Association Between Male Sex and Outcomes of Coronavirus Disease 2019 (COVID-19)—A Danish Nationwide, Register-based Study

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background and objectives</jats:title> <jats:p>Male sex has been associated with severe Coronavirus disease 2019 (Covid-19) infection. We examined the association between male sex and severe Covid-19 infection and if an increased risk remains after adjustment for age and comorbidities.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Nationwide register-based follow-up study of Covid-19 patients in Denmark until May 16, 2020. Average risk ratio comparing 30-day composite outcome of all-cause death, severe Covid-19 diagnosis or intensive care unit (ICU) admission for men versus women standardized to the age and comorbidity distribution of all patients were derived from multivariable Cox regression. Included covariates were age, hypertension, diagnoses including obesity, alcohol, sleep apnea, diabetes, chronic obstructive pulmonary disease, previous myocardial infarction (MI), ischemic heart disease (IHD), heart failure (HF), atrial fibrillation (AF), stroke, peripheral artery disease, cancer, liver-, rheumatic-, and chronic kidney disease (CKD).</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Of 4,842 Covid-19 patients, 2,281 (47.1%) were men. Median age was 57 [25%-75% 43-73] for men versus 52 [38-71] for women (P&amp;lt;0.001); however, octogenarians had equal sex distribution. Alcohol diagnosis, diabetes, hypertension, sleep apnea, prior MI and IHD (all P&amp;lt;0.001) as well as AF, stroke and HF (all P=0.01) were more often seen in men, and so was CKD (P=0.03). Obesity diagnosis (P&amp;lt;0.001) were more often seen in women. Other comorbidity differences were insignificant (P&amp;gt;0.05). The fully adjusted average risk ratio was 1.63 [95% CI 1.44-1.84].</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Men with Covid-19 infection have &amp;gt;50% higher risk of all-cause death, severe Covid-19 infection, or ICU admission than women. The excess risk was not explained by age and comorbidities.</jats:p> </jats:sec>

Study of Clinical and Biological Characteristics of Moroccan Covid-19 Patients With and Without Olfactory and/or Gustatory Dysfunction

“…There was no difference in the proportion of men and women, which was inconsistent with the results of a study that have been conducted by Guan et al (2020) who observed that men were more likely to be infected than women. The same result has been demonstrated by a Danish team (Kragholm et al, 2020).…”

Predictors of illness severity in COVID-19 cases

“…This is also evident by the proportion of asymptomatic cases (15.2%) in our cohort that is less than that described in many similar studies [22]. Thus, the overall infection mortality rate among individuals with Covid-19 infections is likely to be considerably lower as it has been estimated by the CDC and WHO to be around 0.5-1% [23,24]. On the other hand, the reported case fatality rates may have been underestimated considering that several fatal Covid-19 infections remain undiagnosed [25].…”

Sex differences in clinical phenotype and transitions of care among individuals dying of COVID-19 in Italy

“…A debate is ongoing on the interplay between SARS-CoV-2 infection and the impairment of the immune system typical of autoimmune diseases [32]. A recent registry-based analysis of 4842 COVID-19 Danish hospitalized patients with COVID-19 reported an excess risk (on average more than 50%) of adverse outcomes, including mortality and ICU admission in men versus women regardless of age and comorbidities, questioning the central role of advanced age and multi-morbidities in explaining the male predominance [33]. Notably, the age of the Danish cohort was on average lower and women were younger than men across all age ranges as the opposite occurred in our cohort of hospitalized deceased individuals.…”