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Clinical outcomes of coronavirus disease COVID differ substantially between women and men, with men facing an increased risk of critical illness and death. Besides differences in age and prevalence of comorbidities, biological sex differences in immune responses, expression levels of virus entry receptors, endocrinological mechanisms as well as gender-related factors have been suggested to account for the differential outcomes in women and men [ 1 , 2 ].
However, recent research has questioned the major impact of biological sex differences on COVID outcomes [ 3 , 4 ], and it has been hypothesized that non-biological aspects of being male or female e. Gender, measured by a set of prespecified variables, modifies the outcome in acute coronary syndromes [ 5 ], but its role in COVID outcomes has been widely ignored.
We estimated associations between gender sociocultural factors, Supplementary Materials and sex biological factors with disease severity of acute severe acute respiratory syndrome coronavirus SARS-CoV -2 infection in a prospective, observational cohort study of [ Gender-related characteristics were assessed using the short version of a validated questionnaire Supplementary Materials [ 5 ], while clinical data were gathered from electronic medical records.
Multiple logistic regression models with the backward selection method were applied to assess potential predictors of severe illness a detailed description of the statistical approach is provided in Supplementary Materials. In the overall study cohort, male sex odds ratio OR 2. However, once patients were hospitalized, male sex was no longer prognostic for the combined endpoint OR 1.
