Sex differences in susceptibility, severity, and outcomes of coronavirus disease 2019: Cross-sectional analysis from a diverse US metropolitan area

• Published in: PloS one Vol. 16; no. 1; p. e0245556
• Main Authors: Vahidy, Farhaan S., Pan, Alan P., Ahnstedt, Hilda, Munshi, Yashasvee, Choi, Huimahn A., Tiruneh, Yordanos, Nasir, Khurram, Kash, Bita A., Andrieni, Julia D., McCullough, Louise D.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 13.01.2021; Public Library of Science (PLoS)
• Subjects: Analysis; Asthma; Bilirubin; Biology and life sciences; Blood pressure; Body mass; Body mass index; Body size; Bronchitis; C-reactive protein; Calcium-binding protein; Cardiology; Cerebrovascular diseases; Cities - epidemiology; Comorbidity; Complications; Confidence intervals; Congestive heart failure; Coronary artery disease; Coronaviruses; COVID-19; COVID-19 - diagnosis; COVID-19 - epidemiology; Creatinine; Cross-Sectional Studies; Dementia disorders; Diabetes; Diabetes mellitus; Dimers; Disease Susceptibility; Earth Sciences; Editing; Epidemiology; Ethnicity; Family income; Female; Females; Ferritin; Gender aspects; Gender differences; Health risks; Health surveillance; Heart failure; Hospitalization; Hospitals; Humans; Hypertension; Hypoxia; Immune response; Liver; Liver diseases; Lung diseases; Lymphocytes; Male; Males; Medical schools; Medicine and Health Sciences; Methodology; Metropolitan areas; Middle Aged; Minority & ethnic groups; Mortality; Myocardial infarction; Neurology; Oxygen; Oxygen content; Pandemics; Paraplegics; Patients; Population density; Prognosis; Public health; Renal failure; Respiration; Respiratory distress syndrome; Respiratory rate; Severe acute respiratory syndrome coronavirus 2; Severity of Illness Index; Sex differences; Sex Distribution; Sex factors in disease; Sexually transmitted diseases; Social Sciences; Sociodemographics; STD; United States - epidemiology; Vascular diseases; Ventilators; Viral diseases; United States; Cities; New York; United States > US; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0245556

Sex is increasingly recognized as an important factor in the epidemiology and outcome of many diseases. This also appears to hold for coronavirus disease 2019 (COVID-19). Evidence from China and Europe has suggested that mortality from COVID-19 infection is higher in men than women, but evidence from US populations is lacking. Utilizing data from a large healthcare provider, we determined if males, as compared to females have a higher likelihood of SARS-CoV-2 susceptibility, and if among the hospitalized COVID-19 patients, male sex is independently associated with COVID-19 severity and poor in-hospital outcomes. Using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, we conducted a cross-sectional analysis of data from a COVID-19 Surveillance and Outcomes Registry (CURATOR). Data were extracted from Electronic Medical Records (EMR). A total of 96,473 individuals tested for SARS-CoV-2 RNA in nasopharyngeal swab specimens via Polymerized Chain Reaction (PCR) tests were included. For hospital-based analyses, all patients admitted during the same time-period were included. Of the 96,473 patients tested, 14,992 (15.6%) tested positive, of whom 4,785 (31.9%) were hospitalized and 452 (9.5%) died. Among all patients tested, men were significantly older. The overall SARS-CoV-2 positivity among all tested individuals was 15.5%, and was higher in males as compared to females 17.0% vs. 14.6% [OR 1.20]. This sex difference held after adjusting for age, race, ethnicity, marital status, insurance type, median income, BMI, smoking and 17 comorbidities included in Charlson Comorbidity Index (CCI) [aOR 1.39]. A higher proportion of males (vs. females) experienced pulmonary (ARDS, hypoxic respiratory failure) and extra-pulmonary (acute renal injury) complications during their hospital course. After adjustment, length of stay (LOS), need for mechanical ventilation, and in-hospital mortality were significantly higher in males as compared to females. In this analysis of a large US cohort, males were more likely to test positive for COVID-19. In hospitalized patients, males were more likely to have complications, require ICU admission and mechanical ventilation, and had higher mortality than females, independent of age. Sex disparities in COVID-19 vulnerability are present, and emphasize the importance of examining sex-disaggregated data to improve our understanding of the biological processes involved to potentially tailor treatment and risk stratify patients.