Age and Sex Differences in COVID-19 Clinical Symptom: Analysis of 19,588 Indonesian Cases

Abstract

BACKGROUND: Asymptomatic COVID-19 cases are potential for SARS-CoV-2 outbreaks source, yet the feasible predictive factors are unclear. AIM: Our study aimed to determine the age and sex differences in the presence of COVID-19 clinical symptoms at the initial diagnosis. METHODS: We examined the results of individual first-time quantitative reverse transcription-polymerase chain reaction (q-RT-PCR) of 19,588 COVID-19 positive cases registered at the Center for Diagnostic and Research on Infectious Disease Laboratory (PDRPI Lab), Faculty of Medicine, Universitas Andalas, Padang, Indonesia, from April 2020 to December 2020. Asymptomatic cases were those who had no symptoms at the initial confirmation while symptomatic had. The differences of age (classified into five age groups) and sex (female or male) were evaluated in both cases to see their significance. RESULTS: A total of 12,790 (65.30%) of COVID-19 cases were asymptomatic. The COVID-19 patients had average age (mean ± SD) of 37.12 ± 17.22 years old (y.o.). Younger adults (20–39 y.o.; 42.01%; average age (mean ± SD) 29.51 ± 5.52 y.o.) were the most affected, followed by adults (40–59 y.o.; 32.09%; average age (mean ± SD) 49.29 ± 5.63 y.o.), children (≤19 years; 15.30%; average age (mean ± SD) 11.82 ± 5.70 y.o.), older adults (60–79 years; 9.90%; average age (mean ± SD) 65.76 ± 4.86 y.o.), and elderly (≥80 years; 0.71%; average age (mean ± SD) 83.31 ± 3.65 y.o.). Female cases (53.23%; average age (mean ± SD) 34.92 ± 16.57 y.o.) were more prevalent than males (46.77%; average age (mean ± SD) 41.26 ± 17.65 y.o.), with a significant mean age difference (P < 0.001). The odds of being asymptomatic were increased in the younger age group (adults OR as the reference; children OR 0.471, 95% CI 0.426–0.519; younger adults OR 0.68, 95% CI 0.639–0.734; older adults OR 1.766, 95% CI 1.594–1.957; and elderly OR 1.981, 95% CI 1.412–2.780; P < 0.001). Females were more likely than males to be asymptomatic (OR 1.105, 95% CI 1.042–1.172). Conclusions: The younger age and the female sex are associated with asymptomatic COVID-19 cases in the earliest molecular diagnosis.