Covid-19 and Gender: Lower Rate but Same Mortality of Severe Disease in Women

An Observational Study

Federico Raimondi; Luca Novelli; Arianna Ghirardi; Filippo Maria Russo; Dario Pellegrini; Roberta Biza; Roberta Trapasso; Lisa Giuliani; Marisa Anelli; Mariangela Amoroso; Chiara Allegri; Gianluca Imeri; Claudia Sanfilippo; Sofia Comandini; England Hila; Leonardo Manesso; Lucia Gandini; Pietro Mandelli; Martina Monti; Mauro Gori; Michele Senni; Ferdinando Luca Lorini; Marco Rizzi; Tiziano Barbuil Laura Paris; Alessandro Rambaldi; Roberto Cosentini; Giulio Guagliumi; Simonetta Cesa; Michele Colledan; Maria Sessa; Arianna Masciulli; Antonello Gavazzi; Sabrina Buoro; Giuseppe Remuzzi; Piero Ruggenenti; Annapaola Callegaro; Andrea Gianatti; Claudio Farina; Antonio Bellasi; Sandro Sironi; Stefano Fagiuoli; Fabiano Di Marco


BMC Pulm Med. 2021;21(96) 

In This Article

Abstract and Introduction


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.