Sex differences in patients with COVID-19: a retrospective cohort study and meta-analysis
DOI:
https://doi.org/10.3889/oamjms.2020.5380Keywords:
COVID-19, Sex difference, Severe, SARS-CoV-2, Meta-analysisAbstract
BACKGROUND: Accumulated evidence revealed that male was much more likely to higher severity and fatality by SARS-CoV-2 infection than female patients, but few studies and meta-analyses have evaluated the sex differences of the infection and progression of COVID-19 patients.
AIM: We aimed to compare the sex differences of the epidemiological and clinical characteristics in COVID-19 patients; and to perform a meta-analysis evaluating the severe rate, fatality rate, and the sex differences of the infection and disease progression in COVID-19 patients.
METHODS: We analyzed clinical data of patients in Changchun Infectious Hospital and Center, Changchun, Northeast China; and searched PubMed, Embase, Web of Science, and Cochrane Library without any language restrictions for published articles that reported the data of sex-disaggregated, number of severe, and death patients on the confirmed diagnosis of adult COVID-19 patients.
RESULTS: The pooled severe rate and fatality rate of COVID-19 were 22.7% and 10.7%. Male incidence in the retrospective study was 58.1%, and the pooled incidence in male was 54.7%.
CONCLUSION: The pooled severe rate in male and female of COVID-19 was 28.2% and 18.8%, the risky of severe and death was about 1.6folds higher in male compared with female, especially for older patients (> 50 y).
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Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel Coronavirus indicating person-to-person transmission: A study of a family cluster. Lancet. 2020;395(10223):514-23. https://doi.org/10.1016/s0140-6736(20)30154-9 PMid:31986261 DOI: https://doi.org/10.1016/S0140-6736(20)30154-9
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of Coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-20. PMid:32109013 DOI: https://doi.org/10.1056/NEJMoa2002032
Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: A descriptive study. Lancet Infect Dis. 2020;20(4):425- 34. https://doi.org/10.1016/s1473-3099(20)30086-4 PMid:32105637 DOI: https://doi.org/10.1016/S1473-3099(20)30086-4
Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel Coronavirus: Implications for virus origins and receptor binding. Lancet. 2020;395(10224):565-74. PMid:32007145 DOI: https://doi.org/10.1016/S0140-6736(20)30251-8
World Health Organization. Coronavirus Disease 2019 (COVID-19) Situation Report No. 75. Geneva: World Health Organization; 2020. Available from: https://apps.who.int/iris/handle/10665/331688.
Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized With COVID-19 in the New York city area. JAMA. 2020;323(20):2052-9. https://doi.org/10.1001/jama.2020.6775 PMid:32320003 DOI: https://doi.org/10.1001/jama.2020.6775
Cheng JL, Huang C, Zhang GJ, Liu DW, Li P, Lu CY, et al. Epidemiological characteristics of novel Coronavirus pneumonia in Henan. Zhonghua Jie He He Hu Xi Za Zhi. 2020;43(4):327-31. PMid:32118390
Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. The epidemiological characteristics of an outbreak of 2019 novel Coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):145-51. PMid:32064853 DOI: https://doi.org/10.46234/ccdcw2020.032
Livingston E, Bucher K. Coronavirus disease 2019 (COVID-19) in Italy. JAMA. 2020;323(14):1335. https://doi.org/10.1001/jama.2020.4344 PMid:32181795 DOI: https://doi.org/10.1001/jama.2020.4344
Korean Society of Infectious Diseases, Korean Society of Pediatric Infectious Diseases, Korean Society of Epidemiology, Korean Society for Antimicrobial Therapy, Korean Society for Healthcare-associated Infection Control and Prevention, Korea Centers for Disease Control and Prevention. Report on the epidemiological features of Coronavirus disease 2019 (COVID-19) outbreak in the republic of Korea from January 19 to March 2, 2020. J Korean Med Sci. 2020;35(10):e112. https://doi.org/10.3346/jkms.2020.35.e112 PMid:32174069 DOI: https://doi.org/10.3346/jkms.2020.35.e112
Jin JM, Bai P, He W, Wu F, Liu XF, Han DM, et al. Gender differences in patients With COVID-19: Focus on severity and mortality. Front Public Health. 2020;8:152. https://doi.org/10.1101/2020.02.23.20026864 PMid:32411652 DOI: https://doi.org/10.1101/2020.02.23.20026864
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet. 2020;395(10229):1054-62. https://doi.org/10.1016/s0140-6736(20)30566-3 PMid:32171076 DOI: https://doi.org/10.1016/S0140-6736(20)30566-3
Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with Coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43. https://doi.org/10.1001/jamainternmed.2020.0994 PMid:32167524 DOI: https://doi.org/10.1001/jamainternmed.2020.0994
Cai Q, Huang D, Ou P, Yu H, Zhu Z, Xia Z, et al. COVID-19 in a designated infectious diseases hospital outside Hubei Province, China. Allergy. 2020;75(7):1742-52. https://doi.org/10.1111/all.14309 PMid:32239761 DOI: https://doi.org/10.1111/all.14309
Chen J, Qi T, Liu L, Ling Y, Qian Z, Li T, et al. Clinical progression of patients with COVID-19 in Shanghai, China. J Infect. 2020;80(5):e1-6. PMid:32171869 DOI: https://doi.org/10.1016/j.jinf.2020.03.004
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel Coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet. 2020;395(10223):507-13. https://doi.org/10.1016/s0140-6736(20)30211-7 PMid:32007143 DOI: https://doi.org/10.1016/S0140-6736(20)30211-7
Shi Y, Yu X, Zhao H, Wang H, Zhao R, Sheng J. Host susceptibility to severe COVID-19 and establishment of a host risk score: Findings of 487 cases outside Wuhan. Crit Care. 2020;24(1):108. https://doi.org/10.1186/s13054-020-2833-7 PMid:32188484 DOI: https://doi.org/10.1186/s13054-020-2833-7
Zhang G, Hu C, Luo L, Fang F, Chen Y, Li J, et al. Clinical features and short-term outcomes of 221 patients with COVID19 in Wuhan, China. J Clin Virol. 2020;127:104364. https://doi.org/10.1016/j.jcv.2020.104364 PMid:32311650 DOI: https://doi.org/10.1016/j.jcv.2020.104364
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel Coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. https://doi.org/10.1016/s0140-6736(20)30183-5 PMid:31986264 DOI: https://doi.org/10.1016/S0140-6736(20)30183-5
Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1. https://doi.org/10.1186/2046-4053-4-1 PMid:25554246 DOI: https://doi.org/10.1186/2046-4053-4-1
Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, et al. Characteristics and outcomes of 21 critically III patients With COVID-19 in Washington state. JAMA. 2020;323(16):1612- 4. https://doi.org/10.1001/jama.2020.4326 PMid:32191259 DOI: https://doi.org/10.1001/jama.2020.4326
Cao J, Hu X, Cheng W, Yu L, Tu WJ, Liu Q. Clinical features and short-term outcomes of 18 patients with Corona virus disease 2019 in intensive care unit. Intensive Care Med. 2020;46(5):851- 3. https://doi.org/10.1007/s00134-020-05987-7 PMid:32123993 DOI: https://doi.org/10.1007/s00134-020-05987-7
Chen C, Chen C, Yan JT, Zhou N, Zhao JP, Wang DW. Analysis of myocardial injury in patients with COVID-19 and association between concomitant cardiovascular diseases and severity of COVID-19. Zhonghua Xin Xue Guan Bing Za Zhi. 2020;48(7):567-71. PMid:32141280
Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H, et al. Clinical and immunological features of severe and moderate Coronavirus disease 2019. J Clin Invest. 2020;130(5):2620-9. PMid:32217835 DOI: https://doi.org/10.1172/JCI137244
Chen L, Liu HG, Liu W, Liu J, Liu K, Shang J, et al. Analysis of clinical features of 29 patients with 2019 novel Coronavirus pneumonia. Zhonghua Jie He He Hu Xi Za Zhi. 2020;43(1):E005. PMid:32164089
Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with Coronavirus disease 2019: Retrospective study. BMJ. 2020;368:m1091. https://doi.org/10.1136/bmj.m1091 PMid:32217556 DOI: https://doi.org/10.1136/bmj.m1091
Dong XC, Li JM, Bai JY, Liu ZQ, Zhou PH, Gao L, et al. Epidemiological characteristics of confirmed COVID-19 cases in Tianjin. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(5):638-41. PMid:32164400
Goyal P, Choi JJ, Pinheiro LC, Schenck EJ, Chen R, Jabri A, et al. Clinical characteristics of COVID-19 in New York city. N Engl J Med. 2020;382(24):2372-4. PMid:32302078 DOI: https://doi.org/10.1056/NEJMc2010419
Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al. Cardiovascular implications of fatal outcomes of patients with Coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7):811-8. https://doi.org/10.1001/jamacardio.2020.1017 PMid:32219356 DOI: https://doi.org/10.1001/jamacardio.2020.1017
Jin X, Lian JS, Hu JH, Gao J, Zheng L, Zhang YM, et al. Epidemiological, clinical and virological characteristics of 74 cases of Coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut. 2020;69(6):1002-9. PMid:32213556
Lei S, Jiang F, Su W, Chen C, Chen J, Mei W, et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. E Clin Med. 2020;21:100331. https://doi.org/10.1016/j.eclinm.2020.100331 PMid:32292899 DOI: https://doi.org/10.1016/j.eclinm.2020.100331
Li K, Wu J, Wu F, Guo D, Chen L, Fang Z, et al. The clinical and chest CT features associated with severe and critical COVID19 pneumonia. Invest Radiol. 2020;55(6):327-31. https://doi.org/10.1097/rli.0000000000000672 PMid:32118615 DOI: https://doi.org/10.1097/RLI.0000000000000672
Liu K, Fang YY, Deng Y, Liu W, Wang MF, Ma JP, et al. Clinical characteristics of novel Coronavirus cases in tertiary hospitals in Hubei Province. Chin Med J (Engl). 2020;133(9):1025-31. https://doi.org/10.1097/cm9.0000000000000744 PMid:32044814 DOI: https://doi.org/10.1097/CM9.0000000000000744
Liu W, Tao ZW, Wang L, Yuan ML, Liu K, Zhou L, et al. Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel Coronavirus disease. Chin Med J (Engl). 2020;133(9):1032-8. https://doi.org/10.1097/cm9.0000000000000775 PMid:32118640 DOI: https://doi.org/10.1097/CM9.0000000000000775
Peng YD, Meng K, Guan HQ, Leng L, Zhu RR, Wang BY, et al. Clinical characteristics and outcomes of 112 cardiovascular disease patients infected by 2019-nCoV. Zhonghua Xin Xue Guan Bing Za Zhi. 2020;48(6):450-5. PMid:32120458
Qian GQ, Yang NB, Ding F, Ma AH, Wang ZY, Shen YF, et al. Epidemiologic and clinical characteristics of 91 hospitalized patients with COVID-19 in Zhejiang, China: A retrospective, multi-centre case series. QJM. 2020;113(7):474-81. https://doi.org/10.1093/qjmed/hcaa089 PMid:32181807 DOI: https://doi.org/10.1093/qjmed/hcaa089
Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020;46(5):846-8. https://doi.org/10.1007/s00134-020-05991-x PMid:32125452 DOI: https://doi.org/10.1007/s00134-020-05991-x
Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel Coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844-7. https://doi.org/10.1111/jth.14768 PMid:32073213 DOI: https://doi.org/10.1111/jth.14768
Tian S, Hu N, Lou J, Chen K, Kang X, Xiang Z, et al. Characteristics of COVID-19 infection in Beijing. J Infect. 2020;80(4):401-6. PMid:32112886 DOI: https://doi.org/10.1016/j.jinf.2020.02.018
Wan S, Xiang Y, Fang W, Zheng Y, Li B, Hu Y, et al. Clinical features and treatment of COVID-19 patients in Northeast Chongqing. J Med Virol. 2020;92(7):797-806. https://doi.org/10.1002/jmv.25783 PMid:32198776 DOI: https://doi.org/10.1002/jmv.25783
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9. https://doi.org/10.1001/jama.2020.1585 PMid:32031570 DOI: https://doi.org/10.1001/jama.2020.1585
Wu J, Liu J, Zhao X, Liu C, Wang W, Wang D, et al. Clinical characteristics of imported cases of Coronavirus disease 2019 (COVID-19) in Jiangsu Province: A multicenter descriptive study. Clin Infect Dis. 2020;71(15):706-12. https://doi.org/10.1093/cid/ciaa199 PMid:32109279 DOI: https://doi.org/10.1093/cid/ciaa199
Xie H, Zhao J, Lian N, Lin S, Xie Q, Zhuo H. Clinical characteristics of non-ICU hospitalized patients with Coronavirus disease 2019 and liver injury: A retrospective study. Liver Int. 2020;40(6):1321- 6. https://doi.org/10.1111/liv.14449 PMid:32239591 DOI: https://doi.org/10.1111/liv.14449
Xu YH, Dong JH, An WM, Lv XY, Yin XP, Zhang JZ, et al. Clinical and computed tomographic imaging features of novel Coronavirus pneumonia caused by SARS-CoV-2. J Infect. 2020;80(4):394-400. https://doi.org/10.1016/j.jinf.2020.02.017 PMid:32109443 DOI: https://doi.org/10.1016/j.jinf.2020.02.017
Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-81. https://doi.org/10.1016/s2213-2600(20)30079-5 PMid:32105632 DOI: https://doi.org/10.1016/S2213-2600(20)30079-5
Yao N, Wang SN, Lian JQ, Sun YT, Zhang GF, Kang WZ, et al. Clinical characteristics and influencing factors of patients with novel Coronavirus pneumonia combined with liver injury in Shaanxi region. Zhonghua Gan Zang Bing Za Zhi. 2020;28(3):234-9. PMid:32153170
Yuan M, Yin W, Tao Z, Tan W, Hu Y. Association of radiologic findings with mortality of patients infected with 2019 novel Coronavirus in Wuhan, China. PLoS One. 2020;15(3):e0230548. https://doi.org/10.1371/journal.pone.0230548 PMid:32191764 DOI: https://doi.org/10.1371/journal.pone.0230548
Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, et al. Clinical characteristics of 140 patients infected with SARSCoV-2 in Wuhan, China. Allergy. 2020;75(7):1730-41. https://doi.org/10.1111/all.14238 PMid:32077115 DOI: https://doi.org/10.1111/all.14238
Zhao W, Zhong Z, Xie X, Yu Q, Liu J. Relation between chest CT findings and clinical conditions of Coronavirus disease (COVID19) pneumonia: A multicenter study. AJR Am J Roentgenol. 2020;214(5):1072-7. https://doi.org/10.2214/ajr.20.22976 PMid:32125873 DOI: https://doi.org/10.2214/AJR.20.22976
Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel Coronavirusinfected pneumonia. N Engl J Med. 2020;382(13):1199-207. PMid:31995857 DOI: https://doi.org/10.1056/NEJMoa2001316
Lam CW, Chan MH, Wong CK. Severe acute respiratory syndrome: Clinical and laboratory manifestations. Clin Biochem Rev. 2004;25(2):121-32. PMid:18458712
Cai G. Bulk and Single-Cell Transcriptomics Identify Tobacco-Use Disparity in Lung Gene Expression of ACE2, the Receptor of 2019-nCov, MedRxiv; 2020. https://doi.org/10.1101/2020.02.05.20020107 DOI: https://doi.org/10.1101/2020.02.05.20020107
Jaillon S, Berthenet K, Garlanda C. Sexual dimorphism in innate immunity. Clin Rev Allergy Immunol. 2019;56(3):308-21. https://doi.org/10.1007/s12016-017-8648-x PMid:28963611 DOI: https://doi.org/10.1007/s12016-017-8648-x
Patel SK, Velkoska E, Burrell LM. Emerging markers in cardiovascular disease: Where does angiotensin-converting enzyme 2 fit in? Clin Exp Pharmacol Physiol. 2013;40(8):551-9. https://doi.org/10.1111/1440-1681.12069 PMid:23432153 DOI: https://doi.org/10.1111/1440-1681.12069
Cai H. Sex difference and smoking predisposition in patients with COVID-19. Lancet Respir Med. 2020;8(4):e20. https://doi. org/10.1016/s2213-2600(20)30117-x PMid:32171067 DOI: https://doi.org/10.1016/S2213-2600(20)30117-X
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Copyright (c) 2020 Zhijun Li, Lina Feng, Wenyu Cui, Jian Zhang, Yingxin Huang, Yunhong Zhao, Fei Teng, Donglin Wu, Hui Wang, Liquan Deng, Qiong Yu (Author)
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