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

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.