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The Sex Difference and Potential Influence Factors In 96,237 Patients With Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis


 Background: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This disease was first identified in December 2019 in Wuhan and has since spread globally, resulting in the ongoing 2019–20 coronavirus pandemic. Numerous studies of the clinical characteristics of patients with SARS-CoV-2 have been reported, yet yielded varying results given the sex difference of prevalence, severity and fatality rate. We conducted a review and meta-analysis of the sex differences of COVID-19, aiming to reveal the epidemiological characteristics and potential influencing factors of COVID-19 and provide reference for the prevention and treatment of patients.Results: By screening 1436 studies, 156 studies including 96237 COVID-19 patients from multiple countries were included. We found out that females account for 0.47 [95% CI (0.45-0.48)] of the diagnosed COVID-19 cases, while males for 0.53 of the cases [95% CI (0.52-0.55)]. Females admitted into intensive care unit (ICU) or with severe/critical illness were also analyzed, and the ratio was 0.14 [95% CI (0.11-0.17)] among all the severely/critically ill patients, which was almost twice lower than the ratio of males (0.24 [95% CI (0.19-0.29)]). The fatality rate of female patients was 0.10 [95%CI (0.05-0.17)], which was much lower than that of males (0.18[95%CI (0.11-0.29)]).Conclusions: There exists a significantly different clinical outcome between male and female COVID-19 patients. Females are less severely affected, which might be associated with the sex-based difference in immune response, female hormones and behaviors. However, more specific studies are needed to identify more relevant factors.