Effect of sex on clinical outcomes in COVID-19 patients: a population-based study

Abstract Background Previous studies have reported the association between sex and clinical outcomes; however, the most relevant results were obtained as part of analyses evaluating other prognostic factors. This study aimed to evaluate the association between sex and clinical outcomes in patinets with COVID-19 using a population-based dataset. Methods This retrospective study utilized claims data from the Health Insurance Review & Assessment Service of Korea. Confirmed patients were included among all participants who underwent COVID-19 testing. Diseases including COVID-19 were defined using International Classification of Diseases, 10th revision (ICD-10). During follow-up, clinical outcomes except death were defined using Electronic Data Interchange or ICD-10 codes from the dataset. Results A total of 234,427 patients underwent laboratory testing for COVID-19. Finally, 7327 patients were included; of these, 2964 were men and 4363 were women. The proportions of patients with diabetes mellitus or hypertension as major comorbidities were higher among men than among women of the some age groups, but there were no significant differences in the Charlson comorbidity index score between men and women in same age group. Survival and clinical outcomes including acute kidney injury, the use of inotropes, mechanical ventilator, and cardiac events were greater in men than women. The mortality rate was the highest for the populations aged 50–64 or ≥ 65 years. Subgroup analyses for age, diabetes mellitus, or hypertension showed favorable results for patient survival or clinical outcomes in women compared to men. Conclusion Our population-based study showed that female patients with COVID-19 were associated with favorable outcomes, including survival. The impact of sex was more evident in population aged 50–64 or ≥ 65 years.