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Original research
Sex difference in coronavirus disease (COVID-19): a systematic review and meta-analysis
  1. Biruk Beletew Abate1,
  2. Ayelign Mengesha Kassie1,
  3. Mesfin Wudu Kassaw1,
  4. Teshome Gebremeskel Aragie1,
  5. Setamlak Adane Masresha2
  1. 1Nursing, Woldia University, Woldia, Amhara, Ethiopia
  2. 2College of Health Sciences, Department of Public Health, Woldia University, Woldia, Amhara, Ethiopia
  1. Correspondence to Dr Biruk Beletew Abate; birukkelemb{at}


Objective To assess the sex difference in the prevalence of COVID-19 confirmed cases.

Design Systematic review and meta-analysis.

Setting PubMed, Cochrane Library and Google Scholar were searched for related information. The authors developed a data extraction form on an Excel sheet and the following data from eligible studies were extracted: author, country, sample size, number of female patients and number of male patients. Using STATA V.14 for analysis, the authors pooled the overall prevalence of men and/or women using a random-effect meta-analysis model. The authors examined the heterogeneity in effect size using Q statistics and I2 statistics. Subgroup and sensitivity analyses were performed. Publication bias was also checked.

Participants Studies on COVID-19 confirmed cases were included.

Intervention Sex (male/female) of COVID-19 confirmed cases was considered.

Primary and secondary outcome measures The primary outcome was prevalence of COVID-19 among men and women.

Results A total of 57 studies with 221 195 participants were used in the analysis. The pooled prevalence of COVID-19 among men was found to be 55.00 (51.43–56.58, I2=99.5%, p<0.001). Sensitivity analysis showed the findings were not dependent on a single study. Moreover, a funnel plot showed symmetrical distribution. Egger’s regression test p value was not significant, which indicates absence of publication bias in both outcomes.

Conclusions The prevalence of symptomatic COVID-19 was found to be higher in men than in women. The high prevalence of smoking and alcohol consumption contributed to the high prevalence of COVID-19 among men. Additional studies on the discrepancies in severity and mortality rate due to COVID-19 among men and women and the associated factors are recommended.

  • infectious diseases
  • epidemiology
  • immunology

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  • Contributors BBA, AMK, MKW and TGA: developed the study design and protocol, literature review, selection of studies, quality assessment, data extraction, statistical analysis, interpretation of data, development of the initial drafts of the manuscript and prepared the final draft of the manuscript. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. The data sets analysed in the current study are available from the corresponding author upon reasonable request.