Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission
Open accessAbstract
Anecdotal evidence suggests that Coronavirus disease 2019 (COVID-19), caused by the coronavirus SARS-CoV-2, exhibits differences in morbidity and mortality between sexes. Here, we present a meta-analysis of 3,111,714 reported global cases to demonstrate that, whilst there is no difference in the proportion of males and females with confirmed COVID-19, male patients have almost three times the odds of requiring intensive treatment unit (ITU) admission (OR = 2.84; 95% CI = 2.06, 3.92) and higher odds of death (OR = 1.39; 95% CI = 1.31, 1.47) compared to females. With few exceptions, the sex bias observed in COVID-19 is a worldwide phenomenon. An appreciation of how sex is influencing COVID-19 outcomes will have important implications for clinical management and mitigation strategies for this disease.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Two large studies detected no sex difference in PCR positivity for SARS-CoV-2, although men had higher rates of hospitalization, ICU admission, and mortality.
“Two large studies of 3 000 000 and 200 000 patients, respectively, detected no sex difference in whether patients tested PCR positive for SARS-CoV-2, although men had higher rates of hospitalization, intensive care unit admission, and mortality. 13,119”
From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [119]
The Source selection and inclusion section reports that, among 3,111,714 confirmed cases, the proportions of male and female cases did not differ; men had higher odds of ITU admission and death. It does not report PCR positivity rates among people tested or a higher hospitalization rate. The separate 200,000-patient study is not a finding of this source. (LLM, conf=0.88)
Experimental — accuracy not yet measuredOverall COVID-19 death toll is higher among men than women.
“the overall death toll of COVID-19 is higher among men than women”
From The Lancet Commission on lessons for the future from the COVID-19 pandemic (2022) · cites this paper as [289]
Male gender is a risk factor for severe COVID-19.
“(male gender being a risk factor for severe COVID-192,33)”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Part of this paper’s reference list could not be split into single entries.
Yang, X., Yu, Y., Xu, J., Shu, H., Xia, J., Liu, H., Wu, Y., Zhang, L., Yu, Z., Fang, M., et al. (2020) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(20)30079-5 · Cited by 10,066 · see citing works
Richardson, S., Hirsch, J. S., Narasimhan, M., Crawford, J. M., McGinn, T., Davidson, K. W., and the Northwell COVID-19 Research Consortium, Barnaby, D. P., Becker, L. B., Chelico, J. D., et al. (2020) · JAMA · doi:10.1001/jama.2020.6775 · Cited by 9,254 · see citing works
Sex differences in immune responses
Klein, S. L., & Flanagan, K. L. (2016) · Nature Reviews Immunology · doi:10.1038/nri.2016.90 · Cited by 6,370 · see citing works
How to perform a meta-analysis with R: a practical tutorial
Balduzzi, S., Rücker, G., & Schwarzer, G. (2019) · Evidence Based Mental Health · doi:10.1136/ebmental-2019-300117 · Cited by 5,827 · see citing works
Wan, Y., Shang, J., Graham, R., Baric, R. S., & Li, F. (2020) · Journal of Virology · doi:10.1128/jvi.00127-20 · Cited by 4,341 · see citing works
Single-cell RNA expression profiling of ACE2, the receptor of SARS-CoV-2
Zhao, Y., Zhao, Z., Wang, Y., Zhou, Y., Ma, Y., & Zuo, W. (2020) · doi:10.1101/2020.01.26.919985 · Cited by 860 · see citing works
Sexual-dimorphism in human immune system aging
Márquez, E. J., Chung, C.-H., Marches, R., Rossi, R. J., Nehar-Belaid, D., Eroglu, A., Mellert, D. J., Kuchel, G. A., Banchereau, J., & Ucar, D. (2020) · Nature Communications · doi:10.1038/s41467-020-14396-9 · Cited by 584 · see citing works
Sex and gender differences in health: Science & Society Series on Sex and Science
Regitz‐Zagrosek, V. (2012) · The EMBO Reports · doi:10.1038/embor.2012.87 · Cited by 572 · see citing works
Sex and Gender Differences in the Outcomes of Vaccination over the Life Course
Flanagan, K. L., Fink, A. L., Plebanski, M., & Klein, S. L. (2017) · Annual Review of Cell and Developmental Biology · doi:10.1146/annurev-cellbio-100616-060718 · Cited by 508 · see citing works
Kragholm, K. H., Andersen, M. P., Gerds, T. A., Butt, J. H., Østergaard, L., Polcwiartek, C., Phelps, M. D., Andersson, C., Gislason, G., Torp-Pedersen, C. T., et al. (2020) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa924 · Cited by 149 · see citing works
Flagged first, then by citations
Research works printed but not linked: 5
- Singh, S., Chowdhry, M., Chatterjee, A. & Khan, A. Gender-Based Disparities in COVID-19: Clinical Characteristics and Propensity-matched Analysis of Outcomes. medRxiv https://doi.org/10.1101/2020.04.24.20079046 (2020). · DOI
- Jin, J.-M. et al. Gender Differences in Patients With COVID-19: Focus on Severity and Mortality. Front. Public Heal. 8, 152 (2020).
- Sante Publique France. COVID-19: point épidémiologique du 15 mars 2020. https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-et- infections-respiratoires/infection-a-coronavirus/documents/bulletin-national/ covid-19-point-epidemiologique-du-15-mars-2020 (2020).
- RIVM Nederlands. Epidemiologische situatie COVID-19 in Nederland Rijksinstituut voor Volksgezondheid en Milieu -RIVM 26 mei 2020, 10:00. https://www.rivm.nl/coronavirus-covid-19/grafieken (2020).
- Sawyer, C. C. Child mortality estimation: estimating sex differences in childhood mortality since the 1970s. PLoS Med. 9, e1001287 (2012). 100.
Cited by
Sorted by citations
The Lancet Commission on lessons for the future from the COVID-19 pandemic
Sachs, J. D., Karim, S. S. A., Aknin, L., Allen, J., Brosbøl, K., Colombo, F., Barron, G. C., Espinosa, M. F., Gaspar, V., Gaviria, A., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(22)01585-9 · Cited by 842 · see citing works
Islam, N., Shkolnikov, V. M., Acosta, R. J., Klimkin, I., Kawachi, I., Irizarry, R. A., Alicandro, G., Khunti, K., Yates, T., Jdanov, D. A., et al. (2021) · BMJ · doi:10.1136/bmj.n1137 · Cited by 468 · see citing works
COVID-19, Myocarditis and Pericarditis
Fairweather, D., Beetler, D. J., Di Florio, D. N., Musigk, N., Heidecker, B., & Cooper, L. T. (2023) · Circulation Research · doi:10.1161/circresaha.123.321878 · Cited by 181 · see citing works
Pandemics and maternal health: the indirect effects of COVID‐19
Lucas, D. N., & Bamber, J. H. (2021) · Anaesthesia · doi:10.1111/anae.15408 · Cited by 73 · see citing works
Scully, E. P., Schumock, G., Fu, M., Massaccesi, G., Muschelli, J., Betz, J., Klein, E. Y., West, N. E., Robinson, M., Garibaldi, B. T., et al. (2021) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofab448 · Cited by 73 · see citing works
Infectious SARS-CoV-2 Is Emitted in Aerosol Particles
Hawks, S. A., Prussin, A. J., Kuchinsky, S. C., Pan, J., Marr, L. C., & Duggal, N. K. (2021) · mBio · doi:10.1128/mbio.02527-21 · Cited by 57 · see citing works
Long-term consequences in critically ill COVID-19 patients: a prospective cohort study
Schandl, A., Hedman, A., Lyngå, P., Fathi Tachinabad, S., Svefors, J., Roël, M., Geborek, A., Andersson Franko, M., Söderberg, M., Joelsson‐Alm, E., et al. (2021) · Acta Anaesthesiologica Scandinavica · doi:10.1111/aas.13939 · Cited by 50 · see citing works
Iron status and the risk of sepsis and severe COVID-19: a two-sample Mendelian randomization study
Mohus, R. M., Flatby, H., Liyanarachi, K. V., DeWan, A. T., Solligård, E., Damås, J. K., Åsvold, B. O., Gustad, L. T., & Rogne, T. (2022) · Scientific Reports · doi:10.1038/s41598-022-20679-6 · Cited by 28 · see citing works
Lobo, S. M., Plantefève, G., Nair, G., Joaquim Cavalcante, A., Franzin de Moraes, N., Nunes, E., Barnum, O., Berdun Stadnik, C. M., Lima, M. P., Lins, M., et al. (2024) · eClinicalMedicine · doi:10.1016/j.eclinm.2023.102383 · Cited by 27 · see citing works
Gender and sex bias in COVID-19 epidemiological data through the lens of causality
Díaz-Rodríguez, N., Binkytė, R., Bakkali, W., Bookseller, S., Tubaro, P., Bacevičius, A., Zhioua, S., & Chatila, R. (2023) · Information Processing & Management · doi:10.1016/j.ipm.2023.103276 · Cited by 15 · see citing works
Rajan, S., Zaccaria, S., Cannon, M. V., Cam, M., Gross, A. C., Raphael, B. J., & Roberts, R. D. (2021) · doi:10.1101/2021.08.30.458268 · Cited by 33 · see citing works
- Authors
- Peckham, H., de Gruijter, N. M., Raine, C., Radziszewska, A., Ciurtin, C., Wedderburn, L. R., Rosser, E. C., Webb, K., & Deakin, C. T.
- Affiliations
- Great Ormond Street Hospital (GB)
- University College London (GB)
- University of Cape Town (ZA)
- Corresponding author
- Webb, Kate
- Deakin, Claire T.
- ORCID
- Venue
- Nature Communications
- Published
- 2020-12-09
- Volume
- 11
- Issue
- 1
- Pages
- 6317-6317
- ISSN
- 2041-1723 (ISSN-L)
- PMC
- PMC7726563
- OpenAlex
- W3110738325
- Cited by
- 1,503
- References
- 10
- Citations by year
- 2026: 68 · 2025: 89 · 2024: 150 · 2023: 307 · 2022: 474 · 2021: 407 · 2020: 5 · 2018: 2
- FWCI
- 14.11
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Nature Communications (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- The Francis Crick Institute (cc-by)
- Funders
- Francis Crick Institute (10647)
- National Institute for Health and Care Research (NF-SI-0616-10099)
- University College London (21593)
- Versus Arthritis (21593, 22203, MR/R013926/1)
- Medical Research Council (MR/R013926/1, MRF-057-0001-RG-ROSS-C0797, MR/M004600/1)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Keywords
- COVID-19 pandemic, SARS-CoV-2, sex differences, sex bias, mortality, intensive care unit admission, sex as risk factor, sex differences in morbidity
- MeSH terms
- COVID-19, SARS-CoV-2, Female, Humans, Intensive Care Units, Male, Mortality, Risk Factors, Sex Factors, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
