Sex-based Variations in Clinical Manifestations, Co-morbidities, and Outcome of COVID-19 Patients in Baghdad, Iraq, 2020
DOI:
https://doi.org/10.12974/2312-5470.2021.07.07Keywords:
COVID-19, Iraq, Gender, Case fatality ratio, ComorbidityAbstract
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.
References
Wu D, Wu T, Liu Q, Yang Z. The SARS-CoV-2 outbreak: what we know. Int J Infect Dis. 2020; 94: 44-8. https://doi.org/10.1016/j.ijid.2020.03.004
Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020; 109: 102433. https://doi.org/10.1016/j.jaut.2020.102433
Lake MA. What we know so far: COVID-19 current clinical knowledge and research. Clin Med (Lond). 2020; 20: 124-7. https://doi.org/10.7861/clinmed.2019-coron
Singhal T. A review of coronavirus disease-2019 (COVID- 19). Indian J Pediatr. 2020; 87: 281-6. https://doi.org/10.1007/s12098-020-03263-6
Velavan TP, Meyer CG. The COVID-19 epidemic. Trop Med Int Health. (2020) 25: 278-80. https://doi.org/10.1111/tmi.13383
Kopel Jonathan, Perisetti Abhilash, Roghani Ali, Aziz Muhammad, Gajendran Mahesh, Goyal Hemant, Racial and Gender-Based Differences in COVID-19. Frontiers in Public Health. 2020; 28; 8: 418. https://doi.org/10.3389/fpubh.2020.00418
Pingzheng Mo, Yuanyuan Xing, Yu Xiao, Liping Deng, Qiu Zhao, et al. Clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China, Clinical Infectious Diseases, 2020; 16; ciaa270.
Jin JM, Bai P, He W, Wu F, Liu X-F, Han DM, et al. Gender differences in patients with COVID-19: focus on severity and mortality. Front Public Health. 2020; 29; 8: 152. https://doi.org/10.3389/fpubh.2020.00152
Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Archiv Otorhinolaryngol. 2020; 277; 8: 2251-61. https://doi.org/10.1007/s00405-020-05965-1
Klein S, Flanagan K. Sex differences in immune responses. Nat Rev Immunol. 2016; 16; 10: 626-638. https://doi.org/10.1038/nri.2016.90
Maleki Dana P, Sadoughi F, Hallajzadeh J, Asemi Z, Mansournia MA, Yousefi B, et al. An Insight into the Sex Differences in COVID-19 Patients: What are the Possible Causes? Prehospital and Disaster Medicine. Cambridge University Press; 2020; 35(4): 438-41. https://doi.org/10.1017/S1049023X20000837
Rozenberg S, Vandromme J, & Martin C. Are we equal in adversity? Does Covid-19 affect women and men differently? Maturitas 2020; 138,62-68. https://doi.org/10.1016/j.maturitas.2020.05.009
Li L, Huang T, Wang Y, Wang Z, Liang Y, Huang T, et al. COVID-19 patients' clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol. 2020; 92; 6: 577-83. https://doi.org/10.1002/jmv.25757
Report on the epidemiological features of coronavirus disease 2019 (COVID-19) outbreak in the Republic of Korea from January 19 to March 2, 2020. J Korean Med Sci. 2020; 35; 10: e112. https://doi.org/10.3346/jkms.2020.35.e112
Wu J, Liu J, Zhao X, Liu C, Wang W, Wang D, et al. Clinical characteristics of imported cases of coronavirus disease 2019 (COVID-19) in Jiangsu province: a multicenter descriptive study. Clin Infect Dis. 2020; 71; 15: 706-12 https://doi.org/10.1093/cid/ciaa199
Global health 5050, 2020. The COVID- 19 sex-disaggregated data for Iraq. Global health 5050. Available at https: //globalhealth5050.org/the-sex-gender-and-covid-19- project/the-datatracker/? explore=country&country=Iraq#search,
[accessed February 20, 2021]
Primary health care department; Technical affairs department. Alkarkh directorate of health, Ministry of Health- Iraq, 2020.
WHO, 2020. Clinical Management of COVID- 19, interim guidance. World Health Organization. Available at https: //www.who.int/publications/i/item/clinical-management-ofcovid- 19,
[accessed October 30, 2020].
Roved J, Westerdahl H, Hasselquist D. Sex differences in immune responses: hormonal effects, antagonistic selection, and evolutionary consequences. Horm Behav. 2017; 88: 95- 105. https://doi.org/10.1016/j.yhbeh.2016.11.017
Klein SL, Flanagan KL. Sex differences in immune responses. Nat Rev Immunol. 2016; 16; 10: 626-38. https://doi.org/10.1038/nri.2016.90
Critchley JA, Carey IM, Harris T, DeWilde S, Hosking FJ, Cook DG. Glycemic control and risk of infections among people with type 1 or type 2 diabetes in a large primary care cohort study. Diabetes Care. 2018; 41; 10: 2127-35. https://doi.org/10.2337/dc18-0287
Carey IM, Critchley JA, DeWilde S, Harris T, Hosking FJ, Cook DG. Risk of infection in type 1 and type 2 diabetes compared with the general population: a matched cohort study. Diabetes Care. 2018; 41; 3: 513-21. https://doi.org/10.2337/dc17-2131
Alghamdi IG, Hussain II, Almalki SS, Alghamdi MS, Alghamdi MM, El-Sheemy MA. The pattern of Middle East respiratory syndrome coronavirus in Saudi Arabia: a descriptive epidemiological analysis of data from the Saudi Ministry of Health. Int J Gen Med. 2014; 7: 417-23. https://doi.org/10.2147/IJGM.S67061
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020; 382; 18: 1708-20. https://doi.org/10.1056/NEJMoa2002032
Zhao S, Cao P, Chong MK, Gao D, Lou Y, Ran J, et al. The time-varying serial interval of the coronavirus disease (Covid- 19) and its gender-specific difference: a data-driven analysis using public surveillance data in Hong Kong and Shenzhen, China from January 10 to February 15, 2020. Infect Control Hosp Epidemiol. 2020; 41; 6: 750-751. https://doi.org/10.1017/ice.2020.64
Mo P, Xing Y, Xiao Y, Deng L, Zhao Q, Wang H, et al. Clinical characteristics of refractory Covid-19 pneumonia in Wuhan, China. Clin Infect Dis. 2020.
Huang C, Wang Y, LI X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395; 10223: 497-506. https://doi.org/10.1016/S0140-6736(20)30183-5
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395, 10223: 507-13. https://doi.org/10.1016/S0140-6736(20)30211-7
Li LQ, Huang T, Wang YQ, Wang ZP, Liang Y, Huang TB, et al. 2019 novel coronavirus patients' clinical characteristics, discharge rate and fatality rate of meta-analysis. J Med Virol. 2020; 92(6): 577-83. https://doi.org/10.1002/jmv.25757
Guan W, Ni Z, Liang W. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382; 18: 1708-20. https://doi.org/10.1056/NEJMoa2002032
Zhang JJ, Dong X, Cao Y. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy 2020. https://doi.org/10.1111/all.14238
Wu Z, McGoogan JM. Characteristics of and important lessons from the Coronavirus Disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323; 13: 1239-42. https://doi.org/10.1001/jama.2020.2648
Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention.
[The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China].
[Article in Chinese with English abstract]. Zhonghua Liu Xing Bing Xue Za Zhi 2020; 41: 145-51.
Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA 2020; 323; 16: 1574-81. https://doi.org/10.1001/jama.2020.5394
Guan WJ, Ni ZW, Hu Y, Liang WH, Qu CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382; 18: 1708-20. https://doi.org/10.1056/NEJMoa2002032
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020; 323; 11: 1061. https://doi.org/10.1001/jama.2020.1585
Cheng H, Wang Y, Wang GQ. Organ-protective effect of angiotensin-converting enzyme 2 and its effect on the prognosis of COVID-19. J Med Virol 2020; 92; 7: 726-30. https://doi.org/10.1002/jmv.25785
Wang Z, Yang B, Li Q, Wen L, Zhang R. Clinical features of 69 cases with Coronavirus disease 2019 in Wuhan, China. Clin Infect Dis. 2020, 71; 15: 769-77. https://doi.org/10.1093/cid/ciaa272
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID- 19 in Wuhan, China: a retrospective cohort study. Lancet 2020; 395(10229): 1054-1062. https://doi.org/10.1016/S0140-6736(20)30566-3
Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: a retrospective study. BMJ 2020; 368: m1091. Erratum in BMJ 2020; 368: m1295. https://doi.org/10.1136/bmj.m1091
Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: A prospective cohort study. Eur Respir J 2020; 55; 5: 2000524. https://doi.org/10.1183/13993003.00524-2020
Gender. 2020. World Health Organization. https: //www.who.int/healthtopics/gender
[accessed February 20, 2021.
The impact of Covid-19 on women and children experiencing domestic abuse, and the life-saving services that support them. In. Women's Aid UK; 2020. https: //www.womensaid.org.uk/the-impact-of-covid-19-on-womenand- children-experiencing-domestic-abuse-and-the-lifesaving- services-that-support-them/ (Accessed Dec 6, 2020)
Wenham C, Smith J, Morgan R. Covid-19: the gendered impacts of the outbreak. Lancet. 2020; 395(10227): 846-8. https://doi.org/10.1016/S0140-6736(20)30526-2
Cai H. Sex difference and smoking predisposition in patients with Covid-19. Lancet Respir Med. 2020; 8; 4: e20. https://doi.org/10.1016/S2213-2600(20)30117-X