IN a surprising finding that raises important clinical questions, a new analysis of the 2020 National Health Interview Survey shows that women in the U.S. aged 40 and older have significantly higher rates of chronic obstructive pulmonary disease (COPD) than men, even though they report lower exposure to cigarette smoke. The study highlights a striking 50% increase in COPD risk for women, pointing to potential biological or environmental susceptibilities that warrant further investigation.
Published on May 7, 2025, the study examined data from thousands of U.S. adults aged 40 and over, evaluating the associations between gender, smoking history, and COPD diagnosis. Researchers found that 7.8% of women reported physician-diagnosed COPD, compared to just 6.5% of men. This discrepancy persisted even though women were less likely to have ever smoked and reported lower cumulative tobacco exposure—measured by average pack-years—than men.
After adjusting for sociodemographic variables and smoking history using weighted multivariable logistic regressions, the analysis confirmed that female gender was independently associated with a higher risk of COPD. Specifically, women had an adjusted risk ratio of 1.47 (95% CI: 1.30 to 1.65) for developing the disease. Notably, this elevated risk was consistent among both smokers and non-smokers, and no significant interactions were found between gender and smoking status or pack-year history.
These findings challenge the assumption that cigarette use alone accounts for COPD prevalence and emphasize the need for clinicians to consider gender-based risk factors in diagnosis and prevention strategies. The study’s results suggest that other biological, hormonal, or occupational exposures may play a role in COPD development among women.
As COPD continues to place a heavy burden on the healthcare system, especially among aging populations, this research signals a critical gap in understanding that could inform both public health and clinical practice in the years ahead.
Reference:
Steinberg AW et al. Gender, tobacco and chronic obstructive pulmonary disease: analysis of the 2020 National Health Interview Survey. BMJ Open Respir Res. 2025;12:e002462.
