Abstract
BackgroundFemale sex is a significant risk factor for pulmonary arterial hypertension (PAH), yet males with PAH have worse survival – a phenomenon referred to as the “sex paradox” in PAH. MethodsAll adult PAH patients in the Pulmonary Hypertension Association Registry (PHAR) with congruent sex and gender were included. Baseline differences in demographics, hemodynamics, functional parameters, and quality of life were assessed by sex. Kaplan-Meier survival analysis was used to evaluate survival by sex. Mediation analysis was conducted with Cox proportional hazards regression by comparing the unadjusted hazard ratios for sex before and after adjustment for covariates. The plausibility of collider-stratification bias was assessed by modeling how large an unmeasured factor would have to be to generate the observed sex-based mortality differences. Subgroup analysis was performed on idiopathic and incident patients. ResultsAmong the 1,891 patients included, 75% were female. Compared to men, women had less favorable hemodynamics, lower six-minute walk distance, more PAH therapies, and worse functional class; however, sex-based differences were less pronounced when accounting for body surface area or expected variability by gender. On multivariate analysis, women had a 48% lower risk of death compared to men (Hazard Ratio 0.52, 95% Confidence interval 0.36 – 0.74, p<0.001). Modeling found that under reasonable assumptions collider-stratification could account for sex-based differences in mortality. ConclusionsIn this large registry of PAH patients new to a care center, men had worse survival than women despite having more favorable baseline characteristics. Collider-stratification bias could account for the observed greater mortality among men.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
More From: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.