Abstract 17393: Sex Differences in COVID-19 Hospitalization and Mortality in Chicagoland

Abstract

Introduction: The novel coronavirus disease 2019 (COVID-19) pandemic has affected millions of people worldwide. Higher COVID-19 mortality in men compared to women seen in many countries is not yet explained. We analyzed sex differences in COVID-19 outcomes in a large Illinois-based cohort. Methods: This is a multicenter retrospective cohort study of confirmed COVID-19 infections from March 1–June 3, 2020 in Rush University System. We compared men and women with COVID-19 infection for the rates of hospitalization, intensive care unit (ICU) admission, vasopressor use, endotracheal intubation, and death. A multivariable model correcting for age, race, and sum of comorbidities (obesity, hypertension, diabetes, coronary artery disease, heart failure, end-stage renal disease, asthma, chronic obstructive pulmonary disease, active smoking) was used to determine independent association with outcomes. Results: Of the 8,086 patients who tested positive, 4,267 (53%) were females, while 3,819 (47%) were males. Males had a higher rate of hospitalization (19% vs. 14%; p<0.001), ICU transfer (8% vs. 4%; p<0.001), vasopressor support (4% vs. 2%; p<0.001), or endotracheal intubation (5% vs. 2%; p<0.001). Of the 132 patients who died (10% of hospitalized patients), 76 were males, while 56 were females (2% vs. 1%; p=0.018). The prevalence of active smoking, coronary artery disease, end-stage renal disease, and HIV were higher in males, while hypertension and asthma were more common in females. Multivariable model correcting for age, race, and sum of comorbidities showed a significant association between male sex and in-hospital mortality (OR 1.78; 95% CI 1.23-2.58; p=0.002). Conclusions: There were more women who tested positive for COVID-19 disease. Male sex was independently associated with higher rates of death, hospitalization, ICU admissions, need for vasopressors or endotracheal intubation, after correction for important covariates. The interplay of biological and and behavioral factors is likely responsible for the worse outcomes observed in men with COVID-19 infection. Further investigations into the pathophysiology of sex differences in COVID-19 outcomes responses are needed.