Sex-Based Differences in Severe Outcomes, Including Cardiovascular Hospitalization, in Adults With COVID-19 in Ontario, Canada.

While men have experienced higher risks of SARS-CoV-2 infection compared to women, an analysis of sex differences by age in severe outcomes during the acute phase of infection is lacking. The purpose of this study was to assess heterogeneity in severe outcome risks by age and sex by conducting a retrospective cohort study of community-dwelling adults in Ontario who tested positive for SARS-CoV-2 infection during the first 3 waves. Adjusted odds ratios were estimated using multilevel multivariable logistic regression models including an interaction term for age and sex. The primary outcome was a composite of severe outcomes (hospitalization for a cardiovascular (CV) event, intensive care unit admission, mechanical ventilation, or death) within 30 days. Among 30,736, 199,132, and 186,131 adults who tested positive during the first 3 waves, 1,908 (6.2%), 5,437 (2.7%), and 5,653 (3.0%) experienced a severe outcome within 30 days. For all outcomes, the sex-specific risk depended on age (all To mitigate risks in subsequent waves, it is helpful to further understand the factors that contribute to the generally higher risks faced by men across all ages, and the persistent or increasing sex disparity in the risk of CV hospitalization.

© 2023 The Authors.

All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Ms Behrouzi has received research grant support to her institutions from Boehringer Ingelheim, Lilly, and Sanofi-Aventis, outside the submitted work. Dr Farkouh has received research grants from Amgen, Novartis, and Novo Nordisk, outside the submitted work. Dr Goodman reports research grant support (eg, steering committee or data and safety monitoring committee) and/or speaker/consulting honoraria (eg, advisory boards) from: Amgen, Anthos Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CSL Behring, Daiichi-Sankyo/American Regent, Eli Lilly, Esperion, Ferring Pharmaceuticals, HLS Therapeutics, JAMP Pharma, Merck, Novartis, Novo Nordisk A/C, Pendopharm/Pharmascience, Pfizer, Regeneron, Sanofi, Servier, Tolmar Pharmaceuticals, Valeo Pharma; and salary support/honoraria from the Heart and Stroke Foundation of Ontario/University of Toronto (Polo) Chair, Canadian Heart Failure Society, Canadian Heart Research Centre and MD Primer, Canadian VIGOUR Centre, Cleveland Clinic Coordinating Centre for Clinical Research, Duke Clinical Research Institute, New York University Clinical Coordinating Centre, PERFUSE Research Institute, TIMI Study Group (Brigham Health). Dr Udell has received research grant support to his institutions from AstraZeneca, Novartis, and Sanofi; reported service as a consultant for Amgen, Boehringer Ingelheim, Janssen, Merck, Novartis, Novavax, and Sanofi; and received honoraria from Boehringer Ingelheim and Janssen outside the submitted work. No other disclosures were reported. This study received funding from a 10.13039/501100000024Canadian Institutes for Health Research (CIHR) Strategy for Patient-Oriented Research Innovative Clinical Trial Multi-year grant (MYG-151211), a Ted Rogers Centre for Heart Research Innovation Fund - COVID-19 Award, and in part by the Peter Munk Cardiac Centre Innovation Fund. Ms Behrouzi is supported by a 10.13039/501100000024CIHR Canada Graduate Scholarship – Doctoral (CGS D) award, a 10.13039/501100003579University of Toronto MD/PhD studentship, and a Ted Rogers Centre for Heart Research Doctoral Award. Dr Atzema is supported by Mid-Career Investigator Awards from the 10.13039/100004411Heart and Stroke Foundation, Sunnybrook Health Sciences Centre, and 10.13039/100012665ICES. Dr Kapral holds the Lillian Love Chair in Women’s Health from the University Health Network/University of Toronto. Dr Kaul holds a CIHR Sex and Gender Science Chair and a Heart and Stroke Foundation Chair in Cardiovascular Research. Dr Goodman was supported by the 10.13039/100004411Heart and Stroke Foundation of Ontario/10.13039/501100003579University of Toronto Polo Chair. Dr Austin is supported by a Mid-Career Investigator Award from the 10.13039/100004411Heart and Stroke Foundation. Dr McAlister holds the Alberta Health Services Chair in Cardiovascular Outcomes Research. Dr Lee is the Ted Rogers Chair in Heart Function Outcomes, University Health Network, University of Toronto. Dr Udell is supported by a 10.13039/100013873Government of Ontario Early Researcher Award (ER15-11-037), a Clinician Scientist Merit Award, Department of Medicine, University of Toronto, Peter Munk Cardiac Centre, Women’s College Research Institute and Department of Medicine, Women’s College Hospital. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.