Males are more likely to test positive for COVID-19, more likely to have complications and more likely to die from the virus than females, independent of age, according to a new study published this week in the open-access journal PLOS ONE by Farhaan Vahidy of Houston Methodist Research Institute, US, and colleagues.
As the COVID-19 pandemic unfolds and evolves across the globe, researchers have identified population sub-groups with higher levels of disease vulnerability, such as those with advanced age or certain pre-existing conditions. Small studies from China and Europe have indicated that males tend to experience higher disease severity compared to females. However a comprehensive analysis of COVID sex in a large and diverse US metropolitan area has been lacking.
In the new study, researchers used data from a large healthcare provider in the Houston, Texas metropolitan area to determine the associations between sex and COVID-19 epidemiology. Data on COVID testing, hospital stays, mortality and demographics were extracted from Electronic Medical Records (EMRs) of all 96,496 adults over 18 years old who were tested for SARS-CoV-2 by the health system between March 6 and August 22, 2020.
Overall, 15.5% (95% CI 15.3-15.8) of individuals in the cohort tested positive for SARS-CoV-2. After adjusting for sociodemographic factors and comorbidities, males had a higher likelihood of SARS-CoV-2 positivity (aOR 1.39, 95% CI 1.33-1.45) than females. Similarly, the proportion of patients requiring ICU care was significantly higher among males (34.1% (32.2 - 36.0)) as compared to females (27.6% (25.8 - 29.5)), OR: 1.36 (1.20 - 1.53). Moreover, more males (19.0% (17.5 - 20.6)) underwent mechanical ventilation than females (14.7% (13.3 - 16.2)), OR: 1.36 (1.17 - 1.59) and the proportion of males who experienced in-hospital mortality (11.6% (10.4 - 13.0)) was significantly higher as compared to females 8.3% (7.3 - 9.6), OR: 1.44 (1.18 - 1.75).
The authors conclude that there is a clear and strong independent association between male sex and SARS-CoV-2 susceptibility, complications and poor outcomes and say that understanding sex differences in the disease is a fundamental step toward improved disease management and intervention strategies for both men and women.
The authors add:
Males seem to be more likely to contract the SRAS-CoV-2 virus and also have a poor clinical course and outcomes related to COVID-19, compared to females. The exact contribution of gender and sex factors in susceptibility and outcomes of COVID-19 need further investigation."
Vahidy, F. S., et al. (2021) Sex differences in susceptibility, severity, and outcomes of coronavirus disease 2019: Cross-sectional analysis from a diverse US metropolitan area. PLOS ONE. doi.org/10.1371/journal.pone.0245556.