Gender differences in clinical features, comorbidities and prognostic outcomes in idiopathic pulmonary fibrosis-a retrospective cohort analysis from the British Thoracic Society Interstitial Lung Disease Registry

1. Men with idiopathic pulmonary fibrosis (IPF) have a higher comorbidity burden, worse baseline lung function, and shorter survival, with IHD and reduced FVC/DLCO driving mortality.

2. In women with IPF, delayed presentation and impaired gas transfer—rather than FVC—appear to be the dominant prognostic factors.

Evidence Rating Level: 2 (Good) 

Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease with worse outcomes in men, but sex-specific prognostic data are limited. This retrospective cohort study analysed 6,666 IPF patients from the British Thoracic Society UK IPF/ILD Registry (2013–2024) to compare baseline characteristics, comorbidities, treatment and survival between men and women. Investigators collected demographics, smoking history, comorbidities, lung function, imaging and therapy data, and used sex-stratified Cox proportional hazards models to identify survival predictors. Men (78%) had greater smoking exposure and higher rates of ischaemic heart disease and diabetes, presented with lower FVC, and were more frequently treated with antifibrotics. In men, older age, ischaemic heart disease, and lower FVC and DLCO predicted poorer survival, while hiatus hernia was unexpectedly protective. In women, symptom duration >12 months, baseline oxygen requirement and lower DLCO were associated with worse survival, whereas gastro-oesophageal reflux disease predicted better outcomes. Women had longer median survival than men (11.6 vs 8.3 years). The authors conclude that IPF demonstrates clinically meaningful sex differences and that management should incorporate gender-specific risk profiles. Prospective studies are needed to confirm these signals and explore underlying biological mechanisms and health-system factors.

Click here to read this study in BMJ Open

Image: PD

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