Abstract
BackgroundSex has consistently been shown to affect COVID-19 mortality, but it remains unclear how each sex’s clinical outcome may be distinctively shaped by risk factors.MethodsWe studied a primary cohort of 4930 patients hospitalized with COVID-19 in a single healthcare system in New York City from the start of the pandemic till August 5, 2020, and a validation cohort of 1645 patients hospitalized with COVID-19 in the same healthcare system from August 5, 2020, to January 13, 2021.ResultsHere we show that male sex was independently associated with in-hospital mortality, intubation, and ICU care after adjusting for demographics and comorbidities. Using interaction analysis and sex-stratified models, we found that hypoxia interacted with sex to preferentially increase women’s mortality risk while obesity interacted with sex to preferentially increase women’s risk of intubation and intensive care in our primary cohort. In the validation cohort, we observed that male sex remained an independent risk factor for mortality, but sex-specific interactions were not replicated.ConclusionsWe conducted a comprehensive sex-stratified analysis of a large cohort of hospitalized COVID-19 patients, highlighting clinical factors that may contribute to sex differences in the outcome of COVID-19.
Highlights
Sex has consistently been shown to affect COVID-19 mortality, but it remains unclear how each sex’s clinical outcome may be distinctively shaped by risk factors
We explore sex-specific risk factors of inhospital mortality, intubation, and intensive care
The study cohort comprised 4930 COVID-19 patients hospitalized within the Mount Sinai Health System in New York City, of whom 2757 (55.9%) were men and 2173 (44.1%) were women
Summary
We studied a primary cohort of 4930 patients hospitalized with COVID-19 in a single healthcare system in New York City from the start of the pandemic till August 5, 2020, and a validation cohort of 1645 patients hospitalized with COVID-19 in the same healthcare system from August 5, 2020, to January 13, 2021. Results Here we show that male sex was independently associated with in-hospital mortality, intubation, and ICU care after adjusting for demographics and comorbidities. Mount Sinai Health System is a large hospital system in the New York City area, comprising 8 hospitals and more than 410 ambulatory practice locations. In the setting of the COVID19 pandemic, the Mount Sinai Data Warehouse (MSDW) developed and released a de-identified dataset encompassing all COVID-19 related patient encounters within the Mount Sinai system, accompanied by selected demographics, comorbidities, vital signs, medications, and lab values. We used the dataset released on August 5, 2020
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