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Association between pharmaceutical modulation of oestrogen in postmenopausal women in Sweden and death due to COVID-19: a cohort study.
Sund, Malin; Fonseca-Rodríguez, Osvaldo; Josefsson, Andreas; Welen, Karin; Fors Connolly, Anne-Marie.
  • Sund M; Department of Surgical and Perioperative Sciences, Umeå University Faculty of Medicine, Umeå, Sweden.
  • Fonseca-Rodríguez O; Department of Surgery, Univerisity of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Josefsson A; Department of Clinical Microbiology, Umeå University Faculty of Medicine, Umeå, Sweden.
  • Welen K; Department of Surgical and Perioperative Sciences, Umeå University Faculty of Medicine, Umeå, Sweden.
  • Fors Connolly AM; Department of Urology, University of Gothenburg, Gothenburg, Sweden.
BMJ Open ; 12(2): e053032, 2022 02 14.
Article in English | MEDLINE | ID: covidwho-1685589
ABSTRACT

OBJECTIVE:

Determine whether augmentation of oestrogen in postmenopausal women decreases the risk of death following COVID-19.

DESIGN:

Nationwide registry-based study in Sweden based on registries from the Swedish Public Health Agency (all individuals who tested positive for SARS-CoV-2); Statistics Sweden (socioeconomical variables) and the National Board of Health and Welfare (causes of death).

PARTICIPANTS:

Postmenopausal women between 50 and 80 years of age with verified COVID-19.

INTERVENTIONS:

Pharmaceutical modulation of oestrogen as defined by (1) women with previously diagnosed breast cancer and receiving endocrine therapy (decreased systemic oestrogen levels); (2) women receiving hormone replacement therapy (increased systemic oestrogen levels) and (3) a control group not fulfilling requirements for group 1 or 2 (postmenopausal oestrogen levels). Adjustments were made for potential confounders such as age, annual disposable income (richest group as the reference category), highest level of education (primary, secondary and tertiary (reference)) and the weighted Charlson Comorbidity Index (wCCI). PRIMARY OUTCOME

MEASURE:

Death following COVID-19.

RESULTS:

From a nationwide cohort consisting of 49 853 women diagnosed with COVID-19 between 4 February and 14 September 2020 in Sweden, 16 693 were between 50 and 80 years of age. We included 14 685 women in the study with 11 923 (81%) in the control group, 227 (2%) women in group 1 and 2535 (17%) women in group 2. The unadjusted ORs for death following COVID-19 were 2.35 (95% CI 1.51 to 3.65) for group 1 and 0.45 (0.34 to 0.6) for group 2. Only the adjusted OR for death remained significant for group 2 with OR 0.47 (0.34 to 0.63). Absolute risk of death was 4.6% for the control group vs 10.1% and 2.1%, for the decreased and increased oestrogen groups, respectively. The risk of death due to COVID-19 was significantly associated with age, OR 1.15 (1.14 to 1.17); annual income, poorest 2.79 (1.96 to 3.97), poor 2.43 (91.71 to 3.46) and middle 1.64 (1.11 to 2.41); and education (primary 1.4 (1.07 to 1.81)) and wCCI 1.13 (1.1 to 1.16).

CONCLUSIONS:

Oestrogen supplementation in postmenopausal women is associated with a decreased risk of dying from COVID-19 in this nationwide cohort study. These findings are limited by the retrospective and non-randomised design. Further randomised intervention trials are warranted.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pharmaceutical Preparations / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Female / Humans Country/Region as subject: Europa Language: English Journal: BMJ Open Year: 2022 Document Type: Article Affiliation country: Bmjopen-2021-053032

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pharmaceutical Preparations / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Female / Humans Country/Region as subject: Europa Language: English Journal: BMJ Open Year: 2022 Document Type: Article Affiliation country: Bmjopen-2021-053032