key: cord-0956807-9lgnrlu1
authors: Su, Yu-Jang; Kuo, Kuan-Chih; Wang, Ta-Wei; Chang, Chen-Wang
title: Gender based differences in COVID-19
date: 2021-05-20
journal: New Microbes New Infect
DOI: 10.1016/j.nmni.2021.100905
sha: dff62b3925a8f321520c578a174f2723af952294
doc_id: 956807
cord_uid: 9lgnrlu1

The coronavirus disease (COVID-19) is a novel emerging infectious disease spreading worldwide. To further understand the disease, we compared its clinical characteristics, symptoms, and outcomes by gender. In an analysis of public surveillance data of Taiwan from January 21 to April 18, 2020, a total of 398 patients were diagnosed with COVID-19 by the detection of severe acute respiratory syndrome coronavirus 2 in pharynx swabs. We divided the patients into two groups: men and women. The associated data were collected, and multivariate comparisons of radiographic infiltration were conducted to analyze the gender-based differences. The mean incubation period was 5.4±5 days, and the incubation period in men was 3.2 days longer than that in women (8±8.1 vs. 4.8±3, p=0.05). The male patients with COVID-19 with infiltration in chest X-rays (CXR) were 12 years older than their female counterparts. The mortality rate in the male patients with COVID-19 was 6.4-fold higher than that in the female patients (3.2% vs. 0.5%, p<0.05). The patients with co-morbidities of diabetes mellitus and hypertension were vulnerable to infiltration in CXR, and the patients with COVID-19 who had infiltration in CXR easily ended up with intubation, intensive care unit admission, and mortality. Moreover, female patients with COVID-19 who had fever, cough, and dyspnea were susceptible to infiltration in CXR. Irrespective of whether the cases were imported female from Europe, America, or Asia, indigenous male, the factors associated with death in patients with severe COVID-19 were male sex, elderly, female with fever, cough, dyspnea and DM.

surveillance data of Taiwan from January 21 to April 18, 2020, a total of 398 patients 8

were diagnosed with COVID-19 by the detection of severe acute respiratory 9 syndrome coronavirus 2 in pharynx swabs. We divided the patients into two groups: 10 men and women. The associated data were collected, and multivariate comparisons of 11 radiographic infiltration were conducted to analyze the gender-based differences. The 12 mean incubation period was 5.4±5 days, and the incubation period in men was 3.2 13 days longer than that in women (8±8.1 vs. 4.8±3, p=0.05). The male patients with 14 COVID-19 with infiltration in chest X-rays (CXR) were 12 years older than their 15 female counterparts. The mortality rate in the male patients with COVID-19 was 16 6.4-fold higher than that in the female patients (3.2% vs. 0.5%, p<0.05). The patients 17 with co-morbidities of diabetes mellitus and hypertension were vulnerable to 18 infiltration in CXR, and the patients with COVID-19 who had infiltration in CXR 19 easily ended up with intubation, intensive care unit admission, and mortality. 20

Moreover, female patients with COVID-19 who had fever, cough, and dyspnea were 21 susceptible to infiltration in CXR. Irrespective of whether the cases were imported 22 female from Europe, America, or Asia, indigenous male, the factors associated with 23 death in patients with severe COVID-19 were male sex, elderly, female with fever, 24 cough, dyspnea and DM. China was informed of the detection of atypical pneumonia in Wuhan, a city in the 36

Hubei province. The initial name given to the disease was 2019-nCoV which was then 37 revised to coronavirus disease (COVID-19) on February 11, 2020. The COVID-19 38 outbreak is a worldwide concern as the novel coronavirus has already spread in 188 39 countries/regions and can cause atypical pneumonia, respiratory failure, and death. 40 We divided the patients into two groups: men and women. The associated objective 78 data collected for statistical analysis included importation and travel history, days 79 until symptom occurrence, days between symptom occurrence and confirmation of 80 the diagnosis, lung infiltration on chest radiographs (CXR) or computed tomographs 81

(CT), intensive care unit (ICU) admission, mortality, and symptoms including fever 82 and lung infiltration. Subjective data included shortness of breath, rhinorrhea, cough, 83 nasal stuffiness, headache, sore throat, anosmia, dysgeusia, muscle pain, general 84 malaise, and chest pain described by the patients. We also performed multivariate 85 comparisons of radiographic infiltration by gender. The age, origin of transmission, 86 symptoms, co-morbidities, and outcomes were also compared to determine the 87 gender-based differences. 88 89 For statistical analyses, continuous data are expressed as mean ± standard deviation 90 (SD) and compared using Student's t-test. On the other hand, categorical data are 91 described as a percentage (followed by the number of patients represented). Further, 92 the χ 2 test was used to analyze categorical data. All the statistical tests were In total, the data of 398 patients with COVID-19, from January 21 to April 18, 2020, 105 were collected. The mean age was 38.6±16.8 years (mean±SD), and the male: female 106 ratio was approximately 0.87:1 (men, n=187; women, n=211). The mean incubation 107 period (IP) was 5.4±5 days, and the IP in men was 3.2 days greater than that in 108 women (8±8.1 vs. 4.8±3, p=0.05) ( Table 1) . 109

In the indigenous cases and those imported from Europe, America, Asia, Africa, and 111

Oceania, the number of cases were equal in both genders and there was no obvious 112 difference in the case numbers indigenous or imported anywhere (p=0.439 and 113 0.913). The incidence of CXR infiltration in COVID-19 patients ranged from 7.6% to 114 9.6% in females and males, respectively, with a mean of 8.5% and there was no 115 statistical difference between the two sexes. 116

In the multivariate comparisons of X-ray infiltration by gender, we observed that the 118 male patients with COVID-19 having CXR infiltration were 12 years older than the 119 female patients with COVID-19. The patients with co-morbidities of diabetes mellitus 120 (DM) and hypertension were vulnerable to CXR infiltration, and the patients with 121 COVID-19 who had CXR infiltration eventually ended up with intubation, ICU 122 admission, and mortality. Moreover, female patients with COVID-19 who had fever, 123 cough, and dyspnea were susceptible to CXR infiltration ( Table 2 ). The mortality rate 124 in the male patients with COVID-19 was 6.4-fold higher than that in the female 125 patients (3.2% vs. 0.5%, p<0.05). The COVID-19 outbreak involved various races worldwide and presented different 139 clinical pictures. According to the majority of reports from Asia, COVID-19 affected 140 males more than females with a male: female ratio of 1. The majorly reported IP in the previous report of COVID-19 was approximately 6 170 days. In a report from Qingdao City on March 31, 2020, the mean IP was 6.28 days 171

[10]. Another report from Wuhan (n=104) reported the median IP to be 6 days [14] . 172

On April 29, 2020, in a report from Shanghai (n=333), the median IP was found to be 173 to be independently associated with higher in-hospital mortality, and worse 219 in-hospital outcomes were concluded from a study in New York [20] . 220

The mean duration of COVID-19 symptoms in mild-to-moderate cured patients was 221 11.5±5.7 days [9]. The median duration between the first symptoms and death was 222 12.5 days whereas the median duration between admission and death was 8.50 days 223

[21]. In the clinical course of COVID-19, 7 to 13 days after illness onset is the critical 224 stage [19] . Intubated 2 (11.1) 0 (0) 2 (5.9) 0.020* ICU admission 2 (11.1) 0 (0) 2 (5.9) 0.020* Mortality 4 (22.2) 1 (6.3) 5 (14.7) <0.001* Asymptomatic 0 (0) 0 (0) 0 (0) 0.212 J o u r n a l P r e -p r o o f

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Korea 328 National Committee for Clinical Management of COVID-19. Clinical 329 Course and Outcomes of Patients with Severe Acute Respiratory 330 Syndrome Coronavirus 2 Infection: a Preliminary Report of the First 28 331 Patients from the Korean Cohort Study on COVID-19

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Clinical course and 390 outcome of 107 patients infected with the novel coronavirus, SARS-CoV-2, 391 discharged from two hospitals in Wuhan, China. Crit Care

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