Increased COVID-19 infections in women with polycystic ovary syndrome: a population-based study.

Anuradhaa Subramanian,Kelvin Okoth,Konstantinos A Toulis,Michael W O’Reilly,Christopher Sainsbury,Krishna Gokhale,Astha Anand,Nicola J Adderley,Wiebke Arlt,Krishnarajah Nirantharakumar

doi:10.1530/eje-20-1163

Anuradhaa Subramanian, Kelvin Okoth + Show 8 more

Open Access

https://doi.org/10.1530/eje-20-1163

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Abstract

ObjectiveSeveral recent observational studies have linked metabolic comorbidities to an increased risk from COVID-19. Here we investigated whether women with PCOS are at an increased risk of COVID-19 infection.DesignPopulation-based closed cohort study between 31 January 2020 and 22 July 2020 in the setting of a UK primary care database (The Health Improvement Network, THIN).MethodsThe main outcome was the incidence of COVID-19 coded as suspected or confirmed by the primary care provider. We used Cox proportional hazards regression model with stepwise inclusion of explanatory variables (age, BMI, impaired glucose regulation, androgen excess, anovulation, vitamin D deficiency, hypertension, and cardiovascular disease) to provide unadjusted and adjusted hazard risks (HR) of COVID-19 infection among women with PCOS compared to women without PCOS.ResultsWe identified 21 292 women with a coded diagnosis of PCO/PCOS and randomly selected 78 310 aged and general practice matched control women. The crude COVID-19 incidence was 18.1 and 11.9 per 1000 person-years among women with and without PCOS, respectively. Age-adjusted Cox regression analysis suggested a 51% higher risk of COVID-19 among women with PCOS compared to women without PCOS (HR: 1.51 (95% CI: 1.27–1.80), P < 0.001). After adjusting for age and BMI, HR reduced to 1.36 (1.14–1.63)], P = 0.001. In the fully adjusted model, women with PCOS had a 28% increased risk of COVID-19 (aHR: 1.28 (1.05–1.56), P = 0.015).ConclusionWomen with PCOS are at an increased risk of COVID-19 infection and should be specifically encouraged to adhere to infection control measures during the COVID-19 pandemic.Significance statementWomen with polycystic ovary syndrome (PCOS) have an increased risk of cardio-metabolic disease, which have been identified as a risk factor for COVID-19. To investigate whether the increased metabolic risk in PCOS translates into an increased risk of COVID-19 infection, we carried out a population-based closed cohort study in the UK during its first wave of the SARS-CoV-2 pandemic (January to July 2020), including 21 292 women with PCOS and 78 310 controls matched for sex, age and general practice location. Results revealed a 52% increased risk of COVID-19 infection in women with PCOS, which remained increased at 28% above controls after adjustment for age, BMI, impaired glucose regulation and other explanatory variables.

Highlights

The novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) reached a pandemic status in March 2020 with a consequent severe impact on international healthcare systems and the global economy [1]
In the sensitivity analysis restricting to reproductiveaged women, the results suggest that women with polycystic ovary syndrome (PCOS) between the age of 18 and 50 years (n = 17 525) have a 30% increased risk of suspected/confirmed COVID-19 compared to women without PCOS matched for age and general practice (n = 63 775) (aHR: 1.30, P = 0.018) (Table 2)
CI: 0.86–2.00), P = 0.215 and 1.36, P = 0.085, respectively). In this retrospective cohort study spanning the first wave period of the COVID-19 pandemic in the UK, we found that a diagnosis of PCOS confers a 51% increased risk of development of confirmed or suspected COVID19 infection compared to the background age-matched female population

Summary

Introduction

The novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) reached a pandemic status in March 2020 with a consequent severe impact on international healthcare systems and the global economy [1]. Multiple large observational studies have shown that those with metabolic risk factors such as diabetes, obesity and cardiovascular disease are at higher risk of severe COVID-19 infection [2, 3, 4, 5]. Whilst younger age and female sex are typically associated with a lower overall risk of severe COVID-19 infection and mortality [2, 4], patients with PCOS may represent a distinct subgroup of women at higher than average risk of adverse COVID-19-related outcomes. It is, imperative to determine whether PCOS is linked to COVID-19 susceptibility

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