Bronchitis Am. J. Respir. Crit. Care Med., March 1, 2008; 177(5): 486 - 490. [Abstract] [Full Text] [PDF]

				D. D. Sin, S. B.-Z. Cohen, A. Day, H. Coxson, and P. D. Pare Understanding the Biological Differences in Susceptibility to Chronic Obstructive Pulmonary Disease between Men and Women Proceedings of the ATS, December 1, 2007; 4(8): 671 - 674. [Abstract] [Full Text] [PDF]

				L. J. Greaves and L. A. Richardson Tobacco Use, Women, Gender, and Chronic Obstructive Pulmonary Disease: Are the Connections Being Adequately Made? Proceedings of the ATS, December 1, 2007; 4(8): 675 - 679. [Abstract] [Full Text] [PDF]

				S. M. Kennedy, R. Chambers, W. Du, and H. Dimich-Ward Environmental and Occupational Exposures: Do They Affect Chronic Obstructive Pulmonary Disease Differently in Women and Men? Proceedings of the ATS, December 1, 2007; 4(8): 692 - 694. [Abstract] [Full Text] [PDF]

				F. J. Martinez, J. L. Curtis, F. Sciurba, J. Mumford, N. D. Giardino, G. Weinmann, E. Kazerooni, S. Murray, G. J. Criner, D. D. Sin, et al. Sex Differences in Severe Pulmonary Emphysema Am. J. Respir. Crit. Care Med., August 1, 2007; 176(3): 243 - 252. [Abstract] [Full Text] [PDF]

				S. Ben-Zaken Cohen, P. D. Pare, S. F. P. Man, and D. D. Sin The Growing Burden of Chronic Obstructive Pulmonary Disease and Lung Cancer in Women: Examining Sex Differences in Cigarette Smoke Metabolism Am. J. Respir. Crit. Care Med., July 15, 2007; 176(2): 113 - 120. [Abstract] [Full Text] [PDF]

				H. H. Jensen, N. S. Godtfredsen, P. Lange, and J. Vestbo Potential misclassification of causes of death from COPD Eur. Respir. J., October 1, 2006; 28(4): 781 - 785. [Abstract] [Full Text] [PDF]

				M.-C. L. Machado, J. A. Krishnan, S. A. Buist, A. L. Bilderback, G. P. Fazolo, M. G. Santarosa, F. Queiroga Jr., and W. M. Vollmer Sex Differences in Survival of Oxygen-dependent Patients with Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., September 1, 2006; 174(5): 524 - 529. [Abstract] [Full Text] [PDF]

				C. Jenkins Mars and Venus in the GP's office. Eur. Respir. J., August 1, 2006; 28(2): 259 - 261. [Full Text] [PDF]

				J. Zielinski, M. Bednarek, D. Gorecka, G. Viegi, S. S. Hurd, Y. Fukuchi, C. K. W. Lai, P. X. Ran, F. W. S. Ko, S. M. Liu, et al. Increasing COPD awareness. Eur. Respir. J., April 1, 2006; 27(4): 833 - 852. [Full Text] [PDF]

				W. Dejsomritrutai, A. Nana, N. Chierakul, J. Tscheikuna, S. Sompradeekul, P. Ruttanaumpawan, and S. Charoenratanakul Prevalence of Bronchial Hyperresponsiveness and Asthma in the Adult Population in Thailand Chest, March 1, 2006; 129(3): 602 - 609. [Abstract] [Full Text] [PDF]

				D. S. Kim, Y. S. Kim, K.-S. Jung, J. H. Chang, C.-M. Lim, J. H. Lee, S.-T. Uh, J. J. Shim, W. J. Lew, and on behalf of the Korean Academy of Tuberculosis an Prevalence of Chronic Obstructive Pulmonary Disease in Korea: A Population-based Spirometry Survey Am. J. Respir. Crit. Care Med., October 1, 2005; 172(7): 842 - 847. [Abstract] [Full Text] [PDF]

				E F M Wouters, D S Postma, B Fokkens, W C J Hop, J Prins, A F Kuipers, H R Pasma, C A J Hensing, E C Creutzberg, and for the COSMIC (COPD and Seretide: a Multi-Center Withdrawal of fluticasone propionate from combined salmeterol/fluticasone treatment in patients with COPD causes immediate and sustained disease deterioration: a randomised controlled trial Thorax, June 1, 2005; 60(6): 480 - 487. [Abstract] [Full Text] [PDF]

				T. Ringbaek, N. Seersholm, and K. Viskum Standardised mortality rates in females and males with COPD and asthma Eur. Respir. J., May 1, 2005; 25(5): 891 - 895. [Abstract] [Full Text] [PDF]

				A. Lindberg, A.-C. Jonsson, E. Ronmark, R. Lundgren, L.-G. Larsson, and B. Lundback Ten-Year Cumulative Incidence of COPD and Risk Factors for Incident Disease in a Symptomatic Cohort Chest, May 1, 2005; 127(5): 1544 - 1552. [Abstract] [Full Text] [PDF]

				D M Wood, M G Mould, S B Y Ong, and E H Baker "Pack year" smoking histories: what about patients who use loose tobacco? Tob. Control, April 1, 2005; 14(2): 141 - 142. [Abstract] [Full Text] [PDF]

				C Svanes, E Omenaas, D Jarvis, S Chinn, A Gulsvik, and P Burney Parental smoking in childhood and adult obstructive lung disease: results from the European Community Respiratory Health Survey Thorax, April 1, 2004; 59(4): 295 - 302. [Abstract] [Full Text] [PDF]

				N. Tzanakis, U. Anagnostopoulou, V. Filaditaki, P. Christaki, and N. Siafakas Prevalence of COPD in Greece Chest, March 1, 2004; 125(3): 892 - 900. [Abstract] [Full Text] [PDF]

				R. G. Barr, C. C. Wentowski, F. Grodstein, S. C. Somers, M. J. Stampfer, J. Schwartz, F. E. Speizer, and C. A. Camargo Jr Prospective Study of Postmenopausal Hormone Use and Newly Diagnosed Asthma and Chronic Obstructive Pulmonary Disease Arch Intern Med, February 23, 2004; 164(4): 379 - 386. [Abstract] [Full Text] [PDF]

				M. N. Gong, Z. Wei, L.-L. Xu, D. P. Miller, B. T. Thompson, and D. C. Christiani Polymorphism in the Surfactant Protein-B Gene, Gender, and the Risk of Direct Pulmonary Injury and ARDS Chest, January 1, 2004; 125(1): 203 - 211. [Abstract] [Full Text] [PDF]

				C. Patrone, T. N. Cassel, K. Pettersson, Y.-S. Piao, G. Cheng, P. Ciana, A. Maggi, M. Warner, J.-A. Gustafsson, and M. Nord Regulation of Postnatal Lung Development and Homeostasis by Estrogen Receptor {beta} Mol. Cell. Biol., December 1, 2003; 23(23): 8542 - 8552. [Abstract] [Full Text] [PDF]

				I. Cerveri, S. Accordini, A. Corsico, M.C. Zoia, L. Carrozzi, L. Cazzoletti, M. Beccaria, A. Marinoni, G. Viegi, and R. de Marco Chronic cough and phlegm in young adults Eur. Respir. J., September 1, 2003; 22(3): 413 - 417. [Abstract] [Full Text] [PDF]

				P S Burge, P M A Calverley, P W Jones, S Spencer, and J A Anderson Prednisolone response in patients with chronic obstructive pulmonary disease: results from the ISOLDE study Thorax, August 1, 2003; 58(8): 654 - 658. [Abstract] [Full Text] [PDF]

				A. Langhammer, R. Johnsen, A. Gulsvik, T.L. Holmen, and L. Bjermer Sex differences in lung vulnerability to tobacco smoking Eur. Respir. J., June 1, 2003; 21(6): 1017 - 1023. [Abstract] [Full Text] [PDF]

				S.T. Weiss, D.L. DeMeo, and D.S. Postma COPD: problems in diagnosis and measurement Eur. Respir. J., June 1, 2003; 21(41_suppl): 4S - 12s. [Abstract] [Full Text] [PDF]

				S. Burge and J.A. Wedzicha COPD exacerbations: definitions and classifications Eur. Respir. J., June 1, 2003; 21(41_suppl): 46S - 53s. [Abstract] [Full Text] [PDF]

				G. C. Ooi, P. L. Khong, M. Chan-Yeung, J. C. M. Ho, P. K. S. Chan, J. C. K. Lee, W. K. Lam, and K. W. T. Tsang High-Resolution CT Quantification of Bronchiectasis: Clinical and Functional Correlation Radiology, December 1, 2002; 225(3): 663 - 672. [Abstract] [Full Text] [PDF]

				N S Godtfredsen, J Vestbo, M Osler, and E Prescott Risk of hospital admission for COPD following smoking cessation and reduction: a Danish population study Thorax, November 1, 2002; 57(11): 967 - 972. [Abstract] [Full Text] [PDF]

				S. Rennard, M. Decramer, P.M.A. Calverley, N.B. Pride, J.B. Soriano, P.A. Vermeire, and J. Vestbo Impact of COPD in North America and Europe in 2000: subjects' perspective of Confronting COPD International Survey Eur. Respir. J., October 1, 2002; 20(4): 799 - 805. [Abstract] [Full Text] [PDF]

				E Prescott, H Scharling, M Osler, and P Schnohr Importance of light smoking and inhalation habits on risk of myocardial infarction and all cause mortality. A 22 year follow up of 12 149 men and women in The Copenhagen City Heart Study J. Epidemiol. Community Health, September 1, 2002; 56(9): 702 - 706. [Abstract] [Full Text] [PDF]

				J. Vestbo and P. Lange Can GOLD Stage 0 Provide Information of Prognostic Value in Chronic Obstructive Pulmonary Disease? Am. J. Respir. Crit. Care Med., August 1, 2002; 166(3): 329 - 332. [Abstract] [Full Text] [PDF]

				L. P. Stabile, A. L. G. Davis, C. T. Gubish, T. M. Hopkins, J. D. Luketich, N. Christie, S. Finkelstein, and J. M. Siegfried Human Non-Small Cell Lung Tumors and Cells Derived from Normal Lung Express Both Estrogen Receptor {alpha} and {beta} and Show Biological Responses to Estrogen Cancer Res., April 1, 2002; 62(7): 2141 - 2150. [Abstract] [Full Text] [PDF]

				E. Prescott Commentary: Tobacco-related diseases: a gender differential? Int. J. Epidemiol., August 1, 2001; 30(4): 793 - 794. [Full Text] [PDF]

				I. Cerveri, S. Accordini, G. Verlato, A. Corsico, M.C. Zoia, L. Casali, P. Burney, and R. de Marco Variations in the prevalence across countries of chronic bronchitis and smoking habits in young adults Eur. Respir. J., July 1, 2001; 18(1): 85 - 92. [Abstract] [Full Text] [PDF]

				K. R. Chapman, D. P. Tashkin, and D. J. Pye Gender Bias in the Diagnosis of COPD Chest, June 1, 2001; 119(6): 1691 - 1695. [Abstract] [Full Text] [PDF]

				J.M. Anto, P. Vermeire, J. Vestbo, and J. Sunyer Epidemiology of chronic obstructive pulmonary disease Eur. Respir. J., May 1, 2001; 17(5): 982 - 994. [Abstract] [Full Text] [PDF]

				H Hannerz and F Tüchsen Hospital admissions among male drivers in Denmark Occup. Environ. Med., April 1, 2001; 58(4): 253 - 260. [Abstract] [Full Text]

				A. Langhammer, R. Johnsen, J. Holmen, A Gulsvik, and L Bjermer Cigarette smoking gives more respiratory symptoms among women than among men The Nord-Trondelag Health Study (HUNT) J. Epidemiol. Community Health, December 1, 2000; 54(12): 917 - 922. [Abstract] [Full Text]

				E. K. SILVERMAN, S. T. WEISS, J. M. DRAZEN, H. A. CHAPMAN, V. CAREY, E. J. CAMPBELL, P. DENISH, R. A. SILVERMAN, J. C. CELEDON, J. J. REILLY, et al. Gender-Related Differences in Severe, Early-Onset Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., December 1, 2000; 162(6): 2152 - 2158. [Abstract] [Full Text]

				J. B Soriano, W. C Maier, P. Egger, G. Visick, B. Thakrar, J. Sykes, and N. B Pride Recent trends in physician diagnosed COPD in women and men in the UK Thorax, September 1, 2000; 55(9): 789 - 794. [Abstract] [Full Text]

				P. Calverley and D. Bellamy Issues at the interface between primary and secondary care in the management of common respiratory disease bullet 5: The challenge of providing better care for patients with chronic obstructive pulmonary disease: the poor relation of airways obstruction? Thorax, January 1, 2000; 55(1): 78 - 82. [Full Text]

				M. R Becklake and F. Kauffmann Gender differences in airway behaviour over the human life span Thorax, December 1, 1999; 54(12): 1119 - 1138. [Full Text]