PT  - JOURNAL ARTICLE
AU  - Assayag, Deborah
AU  - Morisset, Julie
AU  - Johannson, Kerri A
AU  - Wells, Athol U
AU  - Walsh, Simon L F
TI  - Patient gender bias on the diagnosis of idiopathic pulmonary fibrosis
AID  - 10.1136/thoraxjnl-2019-213968
DP  - 2020 May 01
TA  - Thorax
PG  - 407--412
VI  - 75
IP  - 5
4099  - http://thorax.bmj.com/content/75/5/407.short
4100  - http://thorax.bmj.com/content/75/5/407.full
SO  - Thorax2020 May 01; 75
AB  - 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.