gms | German Medical Science

24. Jahrestagung des Netzwerks Evidenzbasierte Medizin e. V.

Netzwerk Evidenzbasierte Medizin e. V. (EbM-Netzwerk)

22. - 24.03.2023, Potsdam

Systematic reviews neglect to consider the influence of sex or age diversity on outcomes of digital technologies for treatment and monitoring of chronic obstructive pulmonary disease

Meeting Abstract

  • Katja Matthias - University of Applied Sciences Stralsund, Faculty of Electrical Engineering and Computer Science, Stralsund, Deutschland
  • Ivonne Honekamp - University of Applied Sciences Stralsund, Faculty of Business and Economics, Stralsund, Deutschland
  • Monique Heinrich - University of Applied Sciences Stralsund, Faculty of Electrical Engineering and Computer Science, Stralsund, Deutschland
  • Karina Karolina De Santis - Leibniz Institute for Prevention Research and Epidemiology – BIPS, Department Prevention and Evaluation, Deutschland; Leibniz Science Campus Digital Public Health Bremen, Bremen, Deutschland

Gesundheit und Klima – EbM für die Zukunft. 24. Jahrestagung des Netzwerks Evidenzbasierte Medizin. Potsdam, 22.-24.03.2023. Düsseldorf: German Medical Science GMS Publishing House; 2023. Doc23ebmPSI-2-02

doi: 10.3205/23ebm027, urn:nbn:de:0183-23ebm0274

Published: March 21, 2023

© 2023 Matthias et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Background/research question: Chronic obstructive pulmonary disease (COPD) is a common chronic disease that is differentially affected by biological sex and age in terms of prevalence, deaths, and disability-adjusted life years. Digital technologies (DT) offer unique opportunities to assist COPD healthcare in terms of treatment and monitoring. Knowledge from systematic reviews (SR) can assist healthcare professionals to recommend such DT to people with COPD. This study aimed to assess if sex and age diversity are considered in SR of DT for treatment and monitoring of COPD.

Methods: The protocol for this study was prospectively published [1]. Relevant SR were identified from databases (MEDLINE, Cochrane Library, Epistemonikos and Web of Science) and bibliographies of the included SR. SR were independently selected and coded using a standardized data extraction sheet by two researchers. All included SR were appraised with AMSTAR 2.

Results: Of 1.439 records identified in our search, 30 SR met the inclusion criteria. All 30 SR were published in 2010–2022 with majority (20/30) being recent (published in 2017–2022). All 30 SR addressed any DT use for treatment or monitoring of COPD. Most SR included primary studies with any design (randomized controlled trials or non-randomized controlled trials, 16/30) and appraised the risk of bias in primary studies (27/30). Most SR received critically low confidence ratings on AMSTAR 2 (25/30), while low (1/30), moderate (1/30), or high (3/30) ratings were rare. Sex diversity was not considered in any SR. Age diversity was planned to be investigated in sensitivity analysis in 3/30 SR, but only 1/30 SR conducted such analyses. This SR found that acceptance and dropout rates of telehealth measures in COPD were comparable between different age groups (below or above the age of 69). Some SR (9/30) planned or conducted subgroup analyses that did not include sex or age.

Conclusion: There is a growing recognition that the influence of sex and age should be considered in COPD healthcare. Despite complex interactions between sex and age in COPD reported in the Global Burden of Disease Study 2019 [2], SR neglect sex and age when evaluating the outcomes of DT use in COPD. Thus, SR do not communicate the evidence required by healthcare professionals to make individualized (sex- or age-based) recommendations for DT use in COPD. We recommend the consideration of sex and gender diversity in future SR of DT use in COPD.

Competing interests: none


Matthias K, Honekamp I, De Santis KK. The Influence of Sex, Gender, or Age on Outcomes of Digital Technologies for Treatment and Monitoring of Chronic Obstructive Pulmonary Disease: Protocol for an Overview of Systematic Reviews. JMIR Res Protoc. 2022 Oct 12;11(10):e40538. DOI: 10.2196/40538 External link
Safiri S, Carson-Chahhoud K, Noori M, Nejadghaderi SA, Sullman MJM, Ahmadian Heris J, Ansarin K, Mansournia MA, Collins GS, Kolahi AA, Kaufman JS. Burden of chronic obstructive pulmonary disease and its attributable risk factors in 204 countries and territories, 1990-2019: results from the Global Burden of Disease Study 2019. BMJ. 2022 Jul 27;378:e069679. DOI: 10.1136/bmj-2021-069679 External link