Correlation between Chest X‐Ray Severity in COVID‐19 and Age in Mexican‐Mestizo Patients: An Observational Cross‐Sectional Study

Abstract

Introduction. Chest X-ray (CXR) is used for the initial triage of patients with suspected COVID-19. Studies of CXR scoring in the European population found a higher score in males than in females and significantly correlated with age. Because there have not been studies in the Mexican-mestizo community, we aimed to compare the differences in CXR scores between males and females and their correlation with age after controlling comorbidities like diabetes and hypertension. Materials and Methods. A retrospective study of 1000 CXR of Mexican-mestizo patients with SARS-CoV-2 infection, confirmed by RT-PCR. Significant differences between age, age groups, symptoms, comorbidities, and CXR scores between males and females used the Mann–Whitney U , Chi-square tests ( χ 2 ), and Kruskal–Wallis tests. The relationship between the total CXR score and age was measured with the Spearman rank correlation coefficient (Rs); partial correlation analysis controlled the effect of symptoms, risk factors, and comorbidities. Results. The total CXR score did not show a difference between males and females grouped by age. There was a positive, low correlation between the total CXR score and age in males, Rs = 0.260 , p < 0.001 ( N = 616 ), and in females, Rs = 0.170 , p = 0.001 ( N = 384 ). Age only explained a <9% variance of CXR severity. Rs decreased its magnitude (from Rs = 0.152 to Rs = 0.046 ) and lost its significance (change in p value from p < 0.001 to p = 0.145 ) after controlling the effect of hypertension. Conclusions. There is no significant difference in CXR score between males and females in the Mexican-mestizo population grouped by age. Hypertension cancels the significance of CXR severity with age pointing to its role in the pathophysiology of COVID-19. Further research using stratified groups by age and gender in other populations needs to be published.

Convolutional Neural Network-Based Automatic Analysis of Chest Radiographs for the Detection of COVID-19 Pneumonia: A Prioritizing Tool in the Emergency Department, Phase I Study and Preliminary “Real Life” Results

“…The results are summarized in Table 7. For the whole dataset, there was almost no correlation with age, Rs = −0.004, p-value = 0.884; in [35], a low positive correlation was obtained, but it was not statistically significant. Grouped by gender, the correlation result was low and positive in both cases, but not significant, Rs = 0.167 p-value < 5.52 × 10 −10 for the female group, and Rs = 0.065 p-value < 5.13 × 10 −4 for the male one, confirming the results in [35].…”

“…For the whole dataset, there was almost no correlation with age, Rs = −0.004, p-value = 0.884; in [35], a low positive correlation was obtained, but it was not statistically significant. Grouped by gender, the correlation result was low and positive in both cases, but not significant, Rs = 0.167 p-value < 5.52 × 10 −10 for the female group, and Rs = 0.065 p-value < 5.13 × 10 −4 for the male one, confirming the results in [35]. We divided the cases by age groups, and, for each age group, we studied the score distribution testing the differences between genders with the Mann-Whitney U test (alpha = 0.05).…”

“…In [35,36], the relationship between the severity score from [34] and patient age and gender has been analyzed, reporting the same results for age and different ones for gender. In [35], significantly higher scores were determined for male patients in the range between 50 and 80 years old, but this finding has not been confirmed in [36]. In both papers, a low positive correlation with age was found.…”

Biases associated with database structure for COVID-19 detection in X-ray images

“…Other authors as Albrandt-Salmeron et al 91 agree that there is a correlation between age and some symptoms and image findings, but they find out that upon the Mexican-mestizo community, there are no significant different in terms of patient sex 91 , meanwhile Borghesi and Maroldi, 2020 refutes this idea in a study over Italy that finds significantly higher pulmonary insolvents in males than in females 92 , this information can be interpreted in different ways first Mexican study use patients of only one hospital, but they have 1000 chest x-ray images, and Italian study use information of 100 hospitals without specifying the number of images, and both are using the CXR scoring system for COVID-19 pneumonia, proposed by Borghesi and Maroldi of the Italian study 92 that is also used On BrixIA dataset for the severity label, the information shows two main possibilities as an overview, first using 100 hospitals shows more generalization on the population than only using one, meaning there is a tendency on pulmonary involvement’s grater in males rather than females, but also we can argue that both studies are equally valid, but the differences between the results depends on the population that the study focus on meaning that on Italian or even European population the COVID-19 findings are more usual in males while in Mexico there is not a marked difference.…”

The value of chest X-ray and CT severity scoring systems in the diagnosis of COVID-19: A review

“…There is evidence showing that a higher CT severity score was significantly correlated with male gender, older age groups, and a likely positive PCR test ( 12 ). A recent prospective study ( 80 ) has also found that the severity of COVID-19 was associated with higher age, male sex, and higher BMI. The CCT severity score index of lung involvement in the acute phase was also associated with restriction and a reduction in diffusion capacity in follow-up.…”