Kelada Monica, Anto Ailin, Dave Karishma, Saleh Sohag N
Infectious Diseases, Imperial College London, London, GBR.
Pharmacology, Imperial College London, London, GBR.
Cureus. 2020 Aug 29;12(8):e10114. doi: 10.7759/cureus.10114.
A worldwide outbreak of coronavirus disease 2019 (COVID-19), identified as being caused by the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), was classified as a Public Health Emergency of International Concern by the World Health Organisation (WHO) on January 30, 2020. Initial sex-disaggregated mortality data emerging from the Wuhan province of China identified male sex as a risk factor for increased COVID-19 mortality. In this systematic review, we aimed to assess the role of sex in the risk of mortality from COVID-19 in adult patients through comparison of clinical markers and inflammatory indexes. A systematic search was conducted on the following databases: PubMed, WHO COVID-19 database, Ovid MEDLINE, and Web of Science between the dates of June 15, 2020, and June 30, 2020. Key search terms used included: "sex", "gender", "SARS-COV-2", "COVID" and "mortality". We accepted the following types of studies concerning adult COVID-19 patients: retrospective cohort, observational cohort, case series, and applied research. Further studies were extracted from reference searching. The risk of bias was determined using the National Institutes of Health Quality Assessment Tool for Observational Cohort, Cross-Sectional Studies, and Case Series. We identified a total of 16 studies published between January 2020 and June 2020 for analysis in this systematic review. Our study population consisted of 11 cohort studies, four case series, and one genetic study, including a total of 76,555 participants. Ten of the studies included in this review observed a higher risk of mortality among males compared to females, and eight of these studies found this risk to be statistically significant. Sex-disaggregated COVID-19 mortality data identifies male patients with comorbidities as being at an increased risk of mortality worldwide. Further investigation revealed differences in immune response regulated by sex hormones, angiotensin-converting enzyme 2 (ACE2) expression, and health behaviours as contributing factors to increased risk of mortality from COVID-19 among males. Nine out of the 16 studies included were conducted in China. In order to comprehensively assess sex-differences in the risk of mortality from COVID-19, more studies will need to be conducted worldwide. Sex-disaggregated COVID-19 data published in the medical literature is limited, however it has become evident that male sex is an important risk factor for mortality. Further exploration into the impact of sex on this pandemic is required in order to develop targeted therapies, as well as public health policies, and to prevent sex bias in treatment.
2019年冠状病毒病（COVID-19）在全球范围内爆发，被确定为由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起，2020年1月30日世界卫生组织（WHO）将其列为国际关注的突发公共卫生事件。来自中国湖北省的初步按性别分类的死亡率数据表明，男性是COVID-19死亡率增加的一个风险因素。在本系统评价中，我们旨在通过比较临床指标和炎症指标，评估性别在成年COVID-19患者死亡风险中的作用。我们在以下数据库进行了系统检索：PubMed、WHO COVID-19数据库、Ovid MEDLINE和Web of Science，检索时间为2020年6月15日至2020年6月30日。使用的关键检索词包括：“性别”“性”“SARS-CoV-2”“COVID”和“死亡率”。我们纳入了以下类型的关于成年COVID-19患者的研究：回顾性队列研究、观察性队列研究、病例系列研究和应用研究。通过参考文献检索获取了更多研究。使用美国国立卫生研究院观察性队列研究、横断面研究和病例系列研究质量评估工具确定偏倚风险。在本系统评价中，我们共纳入了2020年1月至2020年6月发表的16项研究进行分析。我们的研究人群包括11项队列研究、4项病例系列研究和1项基因研究，共有76555名参与者。本评价纳入的10项研究观察到男性的死亡风险高于女性，其中8项研究发现这种风险具有统计学意义。按性别分类的COVID-19死亡率数据表明，患有合并症的男性患者在全球范围内的死亡风险增加。进一步调查发现，性激素调节的免疫反应、血管紧张素转换酶2（ACE2）表达和健康行为方面的差异是男性COVID-19死亡风险增加的促成因素。纳入的16项研究中有9项在中国进行。为了全面评估COVID-19死亡风险中的性别差异，全球需要开展更多研究。医学文献中发表的按性别分类的COVID-19数据有限，然而，男性显然是一个重要的死亡风险因素。为了制定针对性的治疗方法以及公共卫生政策，并防止治疗中的性别偏见，需要进一步探索性别对这一疫情的影响。
