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We thank Dr Fahim and colleagues1 for their interest in our paper examining gender differences in survival following chronic obstructive pulmonary disease (COPD) hospitalisation.2 Their group has previously examined possible predictors of mortality and readmission in a group of patients hospitalised for COPD.
Fahim et al report a cumulative mortality of 6.8% although the duration of follow-up in their study is not specified. In our cohort of patients hospitalised for COPD, mortality in women and men was 12.6% and 18.3% at 1 year, and 43.8% and 56.2% at 5 years, respectively. Male gender was associated with a significantly increased risk of death (HR 1.45, 95% CI 1.42 to 1.49).
Fahim et al did not observe significant gender differences in mortality. We agree that this is probably due to a significantly smaller sample size and perhaps a younger patient population. The analysis of large health administrative databases has limitations, in particular the absence of smoking status or lung function data. Yet their use provides much strength in numbers. The older age of our cohort is based on the selection of subjects aged ≥66 years, to ensure at least 1 year of prescription information prior to the index hospitalisation.
We agree with Fahim and colleagues that the period immediately following an exacerbation of COPD provides a key window for interventions. Awareness of the high death rate in older patients hospitalised for COPD and increasing recognition of gender differences in mortality and clinical expression of COPD3 4 ultimately may lead to more targeted interventions and better outcomes.