Sex differences in the diagnosis of chronic obstructive pulmonary disease after spirometry

Female patients are more likely than male patients to report delays in the diagnosis of chronic obstructive pulmonary disease (COPD). However, the etiology of these delays is unknown. Vignette-based studies, involving hypothetical patients who differ only by sex, have found that although physicians are less likely to consider COPD as an initial diagnosis in female patients, this difference resolves with the performance of spirometry. The implication is that delays in the diagnosis of COPD in female patients are due to delays in the performance of spirometry. If this hypothesis were true, increasing access to spirometry would yield diagnostic equity in male and female patients. However, this hypothesis has not been tested with clinical data. We sought to test the alternate hypothesis–that sex differences in the diagnosis of COPD persist after the performance of spirometry–by comparing the time to diagnosis of COPD in male and female patients with spirometric evidence of obstruction. This letter was previously circulated as a preprint (https://doi.org/10.1101/2024.08.05.24311519).

National Heart, Lung, and Blood Institute

Alexander T Moffett, Scott D Halpern, Gary E Weissman