Outcome Disparities Among Men and Women With COVID-19: An Analysis of the New York City Population Cohort

October 2020 | Volume 19 | Issue 10 | Original Article | 960 | Copyright © October 2020


Published online October 2, 2020

Nahid Punjani MD MPHa, b, Albert Ha MDc, Joseph Caputo MDc, Vinson Wang MDc, Lisa Wiechmann MDd, Mary Ann Chiasson DrPHb,e, Philip Li MDa, James Hotaling MD MSf, Thomas Walsh MD MSg, Joseph Alukal MDc

aDepartment of Urology, Center for Male Reproductive Medicine and Microsurgery, Weill Cornell Medicine, New York, NY bDepartment of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY cDepartment of Urology, New York-Presbyterian Columbia University Irving Medical Center, New York, NY dDepartment of General Surgery, New York-Presbyterian Columbia University Irving Medical Center, New York, NY eDivision of Infectious Diseases, Department of Medicine, New York-Presbyterian Columbia University Irving Medical Center, New York, NY fDepartment of Urology, University of Utah, Salt Lake City, UT gDepartment of Urology, University of Washington, Seattle, WA

Abstract
Background: Growing evidence suggests a possible sex disparity in COVID-19 disease related outcomes.
Objective: To explore the sex disparity in COVID-19 cases and outcomes using New York City (NYC) population level data.
Setting: NYC surveillance data from February 29 to June 12, 2020.
Participants: Individuals tested for COVID-19 in metropolitan NYC.
Outcome Measurements and Statistical Analysis: Outcomes of interest included rates of COVID-19 case positivity, hospitalization and death. Relative risks and case fatality rates were computed for all outcomes based on sex and were stratified by age groups. Results and Limitations: 911,310 individuals were included, of whom 434,273 (47.65%) were male and 477,037 (52.35%) were female. Men represented the majority of positive cases (n=106,275, 51.36%), a majority of hospitalizations (n=29,847, 56.44%), and a majority of deaths (n=13,054, 59.23%). Following population level adjustments for age and sex, testing rates of men and women were equivalent. The majority of positive cases and hospitalizations occurred in men for all age groups except age >75 years, and death was more likely in men of all age groups. Men were at a statistically significant greater relative risk of case positivity, hospitalization, and death across all age groups except those <18 years of age. The most significant difference for case positivity was observed in the 65–74 age group (RR 1.22, 95%CI 1.19–1.24), for hospitalization in the 45–65 age group (RR 1.85, 95% 1.80–1.90), and for death in the 18–44 age group (RR 3.30, 95% CI 2.82–3.87). Case fatality rates were greater for men in all age-matched comparisons to women. Limitations include the use of an evolving surveillance data set and absence of further demographic characteristics such as ethnographic data.
Conclusion: Men have higher rates of COVID-19 positivity, hospitalization, and death despite greater testing of women; this trend remains after stratification by age.

J Drugs Dermatol. 2020;19(10):960-967. doi:10.36849/JDD.2020.5590

INTRODUCTION

COVID-19 is caused by a coronavirus first identified after an outbreak of atypical pneumonia in Wuhan, China in December 2019. On January 7, 2020 the World Health Organization (WHO) officially recognized this novel virus as SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2).1 The spread of COVID-19 has been rapid; by March 11, 2020 the WHO declared COVID-19 a pandemic.1 By July 2020, worldwide cases surpassed 12 million, with more than 550,000 deaths. In the United States, total cases exceed 3 million with more than 130,000 deaths.2

Early in the pandemic, researchers searched for predictors of viral infection and disease severity. This work suggested that increased age, ethnicity, and certain comorbidities were likely related to adverse outcomes.3 Evidence of a sex disparity also became apparent.4 Worldwide, differential outcomes for men were observed to varying degrees.5 To date, no consensus on this observation exists, nor are there any definitive explanations for a possible sex discrepancy.

Currently, New York State leads the United States in both COVID-19 cases and deaths; NYC was specifically deemed a COVID-19 epicenter. We analyzed the NYC citywide dataset to further explore the sex disparity related to COVID-19. We report sex and age stratified data on testing rates together with COVID-19 related outcomes including positive cases, hospitalizations and deaths in almost one million individuals.