Clinical characteristics and outcomes in women and men hospitalized for coronavirus disease 2019 in New Orleans
Top Cited Papers
Open Access
- 5 February 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Biology of Sex Differences
- Vol. 12 (1), 1-11
- https://doi.org/10.1186/s13293-021-00359-2
Abstract
Objectives Determine if sex differences exist in clinical characteristics and outcomes of adults hospitalized for coronavirus disease 2019 (COVID-19) in a US healthcare system. Design Case series study. Setting and participants Sequentially hospitalized adults admitted for COVID-19 at two tertiary care academic hospitals in New Orleans, LA, between 27 February and 15 July 2020. Measures and outcomes Measures included demographics, comorbidities, presenting symptoms, and laboratory results. Outcomes included intensive care unit admission (ICU), invasive mechanical ventilation (IMV), and in-hospital death. Results We included 776 patients (median age 60.5 years; 61.4% women, 75% non-Hispanic Black). Rates of ICU, IMV, and death were similar in both sexes. In women versus men, obesity (63.8 vs 41.6%, P < 0.0001), hypertension (77.6 vs 70.1%, P = 0.02), diabetes (38.2 vs 31.8%, P = 0.06), chronic obstructive pulmonary disease (COPD, 22.1 vs 15.1%, P = 0.015), and asthma (14.3 vs 6.9%, P = 0.001) were more prevalent. More women exhibited dyspnea (61.2 vs 53.7%, P = 0.04), fatigue (35.7 vs 28.5%, P = 0.03), and digestive symptoms (39.3 vs 32.8%, P = 0.06) than men. Obesity was associated with IMV at a lower BMI (> 35) in women, but the magnitude of the effect of morbid obesity (BMI >= 40) was similar in both sexes. COPD was associated with ICU (adjusted OR (aOR), 2.6; 95%CI, 1.5-4.3) and IMV (aOR, 1.8; 95%CI, 1.2-3.1) in women only. Diabetes (aOR, 2.6; 95%CI, 1.2-2.9), chronic kidney disease (aOR, 2.2; 95%CI, 1.3-5.2), elevated neutrophil-to-lymphocyte ratio (aOR, 2.5; 95%CI, 1.4-4.3), and elevated ferritin (aOR, 3.6; 95%CI, 1.7-7.3) were independent predictors of death in women only. In contrast, elevated D-dimer was an independent predictor of ICU (aOR, 7.3; 95%CI, 2.7-19.5), IMV (aOR, 6.5; 95%CI, 2.1-20.4), and death (aOR, 4.5; 95%CI, 1.2-16.4) in men only. Conclusions This study highlights sex disparities in clinical determinants of severe outcomes in COVID-19 patients that may inform management and prevention strategies to ensure gender equity.Funding Information
- National Institutes of Health (DK074970, DK107444, HL158260, K12HD043451, K12HD043451, U54 GM104940)
- American Diabetes Association (7-20-COVID-051, 7-20-COVID-053)
- U.S. Department of Veterans Affairs (BX003725)
This publication has 41 references indexed in Scilit:
- Sex-Related Disparities in CKD ProgressionJournal of the American Society of Nephrology, 2018
- Sex Differences in the Excess Risk of Cardiovascular Diseases Associated with Type 2 Diabetes: Potential Explanations and Clinical ImplicationsCurrent Cardiovascular Risk Reports, 2015
- Diabetes as risk factor for incident coronary heart disease in women compared with men: a systematic review and meta-analysis of 64 cohorts including 858,507 individuals and 28,203 coronary eventsDiabetologia, 2014
- Review on iron and its importance for human health2014
- The Hyperferritinemic Syndrome: macrophage activation syndrome, Still’s disease, septic shock and catastrophic antiphospholipid syndromeBMC Medicine, 2013
- Do women exhibit greater differences in established and novel risk factors between diabetes and non-diabetes than men? The British Regional Heart Study and British Women’s Heart Health StudyDiabetologia, 2011
- Risk Assessment of Recurrence in Patients With Unprovoked Deep Vein Thrombosis or Pulmonary EmbolismCirculation, 2010
- Differential diagnosis of elevated troponinsHeart, 2006
- High risk of recurrent venous thromboembolism in menJournal of Thrombosis and Haemostasis, 2004
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987