Virginia V Ferretti1, Catherine Klersy1, Raffele Bruno2, Sara Cutti3, Rossella E Nappi4. 1. Unit of Clinical Epidemiology & Biostatistic, Foundation IRCCS San Matteo Hospital, Pavia 27100, Italy. 2. Division of Infectious Diseases, Foundation IRCCS San Matteo Hospital, Italy; Department of Clinical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia 27100, Italy. 3. Medical Direction, Foundation IRCCS San Matteo Hospital, Pavia 27100, Italy. 4. Department of Clinical, Surgical, Diagnostic and Pediatric Science, University of Pavia, Pavia 27100, Italy; Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Obstetrics and Gynecology Unit, Foundation IRCCS San Matteo Hospital, Pavia 27100, Italy. Electronic address: renappi@tin.it.
Dear Editor,We read with interest the brief commentary by Rossato et al. [1]. They reported a comparison of the fatality rate according to gender and age groups from data released by the Italian National Institute of Health on SARS-CoV-2 cases. At variance with our short report (a higher mortality in men with respect to women only after the age of 65 years) [2], they found a higher fatality rate in men than in women also in patients aged 20–49 years (OR 2.21, 95 % CI 1.93–2.54, P < 0.0001) [1]. Unfortunately, we still do not have access to the full original article ([3], in press) and we did not find the specific source data they mention [4]. In any case, we are aware that our results are at variance with the literature from population-based registries. For instance, Green et al. [5] analysed data from internet and national health ministry sites for data on COVID-19 cases and deaths and found a higher case fatality rate (CFR) in males than females in all age groups (with CFR ratios ranging from 1.71 to 2.11 in those aged ≤59 years).However, our data, derived from a registry of hospitalized patients in the first and second waves, might lack the power to show a difference in the 18–49 age group due to the very low numbers of both hospitalizations and observed deaths in this category (4/120 in females and 3/118 in males). It is also relevant to mention that young patients were hospitalized only with very severe disease, possibly obscuring the gender effect. Moreover, our data are in agreement with those reported by Raimondi et al. [6] in a similar setting. They analysed COVID-19 patients hospitalized in Bergamo (Italy) and obtained similar mortality rates in males and females in the younger age group (only 2/32 in females and 7/77 in males among those aged ≤59 years).Anyway, we agree with Rossato et al. that a different population setting may underlie the discrepancy between their results and our analysis, which, in any case, we conducted with the aim of exploring different age groups using a cut-off of 50 years as a crude proxy for menopausal status.
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Declaration of competing interest
The authors declare that they have no competing interest in relation to this letter.