Sex-based Variations in Clinical Manifestations, Co-morbidities, and Outcome of COVID-19 Patients in Baghdad, Iraq, 2020

Abstract

Background: Although it was reported that a higher percentage of the confirmed COVID-19 cases were males. the differences between males and females in clinical manifestations, comorbidities, severity, and outcome remain an area of active investigation.
 Objective: To compare the clinical features, comorbidities, severity, and outcome between male and female COVID-19 patients, Baghdad, Iraq, 2020.
 Methods: A records-based cross-sectional study was conducted by extracting sociodemographic, clinical manifestations, severity, and outcome data from the records of COVID- 19 patients admitted to two COVID-19 hospitals in Baghdad, Iraq during June through August 2020.
 Results: The total number of patients was 2111; males were 1175 (55.7%). The mean patients’ age was 49.6 (±16.4) years with no significant difference between males and females (P=0.240). Respiratory symptoms, sore throat and gastrointestinal manifestations were significantly more common among females (90.5%; P= .034), (14.0%; P=.022), and (11.5%; P=.002), respectively. Males had significantly higher “other” manifestations (5.6%; P=0.024). No significant difference was noted for fever, nasal congestion, conjunctival congestion, headache, and musculoskeletal manifestations (P>0.05). Generally, female patients had a significantly higher proportion of comorbidities compared to males (42.7% vs 36.0%; P=0.002). The proportion of severe cases among males was 28.7% compared to 27.8% among females (P>0.05). Also, the critical cases were seen in 22.3% of males compared to 20.9% of females (P>0.05). The mean time from diagnosis to the outcome was 11.4±6.9 days; it was significantly longer in females (P=.034) while the meantime taken for hospital stay was 7.0±5.1days with no significant difference between males and females (P=0.476). The overall case fatality ratio was 14.8% (313/2111); it was higher in males (16.1%) than females (13.2%) (P= .202).
 Conclusion: Gender affects the clinical course and outcome of COVID-19 patients. Male patients may need more attention considering the higher case fatality ratio.