Mortality Rate for COVID-19 Patients With a Malignant Neoplasm May Be Higher in Women Than Men

Of the 1.6 million patients in the study who were admitted in the hospital from April to December 2020 with COVID-19, 76,655 had a diagnosis of a malignant neoplasm.

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It’s been previously examined that male patients with COVID-19 are more likely to die than female patients. However, based on results from a recent study, the association of a concurrent malignant neoplasm with COVID-19 deaths may be more substantial for women than men.

In a cohort study published in JAMA Oncology, researchers wanted to examine the gender-specific COVID-19 case fatality risks among patients with a malignant neoplasm during hospital admissions as there is little data available for gender-specific COVID-19 mortality.

Using the Healthcare Cost and Utilization Project’s National Inpatient Sample, patients admitted to participating hospitals across 48 states and the District of Columbia from April 1 to December 31, 2020 with COVID-19, were identified by the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code U07.1.

With the information, a data analysis was performed from November 2022 to January 2023.

Reviewed at admission were age, gender, race, number of times admitted that year, household income, patient location, Charlson Comorbidity Index Score, tobacco use, hospital relative bed capacity, hospital location and teaching status (rural, urban non-teaching or urban teaching) and hospital region.

Of the more than 21 million patients admitted during the 9 months of the study period, there were roughly 1.6 million who were admitted to the hospital with a COVID-19 diagnosis.

The COVID-19 in-hospital case fatality rate was 12.9% with a median time to death of 5 days. Frequently reported illnesses among COVID-19 patients included pneumonia (74.3%), respiratory failure (52.9%), cardiac arrythmia or cardiac arrest (29.3%), acute kidney injury (28.0%), sepsis (24.6%), shock (8.6%), cerebrovascular accident (5.2%), and venous thromboembolism or pulmonary embolism (5.0%).

Of the 1.6 million patients admitted with COVID-19, 76,655 had a diagnosis of a malignant neoplasm. Among the group of female patients, there were 5 malignant neoplasms in which the COVID-19 in-hospital case fatality risk was greater than 2-fold higher. These included anal cancer, Hodgkin lymphoma, non-Hodgkin lymphoma, lung cancer and ovarian cancer. Among the group of male patients, Kaposi sarcoma and malignant neoplasm in the small intestine had a greater than 2-fold increased COVID-19 in-hospital case mortality risk.

Cases with multiple diagnoses of malignant neoplasm that were classified as other type were not considered in the analysis.

While COVID-19 case fatality risks were lower for women with COVID-19 infection than for men with COVID-19 infection, the associations of a concurrent malignant neoplasm with the case fatality risk were overall more common for women than for men.

Limitations in this study included lack of information on the malignant neoplasms, for example,disease status and type of anticancer therapy; the COVID-19 treatment and the cause of death outside of COVID. This study examined only in-hospital COVID-19 cases, and mortality events after hospital discharge or in a nonhospital setting were not examined.