The literature is conflicting with regards to gender differences in the CF population with some studies reporting poorer prognosis in CF females. Variations in study design (cross-sectional v longitudinal and single v multi-centre), study populations (paediatric v adults) and small sample sizes may in part explain these differences. In an attempt to overcome some of these limitations we analysed the UK CF Trust Registry database, which collates data on the paediatric and adult UK CF population for evidence of gender differences.
Methods We used the 2010 annual review data and compared males and females in age-groups 0–5, 6–12, 13–15, 16–19, 20–23, 24–29 and 30+ years for lung function (FEV1 and FVC (% predicted)), infection status, treatments (rhDNase, O2 therapy, Non-Invasive Ventilation (NIV), IV antibiotics, supplementary feeding and pancreatic supplements), body mass index and associated complications (CF related diabetes, osteoporosis, liver disease).
Results Of the 7937 patients attending annual review in 2010 47% were female. The sex distribution differed by age whereby the proportion of females dropped from 16 years onwards (Figure 1). The mean FEV1 was significantly(p<0.001) lower in female teens aged 16–19 years compared to males (females: 71.0 (confidence interval 68.8–73.2), males 76.7 (74.6–78.8), but not in any other age group. Similar results were observed for mean FVC for which females aged 20–23 yrs also had significantly lower values than males. Teenage female salso had a significantly (p<0.05) higher use of rhDNase, gastrostomies, O2, had more days/yr on IV antibiotics in hospital and had a significantly(p≤0.001) higher rate of CFRD. In addition, a significantly (p<0.05) higher percentage of females older than 13 had more home IV antibiotics. We did not detect any gender differences with respect to chronic bacterial colonisation(PA, SA, Bcepacia and MRSA).
Conclusions There is evidence of a more severe lung function deficit in teenage years. The reduced proportion of females in the adult cohorts is consistent with a survival difference. Further longitudinal analyses will help characterise the identified gender gap and effects on disease progression.
We thank the UK CF Trust for the registry data.
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