Men with COVID-19 three times more likely to need ICU admission than women, suggests new study

Since the beginning of the pandemic, it has been noted that men are more likely to get severe or die of the disease. However, the evidence had mostly been anecdotal.

Now, a meta-analysis including more than three million global cases of shows that men who get disease are three times more likely to need ICU admission than women, even though both the genders are equally likely to get the disease.

NatThe study

To confirm the relation between sex and mortality in patients, the researchers analysed about 107 different reports collected from all over the world with data from 1 January to 1 June, 2020.

Here is what was found:

• About 90 reports recorded the number of people infected and sorted them by gender. As per these reports, more than 1.56 million women and almost 1.53 million men got the disease during the designated period.
• Around eight reports also noted ITU (intensive treatment unit) admissions along with the total positive cases and sorted them all by gender. These reports showed that out of a total of 193,383 women and 148,180 men who tested positive for SARS-CoV-2, 3,670 women and 8,397 men were admitted to the ITU during the studied duration.

Possible causes

In the study, the authors suggest that gender usually influences the outcome of infectious diseases regardless of age. Gender bias with worse outcomes in men has been previously noted in the SARS and MERS (two related es) outbreaks.

Experts suggest that women have comparatively higher CD8+ and CD4+ cells as well as B cells (immune system cells that help protect the body against infections).

Women also produce more interferon (IFN) 1 which is a cytokine that helps fight viruses and is essential to mount a quick response against SARS-CoV-2, the causing virus. The higher concentration of IFN is due to the presence of two X chromosomes in women. Men have one X and one Y chromosome.

A preprint study had indicated that estradiol (a type of estrogen) in women may be responsible for protecting them from the hyperinflammatory response associated with severe .

On the other hand, testosterone, the male sex hormone is found to have a suppressive effect on the immune system. It is also seen to promote cytokine levels and inflammation.

Men also show a decline in B cells with age and their immune system ages quickly, which may be the reason behind the gender-bias seen in mortality.

Apart from these, the study indicated that some socio-cultural and behavioural factors may be responsible for the elevated risk of ITU admission and death in positive men. For example, men have unequal access to healthcare and testing, they are more likely to smoke and less likely to wash their hands after using the restroom.

For more information, read our article on Mild vs severe .

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