Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States of America.
Houston Methodist Neurological Institute, Houston Methodist, Houston, TX, United States of America.
PLoS One. 2021 Jan 13;16(1):e0245556. doi: 10.1371/journal.pone.0245556. eCollection 2021.
Sex is increasingly recognized as an important factor in the epidemiology and outcome of many diseases. This also appears to hold for coronavirus disease 2019 (COVID-19). Evidence from China and Europe has suggested that mortality from COVID-19 infection is higher in men than women, but evidence from US populations is lacking. Utilizing data from a large healthcare provider, we determined if males, as compared to females have a higher likelihood of SARS-CoV-2 susceptibility, and if among the hospitalized COVID-19 patients, male sex is independently associated with COVID-19 severity and poor in-hospital outcomes.
Using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, we conducted a cross-sectional analysis of data from a COVID-19 Surveillance and Outcomes Registry (CURATOR). Data were extracted from Electronic Medical Records (EMR). A total of 96,473 individuals tested for SARS-CoV-2 RNA in nasopharyngeal swab specimens via Polymerized Chain Reaction (PCR) tests were included. For hospital-based analyses, all patients admitted during the same time-period were included. Of the 96,473 patients tested, 14,992 (15.6%) tested positive, of whom 4,785 (31.9%) were hospitalized and 452 (9.5%) died. Among all patients tested, men were significantly older. The overall SARS-CoV-2 positivity among all tested individuals was 15.5%, and was higher in males as compared to females 17.0% vs. 14.6% [OR 1.20]. This sex difference held after adjusting for age, race, ethnicity, marital status, insurance type, median income, BMI, smoking and 17 comorbidities included in Charlson Comorbidity Index (CCI) [aOR 1.39]. A higher proportion of males (vs. females) experienced pulmonary (ARDS, hypoxic respiratory failure) and extra-pulmonary (acute renal injury) complications during their hospital course. After adjustment, length of stay (LOS), need for mechanical ventilation, and in-hospital mortality were significantly higher in males as compared to females.
In this analysis of a large US cohort, males were more likely to test positive for COVID-19. In hospitalized patients, males were more likely to have complications, require ICU admission and mechanical ventilation, and had higher mortality than females, independent of age. Sex disparities in COVID-19 vulnerability are present, and emphasize the importance of examining sex-disaggregated data to improve our understanding of the biological processes involved to potentially tailor treatment and risk stratify patients.
性别的重要性在许多疾病的流行病学和结局中日益受到重视。这似乎也适用于 2019 年冠状病毒病（COVID-19）。来自中国和欧洲的证据表明，男性 COVID-19 感染的死亡率高于女性，但来自美国人群的数据却缺乏。利用大型医疗保健提供者的数据，我们确定了男性与女性相比是否更有可能感染 SARS-CoV-2，以及在住院 COVID-19 患者中，男性是否与 COVID-19 严重程度和住院不良预后独立相关。
本研究利用观察性研究的报告标准（STROBE）指南，对 COVID-19 监测和结局登记处（CURATOR）的数据进行了横断面分析。数据从电子病历（EMR）中提取。共纳入了 96473 名通过聚合酶链反应（PCR）检测鼻咽拭子样本中 SARS-CoV-2 RNA 的个体。对于基于医院的分析，包括同一时期内所有住院的患者。在 96473 名接受检测的患者中，有 14992 名（15.6%）检测结果呈阳性，其中 4785 名（31.9%）住院，452 名（9.5%）死亡。在所有接受检测的患者中，男性年龄明显较大。所有接受检测的个体中 SARS-CoV-2 的总体阳性率为 15.5%，男性阳性率高于女性，分别为 17.0%和 14.6%[比值比（OR）1.20]。这种性别差异在调整年龄、种族、民族、婚姻状况、保险类型、中位收入、体重指数、吸烟和 Charlson 合并症指数（CCI）中包括的 17 种合并症后仍然存在[aOR 1.39]。在住院期间，与女性相比，男性经历肺部（ARDS、低氧性呼吸衰竭）和肺外（急性肾损伤）并发症的比例更高。调整后，男性的住院时间（LOS）、需要机械通气和住院死亡率均显著高于女性。
在这项对美国大型队列的分析中，男性检测出 COVID-19 的可能性更大。在住院患者中，与女性相比，男性发生并发症、需要 ICU 入院和机械通气以及死亡率更高，这与年龄无关。COVID-19 脆弱性方面的性别差异存在，强调了检查按性别分类的数据的重要性，以提高我们对所涉及的生物学过程的理解，从而有可能针对治疗和风险分层患者。
