Age is a well-known factor that influences the severity and fatality of COVID-19.
In addition, male and female patients are known, at least anecdotally, to fare quite differently in the COVID-19 pandemic.
In a new study, researchers found hormone estradiol may play a big role in these age and gender differences in COVID-19 outcomes.
The research was conducted by a team at the University of Virginia and elsewhere.
In the study, the team helped analyze electronic health records of nearly 70,000 COVID-19 patients distributed across 17 countries.
By surveying these records, they found that there are strong trends that track with patient characteristics—chief among these being age, gender, and the (age-dependent) usage of estrogen-related hormones (e.g., in post-menopausal women).
In age groups from about 20 to 50 years old, women have moderately higher rates of COVID-19 infection than men.
In virtually all age ranges, men have higher mortality rates than women, with the effects particularly pronounced beyond age 50 (50% more fatalities among men in their 70s, versus women).
Among post-menopausal women over the age of 50, use of the hormone estradiol was linked with substantially reduced (by more than 50%) rates of death.
The team says the latter point, regarding estradiol, is a key factor that underlies and unifies these observed trends: by considering the microscopic, molecular level—the COVID-related immunological and cellular pathways in which estrogen hormones are likely involved.
In a nutshell, it’s likely that the apparent protective effects of 17β-estradiol, a naturally occurring, abundant female hormone, relate to a key property of this molecule:
It attenuates the so-called “cytokine storm” that’s thought to underlie much of the cellular-scale and organ/tissue-level damage wrought by a SARS-CoV-2 infection, via dysregulation of a patient’s immune response.
The team found hormone therapy was found to have a strong linkage to the severity and fatality of COVID-19 among women over age 50.
This can explain why are men beyond age 50 so much more likely than similarly aged women to suffer from a severe course of COVID-19, including such a greater likelihood of death.
The team says there is a strong positive effect of estradiol hormone therapy on the survival rates of post-menopausal women.
Whether it could be an effective therapeutic approach not only for women but also for men with COVID-19 is a topic for further research.
One author of the study is Phil Bourne, the dean of’s School of Data Science.
The study is published in BMC Medicine.
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