In a recent study posted to the Research Square* preprint server, researchers investigated sex-based differences amongst coronavirus disease 2019 (COVID-19) patients in the US (US).

Study: Sex-Differences in COVID-19 Diagnosis, Risk Aspects and Disease Comorbidities. Image Credit: Kzenon/Shutterstock

Studies have reported greater severity and fatality related to COVID-19 amongst men in comparison with women across the globe; nevertheless, the mechanisms for sex-based differences in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections are usually not clear. Previous research observations indicate that researchers must consider the patients’ sex as a very important variable for COVID-19 data interpretation.

Concerning the study

In the current study, researchers explored the sex-based differences in sociodemographic characteristics, lifestyle aspects, and comorbidities amongst COVID-19 patients.

This study comprised 62,310 female and male COVID-19 patients with diagnoses confirmed between January 2020 and December 2021 by polymerase chain response (PCR) and immunoglobulin G (IgG)/IgM evaluation. Data were retrospectively obtained from the COVID-19 Research Database. As well as, secondary data were extracted from the Healthjump database pertaining to the patients’ medical claim records and electronic health records (EHRs).

The EHRs comprised medical and social history (race, language, ethnicity), demographics (sex, age), vitals (comparable to blood pressure, oxygen saturation), vaccination, medications, and diagnosis (e.g., diabetes, hypertension, etc), appointments, procedures, and encounters. Logistic regression models were used for the evaluation and the adjusted odds ratios (AOR) were determined.

Results and discussion

An age-dependent rise in COVID-19 cases was observed for men and ladies and individuals most severely affected were aged 50 to 59 years comprising 3,628 men and 6,418 women. Among the many study participants, 13%, 9.4%, 12.3%, 15.5%, 17.7%, 16.3% and 15.9% were aged <20 years, 20 to 29 years, 30 to 39 years, 40 to 49 years, 50 to 59 years, 60 to 69 years and >70 years, respectively.

Substantial differences in comorbidities and socio-demographics were noted between female and male patients, e.g., a substantially greater proportion of men (vs. women) were aged >70 years (17% vs. 15%) and were smokers (11% vs. 9.2%, (OR = 1.4). Moreover, diabetes (8.8% versus 6.5%) and hypertension (4.4% versus 3.9%) were substantially more commonly observed amongst men in comparison with women with AOR values of twenty-two.9 and 66.2, respectively. Pneumonia and influenza were more likely amongst men in comparison with women (OR = 66.2).

Substantial sex-based differences were noted in laboratory parameters, comorbidities, and vaccinations amongst SARS-CoV-2-positive individuals. A rather higher proportion of SARS-CoV-2-positive men presented with mild hypoxemia in comparison with females (9.3% versus 7.1%, (OR = 1.3). A greater proportion of men reported use of caffeine (77.4% versus 75.9%), alcohol (30.7% versus 22.4%) and medicines (6.6% versus 5.2%) and were obese (55.1% versus 54.3%) or obese (31% vs. 26%).

Alternatively, a greater proportion of ladies in comparison with men had health services encounters for genetic susceptibility tests and clinical examinations (14.6% versus 13.9%), thyroid disorders (4.4% versus 2.5%) and stress-related dissociative and other mental illnesses and anxiety (2.9% versus 1.9%), although males suffered substantially more from personality and behavioral disorders and mental disabilities compared to females (OR = 89.7). Further, no substantial sex-based differences were noted concerning living arrangements, transportation, vaccines, and exercises.

Male SARS-CoV-2-positive patients demonstrated a better frequency of comorbid conditions comparable to hypertension and diabetes, and abnormal laboratory and clinical findings based on data adjustments for covariates comparable to education, ethnicity, and age. The current study findings were in accordance with studies on COVID-19 conducted in Europe, China, and the US that reported a disproportionate impact of COVID-19 amongst women and men.

The study findings showed a powerful and independent association between the male gender and enhanced susceptibility to COVID-19. Men have been reported to be more incessantly involved in dangerous practices, comparable to alcohol consumption and smoking. Further, smoking habits have been related to opposed COVID-19 outcomes since smoking elevates the pulmonary angiotensin-converting enzyme 2 (ACE2) expression and subsequently increases SARS-CoV-2 invasion within the host, which can explain the association between smoking and COVID-19 severity. Moreover, alcohol intake and smoking predispose males to comorbidities comparable to pulmonary disorders and cardiovascular disorders.

Sex-based differences are intertwined with role or social differences between men and ladies which influence the outcomes of COVID-19. Men commonly work in occupations and sectors that require social interactions (e.g., agriculture, production and/or distribution of food, pharmacy or food sales and manufacturing, security, and transportation). Increased social gatherings including mask removal to smoke and drink increase SARS-CoV-2 exposure amongst men.

Moreover, women and men respond in another way to self and foreign antigens with sex-based immunological differences. Studies have reported greater interleukin (IL)-8 and 18 cytokine expression amongst men whereas enhanced T lymphocyte activation amongst females in COVID-19 and an association of poor T lymphocyte responses with COVID-19 outcomes.

Conclusion

Overall, the study findings highlighted the sex-based differences in lifestyle aspects, comorbidities, and sociodemographic characteristics in COVID-19, an understanding of which might aid in clinical decision-making to offer medical care to COVID-19 patients. As well as, the findings would inform COVID-19 policy-making and improve the worldwide preparedness and efficacy of health interventions.

*Necessary notice

Research Square publishes preliminary scientific reports that are usually not peer-reviewed and, subsequently, mustn’t be thought to be conclusive, guide clinical practice/health-related behavior, or treated as established information.