Does gender influence clinical expression and disease outcomes in COVID-19? A systematic review and meta-analysis

Ortolan, Augusta; Lorenzin, Mariagrazia; Felicetti, Mara; Doria, Andrea; Ramonda, Roberta

Abstract Background Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV) has been recently characterized, and soon spread around the world generating a pandemic. It has been suggested that men are more severely affected by the viral disease (COVID-19) than women. Objective the aim of the present Systematic Literature Review (SRL) and meta-analysis was to analyse the influence of gender on COVID-19 mortality, severity and disease outcomes. A SRL was performed in PubMed and Embase searching terms corresponding to the “PEO” format (Population = adult patients affected with COVID-19, Exposure = gender; Outcome = any available clinical outcomes by gender, including mortality and disease severity), search dates 01/01/2020-31/04/2020. Exclusion criteria were: case reports/series, reviews, commentaries, language other than English. We included full-text original articles. Data about study type, country, patients characteristics were extracted. Study quality was evaluated by Newcastle-Ottawa Scale (NOS). From a total of 950 hits generated by databases search, 85 articles fulfilling inclusion/exclusion criteria were selected. Results A random-effect meta-analysis was performed to compare mortality, recovery rates and disease severity in men versus women. Male to female ratio was 1: 0.8. A significant association between male sex and mortality (OR = 1.81; 95%CI: 1.25-2.62), as well as a lower chance of recovery in men (OR = 0.72; 95% CI: 0.55- 0.95). Male patients had a higher odd to present with a severe form of COVID-19 (OR = 1.46; 95%CI: 1.10-1.94). Conclusions male are more susceptible to COVID-19 infection, present with a more severe disease and have a worse prognosis. Further studies are warranted to unravel biological mechanisms underlying these observations.