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Meta-Analysis
. 2022 Feb 16:55:e11711.
doi: 10.1590/1414-431X2021e11711. eCollection 2022.

Why do men have worse COVID-19-related outcomes? A systematic review and meta-analysis with sex adjusted for age

J Fabião  1 , B Sassi  1 , E F Pedrollo  2 , F Gerchman  2 , C K Kramer  3 , C B Leitão  2 , L C Pinto  1   2
Affiliations
Meta-Analysis

Why do men have worse COVID-19-related outcomes? A systematic review and meta-analysis with sex adjusted for age

J Fabião et al. Braz J Med Biol Res. .

Abstract

We aimed to study the mechanism behind worse coronavirus disease-19 (COVID-19) outcomes in men and whether the differences between sexes regarding mortality as well as disease severity are influenced by sex hormones. To do so, we used age as a covariate in the meta-regression and subgroup analyses. This was a systematic search and meta-analysis of observational cohorts reporting COVID-19 outcomes. The PubMed (Medline) and Cochrane Library databases were searched. The primary outcome was COVID-19-associated mortality and the secondary outcome was COVID-19 severity. The study was registered at PROSPERO: 42020182924. For mortality, men had a relative risk of 1.36 (95%CI: 1.17 to 1.59; I2 63%, P for heterogeneity <0.01) compared to women. Age was not a significant covariate in meta-analysis heterogeneity (P=0.393) or subgroup analysis. For disease severity, being male was associated with a relative risk of 1.29 (95%CI: 1.19 to 1.40; I2 48%, P for heterogeneity <0.01) compared to the relative risk of women. Again, age did not influence the outcomes of the meta-regression (P=0.914) or subgroup analysis. Men had a higher risk of COVID-19 mortality and severity regardless of age, decreasing the odds of hormonal influences in the described outcomes.

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Figures

Figure 1
Figure 1. Study flowchart.
Figure 2
Figure 2. Forest plot for COVID-19 mortality in male patients.
Figure 3
Figure 3. Forest plot for COVID-19 severity in male patients.
See this image and copyright information in PMC

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