Men with COVID-19 die. Women survive…at any age!

Dear Editor

Ferretti et al. in a recently published retrospective analysis of patients hospitalized for COVID-19 reported a higher mortality in men with respect to women only after the age of 65 years, well beyond the menopause [1].

Epidemiological studies on COVID-19 patients taken as a whole have shown that men are more susceptible than women to hospitalization and severe disease [2], [3]. We have recently analyzed the report of the Italian National Institute of Health on SARS-CoV-2 positive cases considering age, sex and fatality index, reporting that men showed a fatality index significantly higher than that of women (OR 1.38, 95% CI 1.36–1.40, P < 0.0001), without any difference in infection rate [4], [5]. But at variance with the data reported by Ferretti et al. [1], when analyzing the age range 20–49 (a pre-menopausal age range), the fatality rate in men was 2.2 times higher than that of women (OR 2.21, 95% CI 1.93–2.54, P < 0.0001) [4]. Furthermore, while Ferretti et al. reported that women showed a lower fatality rate than men as COVID-19 patient age increased above the average age at menopause, our analysis demonstrated that women's fatality rate for COVID-19 is lower than that of men at any age, although it becomes closer to that of men as age increases [4], [5].

The larger sample in our analysis (more than 2.5 million vs 1764 subjects) and the fact that Ferretti's patients were hospitalized for COVID-19 could explain, at least in part, such contrasting results.

Funding

No funding from an external source supported the publication of this letter.

Declaration of competing interest

The authors declare that they have no competing interest in relation to this letter.