ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Sex Differences in Longitudinal Assessment of COPD Morbidity in SPIROMICS
Session Title
C5 - C005 DIAGNOSIS AND PROGNOSIS IN COPD
Abstract
A1121 - Sex Differences in Longitudinal Assessment of COPD Morbidity in SPIROMICS
Author Block: A. A. Lambert1, Y. Chen2, K. S. Daratha3, S. Murray2, I. Barjaktarevic4, C. B. Cooper5, M. L. Wilgus6, S. P. Bhatt7, J. M. Wells8, S. C. Lazarus9, S. Christenson10, D. P. Tashkin11, V. Kim12, V. E. Ortega13, R. E. Kanner14, M. Scholand15, R. Paine15, C. S. Pirozzi16, J. A. Krishnan17, L. M. Paulin18, M. B. Drummond19, N. Putcha20, R. A. Wise21, E. R. Neptune22, C. O. Ejike23, J. L. Curtis24, N. N. Hansel21, M. K. Han25; 1Pulmonary and Critical Care, University of Washington, Spokane, WA, United States, 2Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States, 3School of Health Informatics, Providence Medical Research Center, Spokane, WA, United States, 4Pulmonary and Critical Care, UCLA, Los Angeles, CA, United States, 5Departments of Medicine and Physiology, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States, 6Department of Medicine; Division of Pulmonary and Critical Care, University of California Los Angeles, Ventura, CA, United States, 7Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, United States, 8Pulmonary, Allergy, and Critical Care Medicine, UAB, Birmingham, AL, United States, 9Division of Pulmonary & Critical Care Medicine, Univ of California San Francisco, San Francisco, CA, United States, 10Pulmonary & Critical Care, University of California- San Francisco, San Francisco, CA, United States, 11Medicine, David Geffen Sch of Medicine at UCLA, Los Angeles, CA, United States, 12Thoracic Medicine and Surgery, Temple Lung Center, Philadelphia, PA, United States, 13Wake Forest School of Medicine, Winston Salem, NC, United States, 14Univ of Utah Sch of Med, Salt Lake City, UT, United States, 15Univ of Utah, Salt Lake City, UT, United States, 16University of Utah, Salt Lake City, UT, United States, 17Univ of Illinois, Chicago, IL, United States, 18Pulmonary/Critical Care, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States, 19Medicine-Pulmonary, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States, 20Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States, 21Johns Hopkins Univ, Baltimore, MD, United States, 22Johns Hopkins Sch of Med, Baltimore, MD, United States, 23Pulmonary/Critical care, John Hopkins University, Baltimore, MD, United States, 24Internal Medicine, Univ of Michigan Hlth System, Ann Arbor, MI, United States, 25University of Michigan School of Medicine, Ann Arbor, MI, United States.
Rationale: Females with chronic obstructive pulmonary disease (COPD) exhibit reduced respiratory-specific quality of life (RSQL) and health-related quality of life (HRQL). We quantified sex longitudinally in the Subpopulations and Intermediate Outcome Measures in COPD study (SPIROMICS), a prospective cohort with detailed clinical phenotyping.
Methods: We examined data from SPIROMICS participants with >20 pack-year smoking history and spirometrically-defined COPD who completed at least 3 of 4 study visits over a 5-year period. Outcomes of interest included RSQL measures (St. George’s Respiratory Questionnaire score, SGRQ, and COPD Assessment Test, CAT); general HRQL (Short Form-12 summary score, SF-12, which combines physical and mental scores); functional capacity (6-minute walk distance, 6MWD); and dyspnea (modified Medical Research Council, mMRC). We constructed generalized estimating equation models to evaluate sex as a predictor of outcomes, adjusting for baseline race, age, waist-to-hip ratio, current/former smoking status, and time-dependent visit, BMI, and FEV1% predicted. Additional models included interactions between sex and visit to assess sex-specific trajectories over time.
Results: Among 696 participants followed over a median of 3 years (IQR: 2.09, 3.14), nearly half (43%) were female; their characteristics were similar to those of males: mean age 66 years, 31% current smokers, 85% white race, and mean FEV1 61% predicted. However, females reported less cumulative smoking than males (mean 50 versus 56 pack-years, P<0.001). In models adjusted for above noted factors including time-dependent lung function, female sex was associated with impaired QoL as represented by a higher SGRQ at baseline (mean difference +4.03, P<0.001) and lower SF-12 summary score at baseline (mean difference -3.06, P=0.001). This disparity persisted at annual follow-up visits (Figure 1A, 1B). Females also had impaired functional capacity, with lower 6MWD at baseline (mean difference -36.5 m, P<0.001) and at each follow-up visit (Figure 1C). Odds of mMRC ≥2 were greater among females at visit 3 (OR 2.03, P<0.001) and visit 4 (OR 1.8, P<0.01), but not visit 1 (OR 1.31, P=0.13) or visit 2 (OR 1.11, P=0.57). Lastly, females were more likely to report CAT ≥10 at baseline (OR 1.71, P<0.01), visit 3 (OR 1.68, P<0.01), and visit 4 (OR 1.55, P=0.048), with visit 2 differences not reaching statistical significance (OR 1.37, P=0.09).
Conclusions: Despite less cumulative smoking, female SPIROMICS participants with COPD demonstrated greater respiratory morbidity than males. This disparity persisted over three years follow-up, even after adjusting for risk factors such as lung function, BMI, waist-to-hip ratio, and smoking status and burden.
Author Block: A. A. Lambert1, Y. Chen2, K. S. Daratha3, S. Murray2, I. Barjaktarevic4, C. B. Cooper5, M. L. Wilgus6, S. P. Bhatt7, J. M. Wells8, S. C. Lazarus9, S. Christenson10, D. P. Tashkin11, V. Kim12, V. E. Ortega13, R. E. Kanner14, M. Scholand15, R. Paine15, C. S. Pirozzi16, J. A. Krishnan17, L. M. Paulin18, M. B. Drummond19, N. Putcha20, R. A. Wise21, E. R. Neptune22, C. O. Ejike23, J. L. Curtis24, N. N. Hansel21, M. K. Han25; 1Pulmonary and Critical Care, University of Washington, Spokane, WA, United States, 2Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States, 3School of Health Informatics, Providence Medical Research Center, Spokane, WA, United States, 4Pulmonary and Critical Care, UCLA, Los Angeles, CA, United States, 5Departments of Medicine and Physiology, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States, 6Department of Medicine; Division of Pulmonary and Critical Care, University of California Los Angeles, Ventura, CA, United States, 7Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, United States, 8Pulmonary, Allergy, and Critical Care Medicine, UAB, Birmingham, AL, United States, 9Division of Pulmonary & Critical Care Medicine, Univ of California San Francisco, San Francisco, CA, United States, 10Pulmonary & Critical Care, University of California- San Francisco, San Francisco, CA, United States, 11Medicine, David Geffen Sch of Medicine at UCLA, Los Angeles, CA, United States, 12Thoracic Medicine and Surgery, Temple Lung Center, Philadelphia, PA, United States, 13Wake Forest School of Medicine, Winston Salem, NC, United States, 14Univ of Utah Sch of Med, Salt Lake City, UT, United States, 15Univ of Utah, Salt Lake City, UT, United States, 16University of Utah, Salt Lake City, UT, United States, 17Univ of Illinois, Chicago, IL, United States, 18Pulmonary/Critical Care, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States, 19Medicine-Pulmonary, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States, 20Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States, 21Johns Hopkins Univ, Baltimore, MD, United States, 22Johns Hopkins Sch of Med, Baltimore, MD, United States, 23Pulmonary/Critical care, John Hopkins University, Baltimore, MD, United States, 24Internal Medicine, Univ of Michigan Hlth System, Ann Arbor, MI, United States, 25University of Michigan School of Medicine, Ann Arbor, MI, United States.
Rationale: Females with chronic obstructive pulmonary disease (COPD) exhibit reduced respiratory-specific quality of life (RSQL) and health-related quality of life (HRQL). We quantified sex longitudinally in the Subpopulations and Intermediate Outcome Measures in COPD study (SPIROMICS), a prospective cohort with detailed clinical phenotyping.
Methods: We examined data from SPIROMICS participants with >20 pack-year smoking history and spirometrically-defined COPD who completed at least 3 of 4 study visits over a 5-year period. Outcomes of interest included RSQL measures (St. George’s Respiratory Questionnaire score, SGRQ, and COPD Assessment Test, CAT); general HRQL (Short Form-12 summary score, SF-12, which combines physical and mental scores); functional capacity (6-minute walk distance, 6MWD); and dyspnea (modified Medical Research Council, mMRC). We constructed generalized estimating equation models to evaluate sex as a predictor of outcomes, adjusting for baseline race, age, waist-to-hip ratio, current/former smoking status, and time-dependent visit, BMI, and FEV1% predicted. Additional models included interactions between sex and visit to assess sex-specific trajectories over time.
Results: Among 696 participants followed over a median of 3 years (IQR: 2.09, 3.14), nearly half (43%) were female; their characteristics were similar to those of males: mean age 66 years, 31% current smokers, 85% white race, and mean FEV1 61% predicted. However, females reported less cumulative smoking than males (mean 50 versus 56 pack-years, P<0.001). In models adjusted for above noted factors including time-dependent lung function, female sex was associated with impaired QoL as represented by a higher SGRQ at baseline (mean difference +4.03, P<0.001) and lower SF-12 summary score at baseline (mean difference -3.06, P=0.001). This disparity persisted at annual follow-up visits (Figure 1A, 1B). Females also had impaired functional capacity, with lower 6MWD at baseline (mean difference -36.5 m, P<0.001) and at each follow-up visit (Figure 1C). Odds of mMRC ≥2 were greater among females at visit 3 (OR 2.03, P<0.001) and visit 4 (OR 1.8, P<0.01), but not visit 1 (OR 1.31, P=0.13) or visit 2 (OR 1.11, P=0.57). Lastly, females were more likely to report CAT ≥10 at baseline (OR 1.71, P<0.01), visit 3 (OR 1.68, P<0.01), and visit 4 (OR 1.55, P=0.048), with visit 2 differences not reaching statistical significance (OR 1.37, P=0.09).
Conclusions: Despite less cumulative smoking, female SPIROMICS participants with COPD demonstrated greater respiratory morbidity than males. This disparity persisted over three years follow-up, even after adjusting for risk factors such as lung function, BMI, waist-to-hip ratio, and smoking status and burden.
