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Does gender influence clinical expression and disease outcomes in COVID-19? A systematic review and meta-analysis.
Int J Infect Dis. 2020 Oct; 99:496-504.IJ

Abstract

BACKGROUND

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) was characterized at the end of 2019, and soon spread around the world, generating a pandemic. It has been suggested that men are more severely affected by the viral disease (COVID-19) than women.

OBJECTIVE

The aim of this systematic literature review (SRL) and meta-analysis was to analyse the influence of gender on COVID-19 mortality, severity, and disease outcomes. A SRL was performed in PubMed and Embase, searching terms corresponding to the 'PEO' format: population = adult patients affected with COVID-19; exposure = gender; outcome = any available clinical outcomes by gender, including mortality and disease severity. The search covered the period from January 1 to April 30, 2020. Exclusion criteria were: case reports/series, reviews, commentaries, languages other than English. Full-text, original articles were included. Data on study type, country, and patients' characteristics were extracted. Study quality was evaluated using the Newcastle-Ottawa scale (NOS). From a total of 950 hits generated by the database search, 85 articles fulfilling the inclusion criteria were selected.

RESULTS

A random-effects meta-analysis was performed to compare mortality, recovery rates, and disease severity in men compared with women. The male to female ratio for cases was 1:0.9. A significant association was found between male sex and mortality (OR = 1.81; 95% CI 1.25-2.62), as well as a lower chance of recovery in men (OR = 0.72; 95% CI 0.55-0.95). Male patients were more likely to present with a severe form of COVID-19 (OR = 1.46; 95% CI 1.10-1.94).

CONCLUSIONS

Males are slightly more susceptible to SARS-CoV2 infection, present with a more severe disease, and have a worse prognosis. Further studies are warranted to unravel the biological mechanisms underlying these observations.

Authors+Show Affiliations

Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy.Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy.Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy.Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy.Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Padova, Italy. Electronic address: roberta.ramonda@unipd.it.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

32800858

Citation

Ortolan, Augusta, et al. "Does Gender Influence Clinical Expression and Disease Outcomes in COVID-19? a Systematic Review and Meta-analysis." International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, vol. 99, 2020, pp. 496-504.
Ortolan A, Lorenzin M, Felicetti M, et al. Does gender influence clinical expression and disease outcomes in COVID-19? A systematic review and meta-analysis. Int J Infect Dis. 2020;99:496-504.
Ortolan, A., Lorenzin, M., Felicetti, M., Doria, A., & Ramonda, R. (2020). Does gender influence clinical expression and disease outcomes in COVID-19? A systematic review and meta-analysis. International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, 99, 496-504. https://doi.org/10.1016/j.ijid.2020.07.076
Ortolan A, et al. Does Gender Influence Clinical Expression and Disease Outcomes in COVID-19? a Systematic Review and Meta-analysis. Int J Infect Dis. 2020;99:496-504. PubMed PMID: 32800858.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does gender influence clinical expression and disease outcomes in COVID-19? A systematic review and meta-analysis. AU - Ortolan,Augusta, AU - Lorenzin,Mariagrazia, AU - Felicetti,Mara, AU - Doria,Andrea, AU - Ramonda,Roberta, Y1 - 2020/08/12/ PY - 2020/05/26/received PY - 2020/07/15/revised PY - 2020/07/19/accepted PY - 2020/8/18/pubmed PY - 2020/10/29/medline PY - 2020/8/18/entrez KW - COVID-19 KW - Gender KW - Meta-Analysis KW - Systematic review SP - 496 EP - 504 JF - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases JO - Int J Infect Dis VL - 99 N2 - BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) was characterized at the end of 2019, and soon spread around the world, generating a pandemic. It has been suggested that men are more severely affected by the viral disease (COVID-19) than women. OBJECTIVE: The aim of this systematic literature review (SRL) and meta-analysis was to analyse the influence of gender on COVID-19 mortality, severity, and disease outcomes. A SRL was performed in PubMed and Embase, searching terms corresponding to the 'PEO' format: population = adult patients affected with COVID-19; exposure = gender; outcome = any available clinical outcomes by gender, including mortality and disease severity. The search covered the period from January 1 to April 30, 2020. Exclusion criteria were: case reports/series, reviews, commentaries, languages other than English. Full-text, original articles were included. Data on study type, country, and patients' characteristics were extracted. Study quality was evaluated using the Newcastle-Ottawa scale (NOS). From a total of 950 hits generated by the database search, 85 articles fulfilling the inclusion criteria were selected. RESULTS: A random-effects meta-analysis was performed to compare mortality, recovery rates, and disease severity in men compared with women. The male to female ratio for cases was 1:0.9. A significant association was found between male sex and mortality (OR = 1.81; 95% CI 1.25-2.62), as well as a lower chance of recovery in men (OR = 0.72; 95% CI 0.55-0.95). Male patients were more likely to present with a severe form of COVID-19 (OR = 1.46; 95% CI 1.10-1.94). CONCLUSIONS: Males are slightly more susceptible to SARS-CoV2 infection, present with a more severe disease, and have a worse prognosis. Further studies are warranted to unravel the biological mechanisms underlying these observations. SN - 1878-3511 UR - https://www.unboundmedicine.com/medline/citation/32800858/Does_gender_influence_clinical_expression_and_disease_outcomes_in_COVID_19_A_systematic_review_and_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1201-9712(20)30607-X DB - PRIME DP - Unbound Medicine ER -