School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ecohealth Institute, School of Public Health, Shandong University, Jinan, Shandong, China.
Clin Infect Dis. 2020 Dec 3;71(9):2488-2494. doi: 10.1093/cid/ciaa683.
The ongoing pandemic of novel coronavirus disease 2019 (COVID-19) is challenging the global public health system. Sex differences in infectious diseases are a common but neglected problem.
We used the national surveillance database of COVID-19 in mainland China to compare gender differences in attack rate (AR), proportion of severe and critical cases (PSCC), and case fatality rate (CFR) in relation to age, affected province, and onset-to-diagnosis interval.
The overall AR was significantly higher in females than in males (63.9 vs 60.5 per 1 million persons; P ˂ .001). In contrast, PSCC and CFR were significantly lower among females (16.9% and 4.0%) than among males (19.5% and 7.2%), with odds ratios of 0.87 and 0.57, respectively (both P ˂ .001). The female-to-male differences were age dependent, and were significant among people aged 50-69 years for AR and in patients aged 30 years or older for both PSCC and CFR (all P ≤ .001). The AR, PSCC, and CFR varied greatly from province to province. However, female-to-male differences in AR, PSCC, and CFR were significant in the epicenter, Hubei province, where 82.2% confirmed cases and 97.4% deaths occurred. After adjusting for age, affected province, and onset-to-diagnosis interval, the female-to-male difference in AR, PSCC, and CFR remained significant in multivariate logistic regression analyses.
We elucidate an age-dependent gender dimorphism for COVID-19, in which females have higher susceptibility but lower severity and fatality. Further epidemiological and biological investigations are required to better understand the sex-specific differences for effective interventions.
新型冠状病毒病 2019（COVID-19）的持续流行正在挑战全球公共卫生系统。传染病中的性别差异是一个常见但被忽视的问题。
我们使用中国大陆 COVID-19 的国家监测数据库，比较了年龄、受影响省份和发病至诊断间隔与攻击率（AR）、严重和危重症病例比例（PSCC）和病死率（CFR）相关的性别差异。
女性的总 AR 明显高于男性（每 100 万人中分别为 63.9 和 60.5；P ˂.001）。相比之下，女性的 PSCC 和 CFR 明显低于男性（分别为 16.9%和 4.0%比 19.5%和 7.2%），比值比分别为 0.87 和 0.57（均 P ˂.001）。这种女性对男性的差异与年龄有关，在 50-69 岁人群中 AR 差异显著，在 30 岁及以上人群中 PSCC 和 CFR 差异显著（均 P ≤.001）。AR、PSCC 和 CFR 因省份而异。然而，在 COVID-19 的震中湖北省，AR、PSCC 和 CFR 的女性对男性差异在年龄、受影响省份和发病至诊断间隔调整后仍然显著，在多变量逻辑回归分析中差异显著。
我们阐明了 COVID-19 中一种依赖年龄的性别二态性，其中女性易感性更高，但严重程度和病死率较低。需要进一步进行流行病学和生物学研究，以更好地了解性别特异性差异，从而采取有效的干预措施。
