Does comorbidity burden explain the higher COVID-19 mortality risk among men? A retrospective cross-sectional analysis of a well-defined cohort of patients in Bronx, New York

• Published in: BMJ open Vol. 12; no. 9; p. e063862
• Main Authors: Vasa, Aastha, Kini, Maya, Neugarten, Joel, Bellin, Eran, Golestaneh, Ladan
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 01.09.2022; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Age; Asthma; Blood pressure; Body mass index; Census of Population; Comorbidity; Coronaviruses; COVID-19; COVID-19 diagnostic tests; Cross-Sectional Studies; Diabetes; Disease; Epidemiology; Ethnicity; Female; Gender differences; Hispanic people; Hospital Mortality; Hospitalization; Hospitals; Humans; Hypertension; Leukemia, Myeloid, Acute; Male; Mortality; New York - epidemiology; Patients; public health; respiratory infections; Retrospective Studies; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Sexes; Vital statistics; Womens health; New York; United States > US; COVID-19; epidemiology; public health; respiratory infections
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2022-063862

ObjectivesMen have a higher mortality rate and more severe COVID-19 infection than women. The mechanism for this is unclear. We hypothesise that innate sex differences, rather than comorbidity burden, drive higher male mortality.DesignRetrospective cohort.SettingMontefiore Health System (MHS) in Bronx, New York, USA.ParticipantsA cohort population of 364 992 patients at MHS between 1 January 2018 and 1 January 2020 was defined, from which individuals hospitalised during the pre-COVID period (1 January 2020–15 February 2020) (n=5856) and individuals hospitalised during the COVID-19 surge (1 March 2020–15 April 2020) (n=4793) were examined for outcomes. A subcohort with confirmed COVID-19+ hospitalisation was also examined (n=1742).Primary and secondary outcome measuresHospitalisation and in-hospital mortality.ResultsMen were older, had more comorbidities, lower body mass index and were more likely to smoke. Unadjusted logistic regression showed a higher odds of death in hospitalised men than women during both the pre-COVID-19 and COVID-19 periods (pre-COVID-19, OR: 1.66 vs COVID-19 OR: 1.98). After adjustment for relevant clinical and demographic factors, the higher risk of male death attenuated towards the null in the pre-COVID-19 period (OR 1.36, 95% CI 1.05 to 1.76) but remained significantly higher in the COVID-19 period (OR 2.02; 95% CI 1.73 to 2.34).In the subcohort of COVID-19+ hospitalised patients, men had 1.37 higher odds of in-hospital death (95% CI 1.09 to 1.72), which was not altered by adjustment for comorbidity (OR remained at 1.38 (95% CI 1.08 to 1.76)) but was attenuated with addition of initial pulse oximetry on presentation (OR 1.26, 95% CI 0.99 to 1.62).ConclusionsHigher male mortality risk during the COVID-19 period despite adjustment for comorbidity supports the role of innate physiological susceptibility to COVID-19 death. Attenuation of higher male risk towards the null after adjustment for severity of lung disease in hospitalised COVID-19+ patients further supports the role of higher severity of COVID-19 pneumonia in men.