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Original research
Patient gender bias on the diagnosis of idiopathic pulmonary fibrosis
  1. Deborah Assayag1,
  2. Julie Morisset2,
  3. Kerri A Johannson3,
  4. Athol U Wells4,
  5. Simon L F Walsh5
  1. 1Department of Medicine, McGill University, Montreal, Quebec, Canada
  2. 2Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
  3. 3Department of Medicine, University of Calgary, Calgary, Alberta, Canada
  4. 4Interstitial Lung Disease Unit, Royal Brompton and Harefield Foundation Trust, Royal Brompton Hospital, London, UK
  5. 5National Heart and Lung Institute, Imperial College, London, UK
  1. Correspondence to Dr Deborah Assayag, Medicine, McGill University Health Centre, Montreal H3G1A4, Quebec, Canada; deborah.assayag{at}mcgill.ca

Abstract

Background Patient sex has clinical and prognostic implications in idiopathic pulmonary fibrosis (IPF). It is not known if sex-related and gender-related discrepancies exist when establishing a diagnosis of IPF. The aim was to determine how patient gender influences the diagnosis of IPF and the physician’s diagnostic confidence.

Methods This study was performed using clinical cases compiled from a single centre, then scored by respiratory physicians for a prior study. Using clinical information, physicians were asked to provide up to five diagnoses, together with their diagnostic confidence. Logistic regression was used to assess the odds of receiving a diagnosis of IPF based on patient gender. Prognostic discrimination between IPF and non-IPF was used to assess diagnostic accuracy with Cox proportional hazards modelling.

Results Sixty cases were scored by 404 physicians. IPF was diagnosed more frequently in men compared with women (37.8% vs 10.6%; p<0.0001), and with greater mean diagnostic confidence (p<0.001). The odds of a male patient receiving an IPF diagnosis was greater than that of female patients, after adjusting for confounders (OR=3.05, 95% CI: 2.81 to 3.31), especially if the scan was not definite for the usual interstitial pneumonia pattern. Mortality was higher in women (HR=2.21, 95% CI: 2.02 to 2.41) than in men with an IPF diagnosis (HR=1.26, 95% CI: 1.20 to 1.33), suggesting that men were more often misclassified as having IPF.

Conclusion Patient gender influences diagnosis of IPF: women may be underdiagnosed and men overdiagnosed with IPF.

  • interstitial fibrosis
  • idiopathic pulmonary fibrosis
  • clinical epidemiology
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Footnotes

  • Contributors All listed authors have substantially contributed to the conception and design of this study. All authors have contributed to the writing of the manuscript and critical revisions for intellectual content, and have read and approved the final version submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests DA reports personal fees and other from Hoffman-La Roche Ltd, personal fees and other from Boehringer Ingelheim, outside the submitted work. JM reports personal fees from Roche, personal fees from Boehringer Ingelheim, outside the submitted work. JK reports personal fees and other from Hoffman-La Roche Ltd, personal fees and other from Boehringer Ingelheim, personal fees from Theravance, grants from CHEST Foundation, grants from UCB Biopharma SPR, grants from University of Calgary, outside the submitted work; AW reports personal fees from Boehringer Ingelheim, personal fees from Intermune/Roche, personal fees from Bayer, outside the submitted work; SW reports personal fees from Boehringer Ingelheim, personal fees from Intermune/Roche, personal fees from Sanofi-Genzyme, personal fees from Bracco, personal fees from Oncoarendi therapeutics, outside the submitted work;

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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