gms | German Medical Science

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