Explaining sex differences in risk of bloodstream infections using mediation analysis in the population-based HUNT study in Norway

Abstract

Previous studies indicate sex differences in incidence and severity of bloodstream infections (BSI). We examined the effect of sex on risk of BSI, BSI mortality, and BSI caused by the most common infecting bacteria. Using causal mediation analyses, we assessed if this effect is mediated by health behaviours (smoking, alcohol consumption), education, cardiovascular risk factors (systolic blood pressure, non-HDL cholesterol, body mass index) and selected comorbidities. This prospective study included 64,040 participants (46.8% men) in the population-based HUNT2 Survey (1995–1997) linked with hospital records in incident BSI. During median follow-up of 15.2 years, 1840 (2.9%) participants (51.3% men) experienced a BSI and 396 (0.6%) died (56.6% men). Men had 41% higher risk of first-time BSI (95% confidence interval (CI), 28–54%) than women. Together, health behaviours, education, cardiovascular risk factors and comorbidities mediated 34% of the excess risk of BSI observed in men. The HR of BSI mortality was 1.87 (95% CI 1.53–2.28), for BSI due to S. aureus 2.09 (1.28–2.54), S. pneumoniae 1.36 (1.05–1.76), E. coli 0.97 (0.84–1.13) in men vs women. This study shows that men have higher risk of BSI and BSI mortality than women. One-third of this effect was mediated by potential modifiable risk factors for incident BSI.

Iron status and the risk of sepsis and severe COVID-19: a two-sample Mendelian randomization study

“…In a study examining nutritional status in European populations, there were indications of low iron status linked to higher mortality from COVID-19 18 . There is evidence of sex differences in incidence and outcomes of COVID-19 infection 19 – 21 . Few studies have evaluated sex differences in iron status at time of infection.…”

Comparison of Length of Hospital Stay for Community-Acquired Infections Due to Enteric Pathogens, Influenza Viruses and Multidrug-Resistant Bacteria: A Cross-Sectional Study in Hungary

“…Compared with patients without comorbidities, the duration of recovery from community-acquired infections is longer for those with immunosuppression, cancer and chronic respiratory diseases [ 36 , 51 ]. Previous studies have shown that differences in health and lifestyle among men and women in combination with CAI can lead to longer hospital stays [ 52 , 53 ]. In addition, it has been reported that in males, infections are at a more advanced stage when they are admitted to hospital, further increasing the length of hospitalization [ 54 ].…”

Interactions between Gender and Sepsis—Implications for the Future

“…Men also display heart disease at a younger age than women [ 87 ]. In one prospective cohort which included 64,040 participants, the risk of bloodstream infection was reported to be 41% higher among men than among women and one-third of this excess risk was mediated by cardiovascular risk factors and comorbidities [ 89 ].…”