The Role of Sex in the Risk of Mortality From COVID-19 Amongst Adult Patients: A Systematic Review

Kelada, Monica; Anto, Ailin; Dave, Karishma; Saleh, Sohag N.

doi:10.7759/cureus.10114

Cited by 41 publications

(42 citation statements)

References 52 publications

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“…Regarding the gender in our study, males had higher risk of developing severe COVID-19 than females, which is consistent with some reports [ 4 , 24 ]. The differences between different gender may be related to underlying biological differences, diversity of immune responses, sex hormones and a combination of behavioral or lifestyle risk factors [ 25 – 27 ]. Furthermore, several comorbidities, which disproportionally occur in men, likely contribute to worse COVID-19 outcomes [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for developing severe COVID-19 in China: an analysis of disease surveillance data

et al. 2021

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Background COVID-19 has posed an enormous threat to public health around the world. Some severe and critical cases have bad prognoses and high case fatality rates, unraveling risk factors for severe COVID-19 are of significance for predicting and preventing illness progression, and reducing case fatality rates. Our study focused on analyzing characteristics of COVID-19 cases and exploring risk factors for developing severe COVID-19. Methods The data for this study was disease surveillance data on symptomatic cases of COVID-19 reported from 30 provinces in China between January 19 and March 9, 2020, which included demographics, dates of symptom onset, clinical manifestations at the time of diagnosis, laboratory findings, radiographic findings, underlying disease history, and exposure history. We grouped mild and moderate cases together as non-severe cases and categorized severe and critical cases together as severe cases. We compared characteristics of severe cases and non-severe cases of COVID-19 and explored risk factors for severity. Results The total number of cases were 12 647 with age from less than 1 year old to 99 years old. The severe cases were 1662 (13.1%), the median age of severe cases was 57 years [Inter-quartile range(IQR): 46–68] and the median age of non-severe cases was 43 years (IQR: 32–54). The risk factors for severe COVID-19 were being male [adjusted odds ratio (aOR) = 1.3, 95% CI: 1.2–1.5]; fever (aOR = 2.3, 95% CI: 2.0–2.7), cough (aOR = 1.4, 95% CI: 1.2–1.6), fatigue (aOR = 1.3, 95% CI: 1.2–1.5), and chronic kidney disease (aOR = 2.5, 95% CI: 1.4–4.6), hypertension (aOR = 1.5, 95% CI: 1.2–1.8) and diabetes (aOR = 1.96, 95% CI: 1.6–2.4). With the increase of age, risk for the severity was gradually higher [20–39 years (aOR = 3.9, 95% CI: 1.8–8.4), 40–59 years (aOR = 7.6, 95% CI: 3.6–16.3), ≥ 60 years (aOR = 20.4, 95% CI: 9.5–43.7)], and longer time from symtem onset to diagnosis [3–5 days (aOR = 1.4, 95% CI: 1.2–1.7), 6–8 days (aOR = 1.8, 95% CI: 1.5–2.1), ≥ 9 days(aOR = 1.9, 95% CI: 1.6–2.3)]. Conclusions Our study showed the risk factors for developing severe COVID-19 with large sample size, which included being male, older age, fever, cough, fatigue, delayed diagnosis, hypertension, diabetes, chronic kidney diasease, early case identification and prompt medical care. Based on these factors, the severity of COVID-19 cases can be predicted. So cases with these risk factors should be paid more attention to prevent severity.

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Section: Discussionmentioning

confidence: 99%

Risk factors for developing severe COVID-19 in China: an analysis of disease surveillance data

et al. 2021

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“…These include the role of comorbidities, as well as decreased efficiency of the immune system related to normal ageing [ 108 ]. Male sex as a risk factor for severe disease is thought to result from a combination of the effect of health behaviours, sex hormone-mediated immune responses, and differential expression of ACE2 between sexes [ 109 ]. Obesity is a risk factor for development of comorbidities such as hypertension, cardiovascular disease, and diabetes.…”

Section: Discussionmentioning

confidence: 99%

Population risk factors for severe disease and mortality in COVID-19: A global systematic review and meta-analysis

Booth¹,

Reed²,

Ponzo³

et al. 2021

PLoS ONE

455

312

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Aim COVID-19 clinical presentation is heterogeneous, ranging from asymptomatic to severe cases. While there are a number of early publications relating to risk factors for COVID-19 infection, low sample size and heterogeneity in study design impacted consolidation of early findings. There is a pressing need to identify the factors which predispose patients to severe cases of COVID-19. For rapid and widespread risk stratification, these factors should be easily obtainable, inexpensive, and avoid invasive clinical procedures. The aim of our study is to fill this knowledge gap by systematically mapping all the available evidence on the association of various clinical, demographic, and lifestyle variables with the risk of specific adverse outcomes in patients with COVID-19. Methods The systematic review was conducted using standardized methodology, searching two electronic databases (PubMed and SCOPUS) for relevant literature published between 1st January 2020 and 9th July 2020. Included studies reported characteristics of patients with COVID-19 while reporting outcomes relating to disease severity. In the case of sufficient comparable data, meta-analyses were conducted to estimate risk of each variable. Results Seventy-six studies were identified, with a total of 17,860,001 patients across 14 countries. The studies were highly heterogeneous in terms of the sample under study, outcomes, and risk measures reported. A large number of risk factors were presented for COVID-19. Commonly reported variables for adverse outcome from COVID-19 comprised patient characteristics, including age >75 (OR: 2.65, 95% CI: 1.81–3.90), male sex (OR: 2.05, 95% CI: 1.39–3.04) and severe obesity (OR: 2.57, 95% CI: 1.31–5.05). Active cancer (OR: 1.46, 95% CI: 1.04–2.04) was associated with increased risk of severe outcome. A number of common symptoms and vital measures (respiratory rate and SpO2) also suggested elevated risk profiles. Conclusions Based on the findings of this study, a range of easily assessed parameters are valuable to predict elevated risk of severe illness and mortality as a result of COVID-19, including patient characteristics and detailed comorbidities, alongside the novel inclusion of real-time symptoms and vital measurements.

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“…Among our study population, 44% were men, which is lower than observed in a recent meta-analysis of 57 studies that found the prevalence of COVID-19 to be 55% among men [ 17 ]. As shown in a systematic review of sixteen studies, including studies from China, United States, Italy, UK and Spain, men had increased disease severity including hospitalisation and ICU admission compared to women [ 18 ]. Although it is not fully understood why men are more susceptible to a severe disease trajectory many factors have been proposed that may underlie these differences including immunological differences, elevated expression of certain factors including angiotensin-converting enzyme 2, differences in hormones (e.g., oestrogen) and also social and behavioural differences [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Underlying conditions and risk of hospitalisation, ICU admission and mortality among those with COVID-19 in Ireland: A national surveillance study

Bennett

Mullooly

O’Loughlin

et al. 2021

The Lancet Regional Health - Europe

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Background To date, over 2 million people worldwide have died with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. To describe the experience in Ireland, this study examined associations between underlying conditions and the following outcomes: mortality, admission to hospital or admission to the intensive care unit (ICU) among those infected with COVID-19. Methods This study used data from the Health Protection Surveillance Centre in Ireland and included confirmed cases of COVID-19 from the first wave of the pandemic between March and July 2020. Two cohorts were included: all cases (community and hospital) and hospital admissions only. For all cases, health outcome data included mortality and hospitalisation. For hospitalised cases, outcome data included mortality and ICU admission. Logistic regression was used to examine associations between underlying conditions and outcomes across both cohorts. Results are presented as adjusted odds ratios (OR) and 95% confidence intervals (CIs). Findings There were 19,789 cases included in analysis, which encompassed 1,476 (7.5%) deaths, 2,811 (14.2%) hospitalisations, and 438 (2.2%) ICU admissions of whom 90 (20.5%) died. Significantly higher risk of mortality, hospitalisation and ICU admission was associated with having chronic heart disease, a BMI ≥40kg/m 2 and male sex. Additionally, diagnosis of a chronic neurological condition (OR 1.41; 95%CI:1.17, 1.69), chronic kidney disease (OR 1.74; 95%CI:1.35, 2.24) and cancer (OR 2.77; 95%CI:2.21, 3.47) were significantly associated with higher risk of mortality among all cases, with similar patterns of association observed for mortality among hospitalised cases. Interpretation The identification of underlying conditions among COVID-19 cases may help identify those at highest risk of the worst health outcomes and inform preventive strategies to improve outcomes. Funding This study was supported by the Health Service Executive, Health Protection Surveillance Centre. KEB and MM are funded by the Health Research Board (RL-15-1579 and EIA-2019-012 respectively).

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The Role of Sex in the Risk of Mortality From COVID-19 Amongst Adult Patients: A Systematic Review

Cited by 41 publications

References 52 publications

Risk factors for developing severe COVID-19 in China: an analysis of disease surveillance data

Risk factors for developing severe COVID-19 in China: an analysis of disease surveillance data

Population risk factors for severe disease and mortality in COVID-19: A global systematic review and meta-analysis

Underlying conditions and risk of hospitalisation, ICU admission and mortality among those with COVID-19 in Ireland: A national surveillance study

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