Covid-19 and gender: lower rate but same mortality of severe disease in women-an observational study

BMC Pulm Med. 2021 Mar 20;21(1):96. doi: 10.1186/s12890-021-01455-0.


Background: Gender-related factors might affect vulnerability to Covid-19. The aim of this study was to describe the role of gender on clinical features and 28-day mortality in Covid-19 patients.

Methods: Observational study of Covid-19 patients hospitalized in Bergamo, Italy, during the first three weeks of the outbreak. Medical records, clinical, radiological and laboratory findings upon admission and treatment have been collected. Primary outcome was 28-day mortality since hospitalization.

Results: 431 consecutive adult patients were admitted. Female patients were 119 (27.6%) with a mean age of 67.0 ± 14.5 years (vs 67.8 ± 12.5 for males, p = 0.54). Previous history of myocardial infarction, vasculopathy and former smoking habits were more common for males. At the time of admission PaO2/FiO2 was similar between men and women (228 [IQR, 134-273] vs 238 mmHg [150-281], p = 0.28). Continuous Positive Airway Pressure (CPAP) assistance was needed in the first 24 h more frequently in male patients (25.7% vs 13.0%; p = 0.006). Overall 28-day mortality was 26.1% in women and 38.1% in men (p = 0.018). Gender did not result an independent predictor of death once the parameters related to disease severity at presentation were included in the multivariable analysis (p = 0.898). Accordingly, the Kaplan-Meier survival analysis in female and male patients requiring CPAP or non-invasive ventilation in the first 24 h did not find a significant difference (p = 0.687).

Conclusion: Hospitalized women are less likely to die from Covid-19; however, once severe disease occurs, the risk of dying is similar to men. Further studies are needed to better investigate the role of gender in clinical course and outcome of Covid-19.

Keywords: Covid-19; Disease severity; Gender.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • COVID-19 / epidemiology*
  • COVID-19 / mortality
  • COVID-19 / physiopathology
  • COVID-19 / therapy
  • Comorbidity
  • Continuous Positive Airway Pressure / statistics & numerical data
  • Diabetes Mellitus / epidemiology
  • Female
  • Humans
  • Hypertension / epidemiology
  • Hypoxia / epidemiology
  • Hypoxia / physiopathology
  • Hypoxia / therapy
  • Italy / epidemiology
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology
  • Noninvasive Ventilation / statistics & numerical data
  • SARS-CoV-2
  • Severity of Illness Index
  • Sex Factors
  • Smoking / epidemiology