COVID-19 gender difference pattern in Iranian population compared to the global pattern; a systematic review and meta-analysis

  1. Misagh Rajabinejad
  2. Hossein Asgarian-Omran

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Abstract

The coronavirus disease 2019 (COVID-19) pandemic has highlighted Sex-related immune responses. In this review, gender differences in seroprevalence, severity, mortality, and recovery in the Iranian population were systematically compared to the COVID-19 global pattern. This compressive meta-analysis was conducted on studies published up to April 1, 2021, examining seroprevalence in the general population as well as disease outcomes in hospitalized patients. Data were analyzed based on gender to determine differences between men and women in COVID-19. The PubMed, Scopus, Google Scholar, WOS, medRxiv, and bioRxiv were searched. The odds ratio (OR) was calculated based on the random-effects model, with a corresponding 95% confidence interval (CI), according to the number of participants reported in papers. Subgroup analyses were performed according to the age, antibody isotype, and detection assay. Overall, 61 studies with 225799 males and 237017 females were eligible for meta-analysis. Seroprevalence was 1.13 times higher (95% CI: 1.03, 1.24), mortality was 1.45 times higher (95% CI: 1.19, 1.77), and severity was up to 1.37 times higher (95% CI: 1.13, 1.67) in males than those of females in the general population across the globe. Mortality was higher in Iranian patients up to 26% in men (95% CI: 1.20, 1.33), but no significant difference was observed between disease severity and serum prevalence between men and women. Besides, the rate of recovery was 29% (global pattern) and 21% (Iran pattern) lower in males than in females. The results of subgroup analyses for seroprevalence were not significant for the age, antibody isotype, and detection methods. The results of our meta-analyses showed that the patient mortality and recovery patterns are similar in Iran and other countries in the context of gender differences, and the disease is more fatal in men.

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  1. ScreenIT

    SciScore for 10.1101/2021.05.23.21257692: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    2.2 Inclusion criteria: 2.3 Electronic searches: PubMed (1th April 2021)
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    , Google Scholar (3rd April 2021),
    Google Scholar
    suggested: (Google Scholar, RRID:SCR_008878)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, the information reported in the papers on how and to what extent possible exposure to the virus was very incomplete, and this was one of the major limitations we faced. The results of our pooled analysis showed that there was a significant difference in seroprevalence rate between males and females which males 13% more likely to be seropositive than females in the general population. Although the results of the meta-analysis were not significant for seroprevalence among the Iranian population, it did not seem to follow the global pattern and the prevalence of anti-COVID-19 Ab was higher in women (7%). Of course, this difference can be due to the variations in the number of articles included for the analysis. There was no significant difference in subgroup analyses based on age, antibody isotype, and detection assays. The difference between male and female seroprevalence in the global pattern can be due to several reasons. First, males may be more exposed to COVID-19 than women and may use less PPE (15, 16). Second, based on the previous knowledge about stronger immune responses in females, perhaps the reason for the lower seroprevalence in them is the stronger innate immune response including type 1 interferon at the onset of the disease (17-19). Although, the results obtained from analyses in Iranian population showed that this pattern is not similar in all countries and regions. Besides, no significant difference was observed in seroprevalence analyses based on age...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2021.05.23.21257692v1 on medRxiv