Objective: The recent outbreak of Novel Coronavirus Disease (COVID-19) is reminiscent of the SARS outbreak in 2003. We aim to compare the severity and mortality between male and female patients with COVID-19 or SARS.
Study Design and Setting: We extracted the data from: (1) a case series of 43 hospitalized patients we treated, (2) a public data set of the first 37 cases of patients who died of COVID-19 and 1,019 patients who survived in China, and (3) data of 524 patients with SARS, including 139 deaths, from Beijing in early 2003.
Results: Older age and a high number of comorbidities were associated with higher severity and mortality in patients with both COVID-19 and SARS. Age was comparable between men and women in all data sets. In the case series, however, men's cases tended to be more serious than women's (P = 0.035). In the public data set, the number of men who died from COVID-19 is 2.4 times that of women (70.3 vs. 29.7%, P = 0.016). In SARS patients, the gender role in mortality was also observed. The percentage of males were higher in the deceased group than in the survived group (P = 0.015).
Conclusion: While men and women have the same prevalence, men with COVID-19 are more at risk for worse outcomes and death, independent of age.
Coronavirus is a large family of viruses that cause illnesses ranging from the common cold to severe pneumonia, such as SARS and Middle East Respiratory Syndrome (MERS). SARS-CoV-2 was first identified in Wuhan, China, by the Chinese Center for Disease Control and Prevention (CDC) . Both epidemiological and clinical features of patients with COVID-19 have recently been reported. However, little data on the prognostic factors of COVID-19 have been reported.
In the Case series of COVID-19, consistent with previous reports, older patients (≥65 years old), were more likely to have a Severe type of COVID-19. Men tended to develop more serious cases than women, according to the clinical classification of severity. In the Public data set of COVID-19, we also found that the percentage of older age (≥65 years) was much higher in the deceased patients than in the patients who survived (83.8% in 37 deceased patients vs. 13.2% in 1,019 patients who survived).
The number of men is 2.4 times that of women in the deceased patients. While men and women had the same susceptibility, men were more prone to dying.
This is the first preliminary study investigating the role of gender in morbidity and mortality of SARS-CoV-2 infection. One study of 425 patients with COVID-19 indicated that 56% were males. Another study of 140 patients found that 50.7% were males. In the present study, similar susceptibility to SARS-CoV-2 between males and females was observed in 1,019 patients who survived the disease (50.0% males), collected from a public data set and in a case series of 43 hospitalized patients (51.2% males). Although the deceased patients were significantly older than the patients who survived COVID-19, ages were comparable between males and females in both the deceased and the patients who survived. Therefore, gender is a risk factor for higher severity and mortality in patients with COVID-19, independent of age and susceptibility. This gender factor, as well as higher incidences in men for most of the diseases, could correlate with a general demographic fact of a shorter life expectancy in men compared to women in China and in the world in general. Although there is no significant difference in median age between male and female groups, the maximum of the range of IQR is lower in males in the case series.
In early 2003, we participated in the Beijing Municipal Medical Taskforce of SARS. Here, we re-analyzed the data of a large population of 520 SARS patients, including 135 deaths in Beijing, and summarized the experience and lessons for present use, because SARS-CoV-2 and SARS-CoV attack cells via the same receptor, ACE2. We have previously reported that high protein expression of ACE2 receptor in specific organs correlated with specific organ failures, indicated by corresponding clinical parameters in SARS patients. It has been shown that circulating ACE2 levels are higher in men than in women and in patients with diabetes or cardiovascular diseases.
This study has some limitations. First, for severity analysis, only a case series of 43 patients with SARS-CoV-2 was included, because detailed patient information, particularly regarding clinical outcomes, was unavailable in the public data set. Second, for mortality analysis only the first 37 cases of patients who died of SARS-CoV-2 were included. Due to the urgent circumstances we are living in, there was no access to unique, homogeneous data for COVID. It could affect the analysis and any possible biased results. However, this is the first preliminary analysis investigating the role of gender in morbidity and mortality in patients with SARS-CoV-2. More clinical and basic research regarding gender and other prognostic factors for individualized assessment and treatment is needed in the future.
In conclusion, this is the first preliminary study investigating the role of gender in morbidity and mortality in patients with COVID-19. Men with COVID-19 are more at risk for worse outcomes and death, independent of age.
Reference & Source information: https://www.frontiersin.org/
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