Men with COVID-19 die. Women survive…at any age!

Abstract

Ferretti et al. in a recently published retrospective analysis of patients hospitalized for COVID-19 reported a higher mortality in men with respect to women only after the age of 65 years, well beyond the menopause [[1]Ferretti V.V. Klersy C. Bruno R. Cutti S. Nappi R.E. Men with COVID-19 die. Women survive.Maturitas. 2022; 158: 34-36https://doi.org/10.1016/j.maturitas.2021.11.014Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar]. Epidemiological studies on COVID-19 patients taken as a whole have shown that men are more susceptible than women to hospitalization and severe disease [2Pijls B.G. Jolani S. Atherley A. Derckx R.T. Dijkstra J.I.R. Franssen G.H.L. Hendriks S. Richters A. Venemans-Jellema A. Zalpuri S. Zeegers M.P. Demographic risk factors for COVID-19 infection, severity, ICU admission and death: a meta-analysis of 59 studies.Br. Med. J. Open. 2021; 11e044640https://doi.org/10.1136/bmjopen-2020-044640Crossref Scopus (119) Google Scholar, 3Ramírez-Soto M.C. Ortega-Cáceres G. Arroyo-Hernández H. Sex differences in COVID-19 fatality rate and risk of death: an analysis in 73 countries, 2020–2021.Infez. Med. 2021; 29: 402-407https://doi.org/10.53854/liim-2903-11Crossref PubMed Scopus (2) Google Scholar]. We have recently analyzed the report of the Italian National Institute of Health on SARS-CoV-2 positive cases considering age, sex and fatality index, reporting that men showed a fatality index significantly higher than that of women (OR 1.38, 95% CI 1.36–1.40, P < 0.0001), without any difference in infection rate [4Rossato M. Di Vincenzo A. Andrisani A. Marin L. Capone F. Vettor R. Sex and gender-related differences in COVID-19 fatality rate.J. Women's Health. 2022; (in press)PubMed Google Scholar, 5Italian Institute of Healthhttps://www.epicentro.iss.it/coronavirus/sars-cov-2-sorveglianza-datiGoogle Scholar]. But at variance with the data reported by Ferretti et al. [[1]Ferretti V.V. Klersy C. Bruno R. Cutti S. Nappi R.E. Men with COVID-19 die. Women survive.Maturitas. 2022; 158: 34-36https://doi.org/10.1016/j.maturitas.2021.11.014Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar], when analyzing the age range 20–49 (a pre-menopausal age range), the fatality rate in men was 2.2 times higher than that of women (OR 2.21, 95% CI 1.93–2.54, P < 0.0001) [[4]Rossato M. Di Vincenzo A. Andrisani A. Marin L. Capone F. Vettor R. Sex and gender-related differences in COVID-19 fatality rate.J. Women's Health. 2022; (in press)PubMed Google Scholar]. Furthermore, while Ferretti et al. reported that women showed a lower fatality rate than men as COVID-19 patient age increased above the average age at menopause, our analysis demonstrated that women's fatality rate for COVID-19 is lower than that of men at any age, although it becomes closer to that of men as age increases [4Rossato M. Di Vincenzo A. Andrisani A. Marin L. Capone F. Vettor R. Sex and gender-related differences in COVID-19 fatality rate.J. Women's Health. 2022; (in press)PubMed Google Scholar, 5Italian Institute of Healthhttps://www.epicentro.iss.it/coronavirus/sars-cov-2-sorveglianza-datiGoogle Scholar]. The larger sample in our analysis (more than 2.5 million vs 1764 subjects) and the fact that Ferretti's patients were hospitalized for COVID-19 could explain, at least in part, such contrasting results.