Dataset Information

Contribution of the elevated thrombosis risk of males to the excess male mortality observed in COVID-19: an observational study.

ABSTRACT:

Background

The mortality rate of COVID-19 is elevated in males compared with females.

Objective

Determine the extent that the elevated thrombotic risk in males relative to females contributes to excess COVID-19 mortality in males.

Design

Observational study.

Setting

Data sourced from electronic medical records from over 200 US hospital systems.

Participants

60 877 patients aged 18 years and older hospitalised with COVID-19.

Exposure

Exposure variable: biological sex; key variable of interest: thrombosis.

Primary outcome measures

Primary outcome was COVID-19 mortality. We measured: (1) mortality rate of males relative to females, (2) rate of thrombotic diagnoses occurring during hospitalisation for COVID-19 in both sexes and (3) mortality rate when evidence of thrombosis was present.

Results

The COVID-19 mortality rate of males was 29.9% higher than that of females. Males had a 35.8% higher rate of receiving a thrombotic diagnosis compared with females. The mortality rate of all patients with a thrombotic diagnosis was 40.0%-over twice that of patients with COVID-19 without a thrombotic diagnosis (adjusted OR 2.50 (2.37 to 2.64), p<0.001). When defining thrombosis as either a documented thrombotic diagnosis or a D-dimer level ≥3.0 µg/mL, 16.4% of the excess mortality in male patients could be explained by increased thrombotic risk.

Conclusions

Our findings suggest the higher COVID-19 mortality rate in males may be significantly accounted for by the elevated risk of thrombosis among males. Understanding the mechanisms that underlie increased male thrombotic risk may allow for the advancement of effective anticoagulation strategies that reduce COVID-19 mortality in males.

SUBMITTER: Cohen KR

PROVIDER: S-EPMC8882638 | biostudies-literature | 2022 Feb

REPOSITORIES: biostudies-literature

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Publications

Contribution of the elevated thrombosis risk of males to the excess male mortality observed in COVID-19: an observational study.

Cohen Kenneth Roy KR Anderson David D Ren Sheng S Cook David J DJ

BMJ open 20220225 2

<h4>Background</h4>The mortality rate of COVID-19 is elevated in males compared with females.<h4>Objective</h4>Determine the extent that the elevated thrombotic risk in males relative to females contributes to excess COVID-19 mortality in males.<h4>Design</h4>Observational study.<h4>Setting</h4>Data sourced from electronic medical records from over 200 US hospital systems.<h4>Participants</h4>60 877 patients aged 18 years and older hospitalised with COVID-19.<h4>Exposure</h4>Exposure variable: b ...[more]

PMID: 35217534

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Project description:We estimated excess mortality in Medicare recipients in the United States with probable and confirmed Covid-19 infections in the general community and amongst residents of long-term care (LTC) facilities. We considered 28,389,098 Medicare and dual-eligible recipients from one year before February 29, 2020 through September 30, 2020, with mortality followed through November 30th, 2020. Probable and confirmed Covid-19 diagnoses, presumably mostly symptomatic, were determined from ICD-10 codes. We developed a Risk Stratification Index (RSI) mortality model which was applied prospectively to establish baseline mortality risk. Excess deaths attributable to Covid-19 were estimated by comparing actual-to-expected deaths based on historical (2017-2019) comparisons and in closely matched concurrent (2020) cohorts with and without Covid-19. Overall, 677,100 (2.4%) beneficiaries had confirmed Covid-19 and 2,917,604 (10.3%) had probable Covid-19. A total of 472,329 confirmed cases were community living and 204,771 were in LTC. Mortality following a probable or confirmed diagnosis in the community increased from an expected incidence of about 4.0% to actual incidence of 7.5%. In long-term care facilities, the corresponding increase was from 20.3% to 24.6%. The absolute increase was therefore similar at 3-4% in the community and in LTC residents. The percentage increase was far greater in the community (89.5%) than among patients in chronic care facilities (21.1%) who had higher baseline risk of mortality. The LTC population without probable or confirmed Covid-19 diagnoses experienced 38,932 excess deaths (34.8%) compared to historical estimates. Limitations in access to Covid-19 testing and disease under-reporting in LTC patients probably were important factors, although social isolation and disruption in usual care presumably also contributed. Remarkably, there were 31,360 (5.4%) fewer deaths than expected in community dwellers without probable or confirmed Covid-19 diagnoses. Disruptions to the healthcare system and avoided medical care were thus apparently offset by other factors, representing overall benefit. The Covid-19 pandemic had marked effects on mortality, but the effects were highly context-dependent.

Dataset Information

Contribution of the elevated thrombosis risk of males to the excess male mortality observed in COVID-19: an observational study.

Background

Objective

Design

Setting

Participants

Exposure

Primary outcome measures

Results

Conclusions

Publications

Contribution of the elevated thrombosis risk of males to the excess male mortality observed in COVID-19: an observational study.

Similar Datasets

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