Examining gender differences in the diagnosis of obstructive airway diseases

Acheampong, Lily (2019) Examining gender differences in the diagnosis of obstructive airway diseases. Masters thesis, Memorial University of Newfoundland.

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Abstract

Gender disparities in the diagnosis of cardiovascular diseases have been well established. Not much is known about gender differences in obstructive airway diseases (OADs). The aim of this thesis is to 1) conduct a systematic review and meta-analysis to synthesize the existing evidence on gender bias in the diagnosis of chronic obstructive pulmonary disease (COPD), 2) conduct a secondary data analysis to examine gender diagnostic bias in patients who meet spirometry criteria for COPD and 3) conduct a secondary data analysis to examine gender diagnostic bias in patients who meet spirometry criteria for asthma. The Cochrane handbook for systematic reviews of interventions was used as a guide for standard methods used in systematic reviews. Literature search was conducted using MEDLINE (PubMed), EMBASE and CINAHL. Relevant articles were selected for descriptive and quantitative synthesis, and the Inverse Variance (IV) random effect model was used for analysis. For the secondary data analysis, multivariate logistic regression was used to assess the effect of sex on diagnostic outcomes (physician-diagnosed COPD or physician-diagnosed asthma, misdiagnosis, referral to a specialist, referral for spirometry and referral for chest x-ray), while controlling for additional patient factors. Results from the meta-analysis suggests that gender disparities do exist in primary care for COPD, as men were about two times more likely to receive a correct diagnosis for COPD, and women with respiratory symptoms were less likely to be referred for spirometry. For the secondary analysis of data, no significant differences between genders were observed for all diagnostic outcomes in patients who meet spirometry criteria for COPD. However, for patients with spirometrically-defined asthma, women were less likely than men to receive a correct diagnosis for asthma, less likely to be referred for spirometry, but more likely than men to be referred for chest-x-ray.

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