Men Do Worse With COVID-19 Except When Certain Malignancies Are Present
From almost the beginning of the COVID-19 pandemic, it has been clear that men generally had worse outcomes than women. That has remained the situation in most cases, but the situation appears to be reversed with many types of cancer. Find out what types of cancer lead to much higher case fatality risks for women.
LOS ANGELES – In general, men have fared worse during the COVID-19 pandemic, but a new study suggests that might be reversed when a malignant neoplasm was involved.
The cohort study of 1.6 million hospitalizations with COVID-19 identified in the National Inpatient Sample more types of malignant neoplasm associated with a COVID-19 in-house case fatality risk of greater than 2-fold in the group of female patients. The study conducted from April 1 to Dec. 31, 2020, and published in JAMA Oncology focused on 5 types of cancer:
- anal cancer (23.8%; aOR, 2.94; 95% CI, 1.84-4.69),
- Hodgkin lymphoma (19.5%; aOR, 2.79; 95% CI, 1.90-4.08),
- non-Hodgkin lymphoma (22.4%; aOR, 2.23; 95% CI, 2.02-2.47),
- lung cancer (24.3%; aOR, 2.21; 95% CI, 2.03-2.39), and
- ovarian cancer (19.4%; aOR, 2.15; 95% CI, 1.79-2.59).
Among the group of male patients, Kaposi sarcoma (33.3%; aOR, 2.08; 95% CI, 1.18-3.66) and malignant neoplasm in the small intestine (28.6%; aOR, 2.04; 95% CI, 1.18-3.53) had a greater than 2-fold increased COVID-19 in-hospital case mortality risk.
“The results of this study suggest that the association of a concurrent malignant neoplasm with COVID-19 mortality may be more substantial for women than men,” write the University of Southern California-led researchers. While the characteristics of COVID-19 infection and mortality among patients with a malignant neoplasm have previously been examined, little data are available for gender-specific COVID-19 mortality.”
To remedy that, the study team sought to examine the gender-specific COVID-19 case fatality risks among patients with a malignant neoplasm.
The cohort study used the Healthcare Cost and Utilization Project’s National Inpatient Sample to pinpoint patients with COVID-19 diagnoses and malignant neoplasms. Data analysis was performed from November 2022 to January 2023.
The focus was on the COVID-19 in-hospital case fatality rate, defined as the number of deaths that occurred during index hospital admissions.
For about 1.6 million patients who were admitted to the hospital during the time period with a diagnosis of SARS-CoV-2 infection, the cohort-level COVID-19 in-hospital case fatality rate was 12.9% with a median time to death of 5 days (IQR, 2-11 days). Researchers point out that frequently reported morbidities among the patients with COVID-19 included:
- pneumonia (74.3%),
- respiratory failure (52.9%),
- cardiac arrhythmia or cardiac arrest (29.3%),
- acute kidney injury (28.0%),
- sepsis (24.6%),
- shock (8.6%),
- cerebrovascular accident (5.2%), and
- venous thromboembolism or pulmonary embolism (5.0%).
In a multivariable analysis, both gender (male vs female, 14.5% vs 11.2%; adjusted odds ratio [aOR], 1.28; 95% CI, 1.27-1.30) and malignant neoplasm (17.9% vs 12.7%; aOR, 1.29; 95% CI, 1.27-1.32) were associated with increased COVID-19 in-hospital case fatality risk at the cohort level, the researchers report
“The results of this cohort study confirmed the substantial case fatality rate among patients with COVID-19 in the early pandemic experience in 2020 in the U.S.,” the authors conclude. “While COVID-19 in-hospital case fatality risks were lower among women compared with men, the associations of a concurrent malignant neoplasm with the COVID-19 case fatality were overall more substantial for women than for men.”
Background information in the article points out that scant data on the gender-specific COVID-19–associated mortality among patients with a malignant neoplasm have been available.
“The results of the present study confirmed the substantial case fatality rate among patients with COVID-19 infection in the early period of the pandemic in 2020 in the US. While COVID-19 case fatality risks were lower for women with COVID-19 infection than for men with COVID-19 infection, the associations of a concurrent malignant neoplasm with the case fatality risk were overall more robust for women than for men, and there were more malignant neoplasms that had a case fatality risk of greater than 2-fold (5 vs 2 malignant neoplasms in women and men),” according to the authors.