Sex-specific difference of in-hospital mortality from COVID-19 in South Korea

We sought to assess the impact of sex on in-hospital mortality of patients with COVID-19 infection in South Korea. The study recruited 5,628 prospective consecutive patients who were hospitalized in South Korea with COVID-19 infection, and enrolled in the Korea Centers for Disease Control and Prevention (KCDC) dataset between January 20, 2020, and April 30, 2020. The primary endpoint was in-hospital death from COVID-19. The cohort comprised of 3,308 women (59%) and 2,320 men (41%). In-hospital death was significantly lower in women than men (3.5% vs. 5.5%, hazard ratio (HR): 0.61; 95% confidence interval (CI): 0.47 to 0.79, p <0.001). Results were consistent after multivariable regression (HR: 0.59; 95% CI: 0.41 to 0.85, p = 0.023) and propensity score matching (HR: 0.51; 95% CI: 0.30 to 0.86, p = 0.012). In South Korea, women had a significantly lower risk of in-hospital death amongst those patients hospitalized with COVID-19 infection.

[1]  J. Bhak,et al.  A Clinical Risk Score to Predict In-hospital Mortality from COVID-19 in South Korea , 2021, Journal of Korean medical science.

[2]  A. Pradhan,et al.  Sex differences in severity and mortality from COVID-19: are males more vulnerable? , 2020, Biology of sex differences.

[3]  S. Klein,et al.  Considering how biological sex impacts immune responses and COVID-19 outcomes , 2020, Nature Reviews Immunology.

[4]  V. Regitz-Zagrosek,et al.  Impact of sex and gender on COVID-19 outcomes in Europe , 2020, Biology of Sex Differences.

[5]  Young Joon Park,et al.  Coronavirus Disease Outbreak in Call Center, South Korea , 2020, Emerging infectious diseases.

[6]  Eun Ji Kim,et al.  Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. , 2020, JAMA.

[7]  T. Liang,et al.  Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study , 2020, BMJ.

[8]  Jun Liu,et al.  Factors associated with prolonged viral RNA shedding in patients with COVID-19 , 2020, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[9]  R. Bhopal.  Covid-19 worldwide: we need precise data by age group and sex urgently , 2020, BMJ.

[10]  Arianna Di Stadio,et al.  Mortality rate and gender differences in COVID-19 patients dying in Italy: A comparison with other countries. , 2020, European Review for Medical and Pharmacological Sciences.

[11]  Korean Society of Infectious Diseases.  Analysis on 54 Mortality Cases of Coronavirus Disease 2019 in the Republic of Korea from January 19 to March 10, 2020 , 2020, Journal of Korean medical science.

[12]  Report on the Epidemiological Features of Coronavirus Disease 2019 (COVID-19) Outbreak in the Republic of Korea from January 19 to March 2, 2020 , 2020, Journal of Korean medical science.

[13]  G. Herrler,et al.  SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor , 2020, Cell.

[14]  R. Morgan,et al.  COVID-19: the gendered impacts of the outbreak , 2020, The Lancet.

[15]  De-Min Han,et al.  Gender Differences in Patients With COVID-19: Focus on Severity and Mortality , 2020, Frontiers in Public Health.

[16]  E. Holmes,et al.  A new coronavirus associated with human respiratory disease in China , 2020, Nature.

[17]  Ting Yu,et al.  Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study , 2020, The Lancet.

[18]  Jing Zhao,et al.  Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia , 2020, The New England journal of medicine.

[19]  J. Klugman,et al.  Gender inequality and restrictive gender norms: framing the challenges to health , 2019, The Lancet.

[20]  V. Taneja.  Sex Hormones Determine Immune Response , 2018, Front. Immunol..

[21]  S. Klein,et al.  Sex differences in immune responses , 2016, Nature Reviews Immunology.

[22]  Shutao Zhao,et al.  Testicular defense systems: immune privilege and innate immunity , 2014, Cellular and Molecular Immunology.

[23]  F. Claessens,et al.  Androgen regulation of the TMPRSS2 gene and the effect of a SNP in an androgen response element. , 2013, Molecular endocrinology.

[24]  H. Shaltout,et al.  Update on the Angiotensin Converting Enzyme 2-Angiotensin (1–7)-Mas Receptor Axis: Fetal Programing, Sex Differences, and Intracellular Pathways , 2013, Front. Endocrinol..

[25]  P. Koopman.  Sex determination: a tale of two Sox genes. , 2005, Trends in genetics : TIG.

[26]  M. Fischer,et al.  Renin angiotensin system and gender differences in the cardiovascular system. , 2002, Cardiovascular research.

[27]  B. Jégou,et al.  Viruses in the Mammalian Male Genital Tract and Their Effects on the Reproductive System , 2001, Microbiology and Molecular Biology Reviews.