MEN WITH COVID-19 were 1.5 times more likely than women to be hospitalised, admitted to ICU, or die during the first two waves of the pandemic in Ireland.

A new study by UCC and TU Dublin has found that symptomatic Covid-19 cases were somewhat higher among women (53.4%) but men were 1.5 times more likely to be hospitalised, admitted to ICU, or die.

The study, which was published by Nature Scientific Reports, analysed 47,265 cases of symptomatic Covid-19 between 29 February and 30 November 2020.

Of those cases, 3,781 were hospital patients and 615 were admitted to ICU.

1,326 died, including 599 people who had not been hospitalised.

The researchers found that the odds of a case progressing to a severe outcome like hospitalisation, ICU or death typically increased with age, comorbidities (underlying conditions) and deprivation.

“The complete Irish dataset of notified cases of Covid-19 throughout the first two waves of the pandemic was analysed to identify case- and geographically-specific attributes that may serve as predictors for hospitalisation, ICU admission and mortality in patients with laboratory-confirmed, symptomatic Covid-19 infection,” the study outlined.

“Older age, male gender and increased comorbidity number” were found to be “consistently significant factors” for Covid-19 severity.

On the difference in outcome between men and women, the study said that a review of cases in Europe “proposes numerous potential reasons for this relationship, including gender-specific lifestyle, health behaviours, psychological stress, and socioeconomic conditions, in addition to several sex-specific biological mechanisms modulating the course of disease, including hormone-regulated gene expression, innate and adaptive immune responses, and immune-aging”.

It pointed to a recent study in the UK which noted that men had “significantly higher rates of ‘behavioural resistance’ to protection actions, noting that 80% of those fined for breaking lockdown measures were male, potentially resulting in higher levels of viral exposure, transmission and loading among males, in concurrence with the aforementioned biological disparities”.

Overall, 21% of people in the recorded cases had one or more underlying condition, but that proportion increased to 60.4% among hospitalised cases, 78.9% among ICU admissions, and 84.2% among the people who died.

People living in rural areas and social housing were at increased risk of hospitalisation.

However, rural residents were less likely to be admitted to ICU, while people from urban areas were around 1.5 times more likely to require critical care.

“Urban living may be indicative of multiple individual or interacting factors including higher levels of deprivation, higher viral exposures (i.e., close contacts) due to increased household and/or local population density or compounded respiratory illnesses due to lower air quality in urban areas, the study noted.”

The study’s co-principal investigator Dr Jean Dwyer said that tracking the outcomes of people who are infected with the virus is important for supporting future planning of how to handle public health emergencies.

“Monitoring the clinical outcomes of patients diagnosed with Covid-19 is vital to understand the epidemiological and healthcare burden of SARS-CoV-2, to help prioritise high-risk cases in the short term, and perhaps more importantly, provide a robust evidence-base for future public health emergency planning,” Dr Dwyer said.