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Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission

Anecdotal evidence suggests that Coronavirus disease 2019 (COVID-19), caused by the coronavirus SARS-CoV-2, exhibits differences in morbidity and mortality between sexes. Here, we present a meta-analysis of 3,111,714 reported global cases to demonstrate that, whilst there is no difference in the proportion of males and females with confirmed COVID-19, male patients have almost three times the odds of requiring intensive treatment unit (ITU) admission (OR = 2.84; 95% CI = 2.06, 3.92) and higher odds of death (OR = 1.39; 95% CI = 1.31, 1.47) compared to females. With few exceptions, the sex bias observed in COVID-19 is a worldwide phenomenon. An appreciation of how sex is influencing COVID-19 outcomes will have important implications for clinical management and mitigation strategies for this disease.

A consistent feature of the ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)1, is the male bias towards severe disease2,3,4,5,6. Despite this, there are few analyses addressing whether this is a global rather than regional phenomenon. There are limited data that indicate whether the bias towards increased mortality in males is due to an increased proportion of infections in males, or a true representation of more severe disease. This gap in the literature highlights that sex remains an under-appreciated variable when interrogating outcomes in infectious diseases.

To address whether the reported sex-bias is validated by large-scale statistical analysis of global data, we have collected available case data from 90 reports including 46 different countries and 44 US states totalling 3,111,714 infected cases, and present a meta-analysis to investigate sex as a risk factor for SARS-CoV-2 infection, and COVID-19 morbidity and mortality. We demonstrate that while there is no difference in the proportion of males and females infected with SARS-CoV-2, males face higher odds of both intensive therapy unit (ITU) admission and death compared to females. The confirmation of this sex disparity with global data has important implications for the continuing public health response to this pandemic.

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