Sex differences in mortality among patients with COVID-19 related stroke

Introduction: Overall poor COVID-19 outcomes have been reported among males We evaluated sex differences in mortality among patients with stroke related to COVID-19 Methods: Utilizing pooled deidentified data from 30 healthcare organizations, we identified COVID- 19 patients via ICD-10 diagnosis or documented laboratory confirmation of SARS-CoV-2 RNA or antibodies Patients with ICD-10 diagnoses of ischemic stroke or intracerebral hemorrhage within 30 days before or after the COVID-19 event were flagged Male and female patients were propensity score (PS) matched on other demographic and comorbidity variables Risk Ratio (RR) and 95% Confidence Interval (CI) for association between sex and 90-day mortality is reported Kaplan-Meier analyses with log rank test (LRT) were conducted for time-to-death As a sensitivity analysis, we only included a smaller sub-set with first instance of IS or ICH ± 30-days of COVID-19 diagnosis Results: Among 149,410 COVID-19 patients, 1,618 (1 1%) had a stroke diagnosis ± 30-days of confirmed COVID-19 Of whom, 1,609 patients (847 males and 762 females) were included in primary analyses Females were older (67 7 vs 65 7 years) and were more likely to be of black race (34 1% vs 27 6%) Females had a significantly higher proportion of chronic pulmonary disease (38 8% vs 28 8%) and obesity (34 2% vs 24 8%);whereas males had higher proportion of alcohol abuse (8 5% vs 3 8%) A 1:1 PS algorithm yielded an optimally matched sample of 634 males and females each, balanced on all covariates In the matched sample, 11 7% of females and 15 8% of males experienced 90-day mortality;RR (CI): 1 35 (1 02 - 1 78), LRT p value 0 04 Higher risk of 90- day mortality among males with COVID-19 and stroke was maintained in the sensitivity analyses, RR (CI): 1 47 (1 06 - 2 00), LRT p value = 0 03 (graphic) Conclusion: Future studies examining the socio-demographic and biological mechanisms for poor stroke outcomes among males with COVID-19 are needed