Associations Between Cancer and COVID-19 Death “More Substantial” in Women

The risk of in-hospital death from COVID-19 for patients with cancer differs by sex and cancer type, according to research published in JAMA Oncology.

Researchers found that, among women, 5 cancers were associated with a more than 2-fold higher risk of in-hospital COVID-19 death. Among men, 2 cancers were associated with a more than 2-fold higher risk of in-hospital COVID-19 death.

This study included data from 1,622,755 patients from the Healthcare Cost and Utilization Project’s National Inpatient Sample. All patients were admitted to the hospital with COVID-19 between April 1, 2020, and December 31, 2020. The primary outcome was in-hospital COVID-19 case fatality rate.

A total of 76,655 patients had cancer (4.7%). In the entire cohort, 51.8% of patients were men, and 48.2% were women. The most common comorbidities were pneumonia (74.3%), respiratory failure (52.9%), cardiac arrhythmia or arrest (29.3%), acute kidney injury (28.0%), and sepsis (24.6%).

The in-hospital COVID-19 case fatality rate for the entire cohort was 12.9%, and the median time to death was 5 days (interquartile range, 2-11 days). 

The in-hospital COVID-19 case fatality rate was higher in patients with cancer than in those without it — 17.9% and 12.7%, respectively (adjusted odds ratio [aOR], 1.29; 95% CI, 1.27-1.32). It was also higher in men than in women — 14.5% and 11.2%, respectively (aOR, 1.28; 95% CI, 1.27-1.30). 

In women and men, there were 13 cancers associated with an increased risk of in-hospital death from COVID-19. Women with 5 cancers — lung cancer, Hodgkin and non-Hodgkin lymphoma, anal cancer, and ovarian cancer — had a more than 2-fold higher risk of in-hospital death from COVID-19. 

Men with 2 cancers — Kaposi sarcoma and malignant neoplasm of the small intestine — had a more than 2-fold higher risk of in-hospital death from COVID-19. More details can be seen in the table below.

Results in Women
Cancer Type	COVID-19 Case Fatality Rate	Adjusted Odds Ratio
Anal cancer	23.8%	2.94 (95% CI, 1.84-4.69)
Hodgkin lymphoma	19.5%	2.79 (95% CI, 1.90-4.08)
Non-Hodgkin lymphoma	22.4%	2.23 (95% CI, 2.02-2.47)
Lung cancer	24.3%	2.21 (95% CI, 2.03-2.39)
Ovarian cancer	19.4%	2.15 (95% CI, 1.79-2.59)
Pancreatic cancer	23.0%	1.94 (95% CI, 1.59-2.37)
Myeloid leukemia	19.4%	1.94 (95% CI, 1.64-2.31)
Multiple myeloma	21.9%	1.63 (95% CI, 1.46-1.82)
Liver cancer	26.2%	1.59 (95% CI, 1.23-2.06)
Rectal cancer	18.9%	1.42 (95% CI, 1.02-1.97)
Colon cancer	17.1%	1.40 (95% CI, 1.20-1.64)
Lymphoid leukemia	16.0%	1.31 (95% CI, 1.17-1.48)
Breast cancer	12.8%	1.19 (95% CI, 1.09-1.30)
Results in Men
Cancer Type	COVID-19 Case Fatality Rate	Adjusted Odds Ratio
Kaposi sarcoma	33.3%	2.08 (95% CI, 1.18-3.66)
Malignant neoplasm in small intestine	28.6%	2.04 (95% CI, 1.18-3.53)
Colon cancer	23.7%	1.94 (95% CI, 1.72-2.19)
Lung cancer	25.9%	1.80 (95% CI, 1.67-1.95)
Esophageal cancer	22.0%	1.56 (95% CI, 1.26-1.94)
Myeloid leukemia	21.4%	1.54 (95% CI, 1.33-1.78)
Pancreatic cancer	22.2%	1.53 (95% CI, 1.24-1.87)
Multiple myeloma	22.9%	1.43 (95% CI, 1.30-1.58)
Oral, lip, and pharynx cancer	16.7%	1.34 (95% CI, 1.02-1.75)
Non-Hodgkin lymphoma	18.9%	1.32 (95% CI, 1.21-1.45)
Bladder cancer	25.1%	1.29 (95% CI, 1.11-1.48)
Liver cancer	25.1%	1.28 (95% CI, 1.11-1.49)
Lymphoid leukemia	17.9%	1.27 (95% CI, 1.17-1.38)

“While COVID-19 in-hospital case fatality risks were lower among women compared with men, the associations of a concurrent malignant neoplasm with the COVID-19 case fatality were overall more substantial for women than for men,” the researchers wrote.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Cancer Therapy Advisor