Sex differences in hospitalized COVID-19 patients

The novel coronavirus disease (COVID-19) affected females less than males, as demonstrated by sex-disaggregated data present in the literature. During the first wave, females hospitalized at San Raffaele Hospital, Milan, Italy were few in number, presented symptoms later and had less critical clinical conditions than males. The present study aimed to evaluate the epidemiological status of the female population during the second wave, which occurred in Autumn 2020 in Italy. This prospective cohort study included all patients, with a positive real-time reverse-transcriptase polymerase chain reaction for COVID-19, who attended the emergency department or were hospitalized in wards and/or intensive care unit (ICU) from 29th September 2020 to 29th November 2020. A total of 1216 COVID-19 patients were included, of whom 459 (37.8%) were females. The percentage of females admitted was 41.3% in the first period and 36.3% in the second period, without significant increase over time (p = 0.3). Females accounted for 25% of all COVID-19 intensive care unit admissions. There was significantly sex-based difference in the overall hospital mortality (4.1% for females and 11.3% for males, p < 0.0001). At San Raffaele Hospital, Milan, Italy during the second wave, female patients were few and affected by a less severe form of COVID-19. An increase over time of females hospitalized patients was not reported, unlike what was previously demonstrated during the first wave. Copyright © 2022 The Author(s). Published by MRE Press.

Sex-disaggregated data matters: tracking the impact of COVID-19 on the health of women and men.

Sex and gender matter to health outcomes, but despite repeated commitments to sex-disaggregate data in health policies and programmes, a persistent and substantial absence of such data remains especially in lower-income countries. This represents a missed opportunity for monitoring and identifying gender-responsive, evidence-informed solutions to address a key driver of the pandemic. In this paper we review the availability of national sex-disaggregated surveillance data on COVID-19 and examine trends on the testing-to-outcome pathway. We further analyse the availability of data according to the economic status of the country and investigate the determinants of sex differences, including the national gender inequality status (according to a global index) in each country. Results are drawn from 18 months of global data collection from over 200 countries. We find differences in COVID-19 prevention behaviours and illness outcomes by sex, with lower uptake of vaccination and testing plus an elevated risk of severe disease and death among men. Supporting and maintaining the collection, collation, interpretation and presentation of sex-disaggregated data requires commitment and resources at subnational, national and global levels, but provides an opportunity for identifying and taking gender-responsive action on health inequities. As a first step the global health community should recognise, value and support the importance of sex-disaggregated data for identifying and tackling an inequitable pandemic.

COVID-19, sex, and gender in China: a scoping review.

BACKGROUND: During the course of the COVID-19 pandemic, states were called upon by the World Health Organization to introduce and prioritise the collection of sex-disaggregated data. The collection of sex-disaggregated data on COVID-19 testing, infection rates, hospital admissions, and deaths, when available, has informed our understanding of the biology of the infectious disease. The collection of sex-disaggregated data should also better inform our understanding of the gendered impacts that contribute to risk of exposure to COVID-19. In China, the country with the longest history of fighting the COVID-19 infection, what research was available on the gender-differential impacts of COVID-19 in the first 6 months of the COVID-19 pandemic? METHODS: In this scoping review, we examine the first 6 months (January-June 2020) of peer-reviewed publications (n = 451) on sex and gender experiences related to COVID-19 in China. We conducted an exhaustive search of published Chinese and English language research papers on COVID-19 in mainland China. We used a COVID-19 Gender Matrix informed by the JPHIEGO gender analysis toolkit to examine and illuminate research into the gendered impacts of COVID-19 within China. RESULTS: In China, only a small portion of the COVID-19-related research focused on gender experiences and differences. Near the end of the six-month literature review period, a small number of research items emerged on women healthcare workers, women's mental health, and pregnant women's access to care. There was an absence of research on the gendered impact of COVID-19 amongst populations. There was minimal consideration of the economic, social and security factors, including gender stereotypes and expectations, that affected different populations' experiences of infection, treatment, and lockdown during the period of review. CONCLUSION: At the outset of health emergencies in China, gender research needs to be prioritised during the first stage of an outbreak to assist with evaluation of the most effective public health measures, identifying access to healthcare and social welfare barriers amongst priority communities. Gender stereotypes and gendered differences lead to different patterns of exposure and treatment. The exclusion of this knowledge in real time affects the design of effective prevention and recovery.

Mortality in COVID-19: Further Evidence for a Sex-Based Difference in the OpenSAFELY Study.

Although COVID-19 death rates are lower in women compared to men, it is not clear whether this difference in mortality is due to sex (biological) based factors, comorbidities that differ in men and women, or gender influences. New evidence supports a sex-based difference in COVID-19 mortality. Data from the OpenSAFELY cohort study in 17 million adult patients in England demonstrate that COVID-19-related deaths were associated with male sex (hazard ratio 1.59; 95% confidence interval 1.53-1.65) when fully adjusted for age, low income, smoking, pre-existing diseases, and ethnicity. Women have stronger innate and adaptive responses to infection. It is hypothesized that biological differences in the immune system may have a role in the sex-based difference in mortality from COVID-19. The results of OpenSAFELY demonstrate the importance of collection and analysis of sex-disaggregated data in research and public surveillance.