ABSTRACT
Background: Males have increased rates of severe illness and mortality from SARS-CoV2 compared to females. It is unknown whether this is due to differential care seeking, health status, illness presentation, comorbidities, and/ or treatment responses. Understanding factors associated with sex/genderbased differences in COVID-19 outcomes is important for optimal care and therapeutics. Methods: SARS-CoV-2 test positivity and admission rates were assessed between March and October of 2020 in the Johns Hopkins Medicine (JHM) system of five hospitals. Detailed patient-level data were extracted for hospitalized patients from the JH-CROWN, a COVID-19 registry utilizing the Hopkins Precision Medicine Analytics Platform. Descriptive statistics were used to analyze differences between males and females. Results: 57% of 213,175 tests were done in females with a similar positivity rate (8.2% F vs 8.9%M). Males were more frequently hospitalized(28%F vs 33%M). Of 2608 hospitalized, more males reported fever, whereas more females reported headache, loss of smell and vomiting(p<0.05). Females had more favorable presenting respiratory parameters with lower respiratory rates and higher SpO2:FiO2 ratios(p<0.001). There was a similar burden of comorbities (Charlson score) but differences in specific comorbidities: obesity and asthma higher among females(p<0.001), heart disease (p=0.06), complicated hypertension(p<0.01), chronic kidney disease, smoking and alcohol use higher among males(p<0.001). Admission and peak lab values showed lower IL-6, ferritin, CRP, higher absolute lymphocyte count and lower neutrophil:lymphocyte ratio in females(p=0.001 for all), but no difference in D-dimer or ESR. Test of interaction between sex and age was significant for IL-6 and ferritin(F test, p<0.05). Males and females received medications against SARS-CoV-2 with similar frequency with exception of tocilizumab which was used more frequently in males. Males had a higher incidence of severe/death outcomes across all ages (28% vs 36%, p<0.001) and in particular among the 18-49 age group (11% v 25%, p<0.001). Conclusion: Females were less frequently admitted to the hospital after a diagnosis with SARS-CoV-2 infection. Despite an excess of obesity, females had a lower severity of respiratory parameters and lower inflammatory markers on presentation and had a lower frequency of severe outcomes from SARS-CoV-2 infection. Sex and age interactions with severe disease highlight critical risk features unique to males and females.