Children's National Research Institute, Center for Genetic Medicine Research, 111 Michigan Avenue NW, Washington, DC, 20010, USA.
Department of Genomics and Precision Medicine, George Washington University, Washington, DC, USA.
Arch Sex Behav. 2021 Feb;50(2):407-426. doi: 10.1007/s10508-020-01882-w. Epub 2021 Jan 4.
COVID-19 has joined the long list of sexually dimorphic human disorders. Higher lethality in men, evident in the first reports from China, was confirmed in the subsequent Italian outbreak. Newspapers and scientific journals commented on this finding and the preexisting conditions, biological processes, and behavioral differences that may underlie it. However, little appeared to be released about sex differences in severity of disease, comorbidities, rate of recovery, length of hospital stay, or number of tests performed. Systematic analysis of official websites for 20 countries and 6 US states revealed a wide disparity in sex-disaggregated data made available to the public and scholars. Only a handful reported cases by sex. None of the other characteristics, including deaths, were stratified by sex at the time. Beyond suboptimal sex disaggregation, we found a paucity of usable raw data sets and a generalized lack of standardization of captured data, making comparisons difficult. A second round of data capture in April found more complete, but even more disparate, information. Our analysis revealed a wide range of sex ratios among confirmed cases. In countries where a male bias was initially reported, the proportion of women dramatically increased in 3 weeks. Analysis also revealed a complex pattern of sex ratio variation with age. Accurate, peer-reviewed, analysis of harmonized, sex-disaggregated data for characteristics of epidemics, such as availability of testing, suspected source of infection, or comorbidities, will be critical to understand where the observed disparities come from and to generate evidence-based recommendations for decision-making by governments.
COVID-19 加入了一系列具有性别差异的人类疾病之列。中国最初的报告显示男性死亡率更高，这一现象在随后的意大利疫情中得到了证实。报纸和科学期刊对这一发现以及可能导致这一现象的潜在条件、生物过程和行为差异进行了评论。然而，关于疾病严重程度、合并症、康复率、住院时间或进行的测试数量等方面的性别差异，似乎没有多少信息公布。对 20 个国家和 6 个美国州的官方网站进行系统分析后发现，向公众和学者提供的按性别分类的数据存在很大差异。只有少数报告按性别报告了病例。当时，没有其他特征（包括死亡）按性别进行分层。除了性别分类不充分之外，我们还发现可用的原始数据集很少，并且捕获的数据缺乏标准化，这使得比较变得困难。第二轮数据采集于 4 月进行，提供了更完整但更不一致的信息。我们的分析显示，确诊病例中的性别比例差异很大。在最初报告男性偏多的国家，女性比例在 3 周内大幅上升。分析还揭示了性别比例随年龄变化的复杂模式。对检测可用性、疑似感染源或合并症等流行特征进行准确的、经过同行评审的、按性别分类的分析，对于了解观察到的差异的来源以及为政府决策提供循证建议将至关重要。
