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Gender Differences in Hospital Outcomes among COVID-19 Hospitalizations
Sandeep Appunni1, Muni Rubens, Venkataraghavan Ramamoorthy2
1From the Government Medical College, Kozhikode, Kerala, India.
Insights
Males hospitalized with COVID-19 (coronavirus disease 2019) experienced higher rates of mortality, prolonged hospital stays, and intensive care unit admission. Male sex is a significant risk factor for severe COVID-19 outcomes.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- Epidemiological studies present conflicting data on sex-based differences in COVID-19 (coronavirus disease 2019) prevalence and outcomes.
- Previous research has not definitively established whether males are disproportionately affected by COVID-19 compared to females.
Purpose of the Study:
- To investigate sex-based disparities in COVID-19 hospitalization rates.
- To analyze differences in in-hospital outcomes between male and female COVID-19 patients using a large administrative database.
Main Methods:
- Retrospective analysis of the 2020 California State Inpatient Database.
- Identification of COVID-19 hospitalizations using ICD-10-CM code U07.1.
- Stratification of hospitalizations by sex and comparison of outcomes including mortality, length of stay, vasopressor use, mechanical ventilation, and ICU admission.
Main Results:
- Out of 95,180 COVID-19 hospitalizations, 55.1% were male and 44.9% were female.
- Male hospitalizations showed significantly higher rates of in-hospital mortality (12.4% vs 10.1%), prolonged hospital stays (30.6% vs 25.8%), vasopressor use (2.6% vs 1.6%), mechanical ventilation (11.8% vs 8.0%), and ICU admission (11.4% vs 7.8%).
- Logistic regression confirmed male sex as a significant risk factor for increased mortality, longer hospital stays, and higher rates of vasopressor use, mechanical ventilation, and ICU admission.
Conclusions:
- Male sex is an independent and strong risk factor associated with increased COVID-19 severity.
- These findings highlight significant sex-based differences in COVID-19 outcomes, emphasizing the need for sex-specific considerations in clinical management and public health strategies.
Objectives:
Many epidemiological studies have shown that coronavirus disease 2019 (COVID-19) disproportionately affects males, compared with females, although other studies show that there were no such differences. The aim of the present study was to assess differences in the prevalence of hospitalizations and in-hospital outcomes between the sexes, using a larger administrative database.
Methods:
We used the 2020 California State Inpatient Database for this retrospective analysis. International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code U07.1 was used to identify COVID-19 hospitalizations. These hospitalizations were subsequently stratified by male and female sex. Diagnosis and procedures were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. The primary outcome of the study was hospitalization rate, and secondary outcomes were in-hospital mortality, prolonged length of stay, vasopressor use, mechanical ventilation, and intensive care unit (ICU) admission.
Results:
There were 95,180 COVID-19 hospitalizations among patients 18 years and older, 52,465 (55.1%) of which were among men and 42,715 (44.9%) were among women. In-hospital mortality (12.4% vs 10.1%), prolonged length of hospital stays (30.6% vs 25.8%), vasopressor use (2.6% vs 1.6%), mechanical ventilation (11.8% vs 8.0%), and ICU admission rates (11.4% versus 7.8%) were significantly higher among male compared with female hospitalizations. Conditional logistic regression analysis showed that the odds of mortality (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.38-1.44), hospital lengths of stay (OR 1.35, 95% CI 1.31-1.39), vasopressor use (OR 1.59, 95% CI 1.51-1.66), mechanical ventilation (OR 1.62, 95% CI 1.47-1.78), and ICU admission rates (OR 1.58, 95% CI 1.51-1.66) were significantly higher among male hospitalizations.
Conclusion:
Our findings show that male sex is an independent and strong risk factor associated with COVID-19 severity.
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