Original Article

Gender Differences in Hospital Outcomes among COVID-19 Hospitalizations

Authors: Sandeep Appunni, MD, Muni Rubens, MD, PhD, Venkataraghavan Ramamoorthy, MD, PhD, Anshul Saxena, BDS, PhD, Mayur Doke, PhD, Mukesh Roy, PhD, Juan Gabriel Ruiz-Pelaez, MD, Yanjia Zhang, PhD, Md Ashfaq Ahmed, PhD, Zhenwei Zhang, PhD, Peter McGranaghan, PhD, Sandra Chaparro, MD, Javier Jimenez, MD

Abstract

Objectives: Many epidemiological studies have shown that coronavirus disease 2019 (COVID-19) disproportionately affects males, compared with females, although other studies show that there were no such differences. The aim of the present study was to assess differences in the prevalence of hospitalizations and in-hospital outcomes between the sexes, using a larger administrative database.

Methods: We used the 2020 California State Inpatient Database for this retrospective analysis. International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code U07.1 was used to identify COVID-19 hospitalizations. These hospitalizations were subsequently stratified by male and female sex. Diagnosis and procedures were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. The primary outcome of the study was hospitalization rate, and secondary outcomes were in-hospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and intensive care unit (ICU) admission.

Results: There were 95,180 COVID-19 hospitalizations among patients 18 years and older, 52,465 (55.1%) of which were among men and 42,715 (44.9%) were among women. In-hospital mortality (12.4% vs 10.1%), prolonged length of hospital stays (30.6% vs 25.8%), vasopressor use (2.6% vs 1.6%), mechanical ventilation (11.8% vs 8.0%), and ICU admission rates (11.4% versus 7.8%) were significantly higher among male compared with female hospitalizations. Conditional logistic regression analysis showed that the odds of mortality (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.38–1.44), hospital lengths of stay (OR 1.35, 95% CI 1.31–1.39), vasopressor use (OR 1.59, 95% CI 1.51–1.66), mechanical ventilation (OR 1.62, 95% CI 1.47–1.78), and ICU admission rates (OR 1.58, 95% CI 1.51–1.66) were significantly higher among male hospitalizations.

Conclusion: Our findings show that male sex is an independent and strong risk factor associated with COVID-19 severity.
Posted in: Infectious Disease146

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Johns Hopkins Coronavirus Resource Center. COVID-19 dashboard. https://coronavirus.jhu.edu/map.html. Accessed October 3, 2022.
 
2. Jackson CB, Farzan M, Chen B, et al. Mechanisms of SARS-CoV-2 entry into cells. Nature Rev Molec Cell Biol 2022;23:3–20.
 
3. Tartof SY, Malden DE, Liu I-LA, et al. Health care utilization in the 6 months following SARS-CoV-2 infection. JAMA Network Open 2022;5:e2225657.
 
4. Petersen E, Koopmans M, Go U, et al. Comparing SARS-CoV-2 with SARS-CoV and influenza pandemics. Lancet Infect Dis 2020;20:e238–e244.
 
5. Schoeni RF, Wiemers EE, Seltzer JA, et al. Association between risk factors for complications from COVID-19, perceived chances of infection and complications, and protective behavior in the US. JAMA Network Open 2021;4:e213984.
 
6. Kaeuffer C, Le Hyaric C, Fabacher T, et al. Clinical characteristics and risk factors associated with severe COVID-19: prospective analysis of 1,045 hospitalised cases in north-eastern France, March 2020. Eurosurveillance 2020;25:2000895.
 
7. Nguyen NT, Chinn J, De Ferrante M, et al. Male gender is a predictor of higher mortality in hospitalized adults with COVID-19. PLoS One 2021; 16:e0254066.
 
8. Jin J-M, Bai P, He W, et al. Gender differences in patients with COVID-19: focus on severity and mortality. Front Public Health 2020;8:152.
 
9. Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19)—China, 2020. China CDC Wkly 2020;2:113–122.
 
10. Stokes EK, Zambrano LD, Anderson KN, et al. Coronavirus disease 2019 case surveillance—United States, January 22–May 30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:759–765.
 
11. Agency for Healthcare Research and Quality. Overview of the State Inpatient Databases (SID).https://hcup-us.ahrq.gov/sidoverview.jsp. Accessed October 13, 2022.
 
12. Von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007;147:573–577.
 
13. Garg S, Kim L, Whitaker M, et al. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019— COVID-NET, 14 States, March 1–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:458–464.
 
14. Williamson E, Walker AJ, Bhaskaran K, et al. OpenSAFELY: factors associated with COVID-19-related hospital death in the linked electronic health records of 17 million adult NHS patients. Nature 2020;584:430–436.
 
15. Docherty AB, Harrison EM, Green CA, et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ. 2020;369:m1985.
 
16. Public Health England. Disparities in the Risk and Outcomes of COVID-19. London: Public Health England; 2020.
 
17. Lakbar I, Luque-Paz D, Mege J-L, et al. COVID-19 gender susceptibility and outcomes: a systematic review. PLoS One 2020;15:e0241827.
 
18. Brandi ML, Giustina A. Sexual dimorphism of coronavirus 19 morbidity and lethality. Trends Endocrinol Metab 2020;31:918–927.
 
19. Warraich HJ, Califf RM. Differences in health outcomes between men and women: biological, behavioral, and societal factors. Clin Chem 2019;65: 19–23.
 
20. Gabriele L, Fragale A, Romagnoli G, et al. Type I IFN-dependent antibody response at the basis of sex dimorphism in the outcome of COVID-19. Cytokine Growth Factor Rev 2021;58:66–74.
 
21. Li Y, Jerkic M, Slutsky AS, et al. Molecular mechanisms of sex bias differences in COVID-19 mortality. Crit Care 2020;24:1–6.
 
22. Channappanavar R, Fett C, Mack M, et al. Sex-based differences in susceptibility to severe acute respiratory syndrome coronavirus infection. J Immunol 2017;198:4046–4053.
 
23. Bonanad C, García-Blas S, Tarazona-Santabalbina F, et al. The effect of age on mortality in patients with COVID-19: a meta-analysis with 611,583 subjects. J Am Med Dir Assoc 2020;21:915–918.
 
24. Gallo Marin B, Aghagoli G, Lavine K, et al. Predictors of COVID-19 severity: a literature review. Rev Med Virol 2021;31:1–10.
 
25. Sanyaolu A, Okorie C, Marinkovic A, et al. Comorbidity and its impact on patients with COVID-19. SN Compr Clin Med 2020;2:1069–1076.
 
26. Ejaz H, Alsrhani A, Zafar A, et al. COVID-19 and comorbidities: deleterious impact on infected patients. J Infect Public Health 2020;13:1833–1839.