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Being Male Is Powerful Risk Factor for More Severe COVID-19 Cases

One of the most significant risk factors for severe COVID-19 affects a very large proportion of the population. Find out how male sex affects the likelihood of testing positive for the infection, of having more serious complications and of eventually dying from the novel coronavirus. The authors suggest stratifying by sex to better understand what is going on.

HOUSTON – Of all of the risk factors for having more serious cases of COVID-19, one of the most important appears to be gender. A new review suggests that males are more likely to test positive for COVID-19, more likely to have complications and more likely to die from the virus than females, at any age.

The study was published in the open-access journal PLOS ONE.

Houston Methodist Research Institute-led researchers note that, while smaller studies from China and Europe have indicated that males tend to experience higher disease severity compared to females, a comprehensive analysis of COVID sex in a large and diverse US metropolitan area has been lacking.

To remedy that, the study team used data from a large healthcare provider in the Houston metropolitan area to determine the associations between sex and COVID-19 epidemiology. They extracted data on COVID testing, hospital stays, mortality and demographics from electronic medical records of all 96,496 adults who were tested for SARS-CoV-2 by the Texas health system between March 6 and Aug. 22, 2020.

They determined that, overall, 15.5% (95% CI 15.3-15.8) of individuals in the cohort tested positive for SARS-CoV-2. After adjusting for sociodemographic factors and comorbidities, results indicate that males had a higher likelihood of SARS-CoV-2 positivity (aOR 1.39, 95% CI 1.33-1.45) than females. In addition, the proportion of patients requiring ICU care was found to be significantly higher among males (34.1% (32.2 - 36.0)) as compared to females (27.6% (25.8 - 29.5)), OR: 1.36 (1.20 - 1.53). Males (19.0% (17.5 - 20.6)) also underwent mechanical ventilation more than females (14.7% (13.3 - 16.2)), OR: 1.36 (1.17 - 1.59) and the proportion of males who experienced in-hospital mortality (11.6% (10.4 - 13.0)) was significantly higher as compared to females 8.3% (7.3 - 9.6), OR: 1.44 (1.18 - 1.75).

The study states that a higher proportion of males vs. females experienced pulmonary (ARDS, hypoxic respiratory failure) and extra-pulmonary (acute renal injury) complications during their hospital course.

All of that led to the conclusion that there is a clear and strong independent association between male sex and SARS-CoV-2 susceptibility, complications and poor outcomes. The authors advise that understanding sex differences in the disease is an important step toward improved disease management and intervention strategies for both men and women.

 "Males seem to be more likely to contract the SRAS-CoV-2 virus and also have a poor clinical course and outcomes related to COVID-19, compared to females,” researchers point out. “The exact contribution of gender and sex factors in susceptibility and outcomes of COVID-19 need further investigation."

They add, “Sex disparities in COVID-19 vulnerability are present and emphasize the importance of examining sex-disaggregated data to improve our understanding of the biological processes involved to potentially tailor treatment and risk stratify patients.”