Sex and COVID-19 mortality: Comparison
Please note this is a comparison between Version 2 by Mario Rivera-Izquierdo and Version 1 by Mario Rivera-Izquierdo.

Spain is one of the countries most affected by the COVID-19 pandemic. Although risk factors for severe disease are published, sex differences have been widely neglected. In this multicentre study, we aimed to identify predictors of in-hospital mortality in men and women hospitalised with COVID-19. An observational longitudinal study was conducted in the cohort of patients admitted to four hospitals in Andalusia, Spain, from 1 March 2020 to 15 April 2020. Sociodemographic and clinical data were collected from hospital records. The Kaplan-Meier method was used to estimate 30-day survival and multiple Cox regression models were applied. All analyses were stratified by sex. A total of 968 patients were included (54.8% men, median age 67.0 years). In-hospital mortality reached 19.1% in men and 16.0% in women. Factors independently associated with an increased hazard of death were advanced age, higher CURB-65 score and not receiving azithromycin treatment, in both sexes; active cancer and autoimmune disease, in men; cardiovascular disease and chronic lung disease, in women. Disease outcomes and predictors of death differed between sexes. In-hospital mortality was higher in men, but the long-term effects of COVID-19 merit further research. The sex-differential impact of the pandemic should be addressed in public health policies.

  • COVID-19
  • SARS-CoV-2
  • hospital mortality
  • risk factors
  • sex


We described the baseline characteristics, treatments received and main outcomes of patients with COVID-19 admitted to four centres in Andalusia, Spain, in the first wave of the pandemic. We analysed predictors of in-hospital mortality. In both sexes, advanced age, higher CURB-65 score upon admission and not receiving treatment with azithromycin increased the risk of death. Sex-specific risk factors were active cancer and autoimmune disease in men, and cardiovascular disease and chronic lung disease in women.

In this study, men show higher rates of ICU admission and in-hospital mortality. Nevertheless, this may not be the case in middle- and especially low-income countries, where less research is conducted. Another topic that should be addressed in future studies is the long-term impact of the pandemic, as it might be greater on women. Several authors [1][2] have made a call to address the sex- and gender-specific long-run effects of COVID-19 on population health: healthcare systems are facing the growing demand for care and the mental health fallout[3]. To this end, governments must allocate resources[4] to overcome barriers to health services access and expand social protection.


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  1. Jade Connor; Sarina Madhavan; Mugdha Mokashi; Hanna Amanuel; Natasha R. Johnson; Lydia E. Pace; Deborah Bartz; Health risks and outcomes that disproportionately affect women during the Covid-19 pandemic: A review. Social Science & Medicine 2020, 266, 113364-113364, 10.1016/j.socscimed.2020.113364.
  2. Primavera A. Spagnolo; JoAnn E. Manson; Hadine Joffe; Sex and Gender Differences in Health: What the COVID-19 Pandemic Can Teach Us. Annals of Internal Medicine 2020, 173, 385-386, 10.7326/m20-1941.
  3. Clare Bambra; Viviana Albani; Paula Franklin; COVID-19 and the gender health paradox. Scandinavian Journal of Public Health 2020, 49, 17-26, 10.1177/1403494820975604.
  4. Clare Bambra; Ryan Riordan; John Ford; Fiona Matthews; The COVID-19 pandemic and health inequalities. Journal of Epidemiology and Community Health 2020, 74, 964-968, 10.1136/jech-2020-214401.
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