OBJECTIVES: The impact of sex-gender in the incidence and severity of COVID-19 remains controversial. The aim of this study was to examine potential sex-gender differences in clinical manifestations (e.g. frequency, severity) and in health outcomes (e.g., hospitalization, mortality) using data from a large US-based COVID-19 Research Database.

METHODS: This is a retrospective cohort study comparing males versus females with COVID-19 diagnosis and outcomes. The study used secondary data, called Healthjump, which were extracted from patients’ medical claims and electronic health records. The Healthjump data comprised all patients in the source population with test-confirmed COVID-19 between January 2020 and December 2021. The study sample included demographics, appointments, encounters, medical history, medications, diagnosis, procedures, social history and vitals.

RESULTS: A total of 108,217 patients with a confirmed diagnosis of COVID-19 were identified. Of these, males (vs. females) were significantly older with higher proportion aged 50-89 years (47.7 vs. 46.0%) and predominantly white (52.7 vs. 51.4%). Though more males were physically active (65.9 vs 59.8%), a higher proportion of males were current or past smokers (10.4 vs. 8.6%) caffeine users (85.4 vs 83.4%) and drug users (5.2 vs. 4.0%) compared to females. Regarding symptoms upon diagnosis, fever, cough and anosmia were significantly less frequent in males than females. Re-hospital resource use, males showed higher proportion of hospitalization (63.0% vs. 45.3%) and ICU admission (6.4% vs. 2.9%) than females. In-hospital mortality were significantly higher in males as compared to females.

CONCLUSIONS: In this analysis of a large US cohort, findings revealed significant sex-gender differences in the diagnosis, hospitalization and mortality of patients with COVID-19. These findings will help inform governments, policy makers and global health institutions to consider seriously the sex and gender effects of COVID-19 outbreak. Further research is encouraged to identify and close the gender gap in the ongoing pandemic.