Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct 16;11(1):57.
doi: 10.1186/s13293-020-00334-3.

Sex differences in clinical phenotype and transitions of care among individuals dying of COVID-19 in Italy

Valeria Raparelli  1 , Luigi Palmieri  2 , Marco Canevelli  3   4 , Flavia Pricci  2 , Brigid Unim  2 , Cinzia Lo Noce  2 , Emanuele R Villani  5 , Paula A Rochon  6 , Louise Pilote  7 , Nicola Vanacore  3 , Graziano Onder  2 ; Italian National Institute of Health COVID-19 Mortality Group
Collaborators, Affiliations

Sex differences in clinical phenotype and transitions of care among individuals dying of COVID-19 in Italy

Valeria Raparelli et al. Biol Sex Differ. .

Abstract

Background: Among the unknowns posed by the coronavirus disease 2019 (COVID-19) outbreak, the role of biological sex to explain disease susceptibility and progression is still a matter of debate, with limited sex-disaggregated data available.

Methods: A retrospective analysis was performed to assess if sex differences exist in the clinical manifestations and transitions of care among hospitalized individuals dying with laboratory-confirmed SARS-CoV-2 infection in Italy (February 27-June 11, 2020). Clinical characteristics and the times from symptoms' onset to admission, nasopharyngeal swab, and death were compared between sexes. Adjusted multivariate analysis was performed to identify the clinical features associated with male sex.

Results: Of the 32,938 COVID-19-related deaths that occurred in Italy, 3517 hospitalized and deceased individuals with COVID-19 (mean 78 ± 12 years, 33% women) were analyzed. At admission, men had a higher prevalence of ischemic heart disease (adj-OR = 1.76, 95% CI 1.39-2.23), chronic obstructive pulmonary disease (adj-OR = 1.7, 95% CI 1.29-2.27), and chronic kidney disease (adj-OR = 1.48, 95% CI 1.13-1.96), while women were older and more likely to have dementia (adj-OR = 0.73, 95% CI 0.55-0.95) and autoimmune diseases (adj-OR = 0.40, 95% CI 0.25-0.63), yet both sexes had a high level of multimorbidity. The times from symptoms' onset to admission and nasopharyngeal swab were slightly longer in men despite a typical acute respiratory illness with more frequent fever at the onset. Men received more often experimental therapy (adj-OR = 2.89, 95% CI 1.45-5.74) and experienced more likely acute kidney injury (adj-OR = 1.47, 95% CI 1.13-1.90).

Conclusions: Men and women dying with COVID-19 had different clinical manifestations and transitions of care. Identifying sex-specific features in individuals with COVID-19 and fatal outcome might inform preventive strategies.

Keywords: COVID-19; Comorbidities; In-hospital complications; Sex; Transition of care.

PubMed Disclaimer

Conflict of interest statement

No financial relationships with any organization that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig. 1
Fig. 1
Adjusted multivariable model of clinical phenotype independently associated to being a man dying with COVID-19
See this image and copyright information in PMC

References

    1. Wenham C, Smith J, Morgan R, Gender and COVID-19 Working Group COVID-19: the gendered impacts of the outbreak. Lancet. 2020;395:846–848. doi: 10.1016/S0140-6736(20)30526-2. - DOI - PMC - PubMed
    1. Sex, gender and COVID-19: Disaggregated data and health disparities. Available at: https://blogs.bmj.com/bmjgh/2020/03/24/sex-gender-and-covid-19-disaggreg.... Accessed 14 July 2020.
    1. Spagnolo PA, Manson JE, Joffe H. Sex and Gender Differences in Health: What the COVID-19 Pandemic Can Teach Us. Ann Intern Med. 2020;173:385-6. - PMC - PubMed
    1. Scully EP, Haverfield J, Ursin RL, Tannenbaum C, Klein SL. Considering how biological sex impacts immune responses and COVID-19 outcomes. Nat Rev Immunol. 2020;20:1–6. - PMC - PubMed
    1. Gebhard C, Regitz-Zagrosek V, Neuhauser HK, et al. Impact of sex and gender on COVID-19 outcomes in Europe. Biol Sex Differ. 2020;11:29. doi: 10.1186/s13293-020-00304-9. - DOI - PMC - PubMed

MeSH terms

LinkOut - more resources