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Association between pharmaceutical modulation of oestrogen in postmenopausal women in Sweden and death due to COVID-19: a cohort study
Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi. Department of Surgery, Univerisity of Helsinki and Helsinki University Hospital, Helsinki, Finland.ORCID-id: 0000-0002-7516-9543
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi.
Umeå universitet, Medicinska fakulteten, Wallenberg centrum för molekylär medicin vid Umeå universitet (WCMM). Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Urologi och andrologi. Department of Urology, University of Gothenburg, Gothenburg, Sweden.ORCID-id: 0000-0002-2013-0887
Department of Urology, University of Gothenburg, Gothenburg, Sweden.
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2022 (Engelska)Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 12, nr 2, artikel-id e053032Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: Determine whether augmentation of oestrogen in postmenopausal women decreases the risk of death following COVID-19.

DESIGN: Nationwide registry-based study in Sweden based on registries from the Swedish Public Health Agency (all individuals who tested positive for SARS-CoV-2); Statistics Sweden (socioeconomical variables) and the National Board of Health and Welfare (causes of death).

PARTICIPANTS: Postmenopausal women between 50 and 80 years of age with verified COVID-19.

INTERVENTIONS: Pharmaceutical modulation of oestrogen as defined by (1) women with previously diagnosed breast cancer and receiving endocrine therapy (decreased systemic oestrogen levels); (2) women receiving hormone replacement therapy (increased systemic oestrogen levels) and (3) a control group not fulfilling requirements for group 1 or 2 (postmenopausal oestrogen levels). Adjustments were made for potential confounders such as age, annual disposable income (richest group as the reference category), highest level of education (primary, secondary and tertiary (reference)) and the weighted Charlson Comorbidity Index (wCCI). PRIMARY OUTCOME MEASURE: Death following COVID-19.

RESULTS: From a nationwide cohort consisting of 49 853 women diagnosed with COVID-19 between 4 February and 14 September 2020 in Sweden, 16 693 were between 50 and 80 years of age. We included 14 685 women in the study with 11 923 (81%) in the control group, 227 (2%) women in group 1 and 2535 (17%) women in group 2. The unadjusted ORs for death following COVID-19 were 2.35 (95% CI 1.51 to 3.65) for group 1 and 0.45 (0.34 to 0.6) for group 2. Only the adjusted OR for death remained significant for group 2 with OR 0.47 (0.34 to 0.63). Absolute risk of death was 4.6% for the control group vs 10.1% and 2.1%, for the decreased and increased oestrogen groups, respectively. The risk of death due to COVID-19 was significantly associated with: age, OR 1.15 (1.14 to 1.17); annual income, poorest 2.79 (1.96 to 3.97), poor 2.43 (91.71 to 3.46) and middle 1.64 (1.11 to 2.41); and education (primary 1.4 (1.07 to 1.81)) and wCCI 1.13 (1.1 to 1.16).

CONCLUSIONS: Oestrogen supplementation in postmenopausal women is associated with a decreased risk of dying from COVID-19 in this nationwide cohort study. These findings are limited by the retrospective and non-randomised design. Further randomised intervention trials are warranted.

Ort, förlag, år, upplaga, sidor
BMJ Publishing Group Ltd, 2022. Vol. 12, nr 2, artikel-id e053032
Nyckelord [en]
COVID-19, epidemiology, sex steroids & HRT
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
URN: urn:nbn:se:umu:diva-192740DOI: 10.1136/bmjopen-2021-053032ISI: 000755179700010PubMedID: 35165090Scopus ID: 2-s2.0-85124680027OAI: oai:DiVA.org:umu-192740DiVA, id: diva2:1640489
Forskningsfinansiär
Region Västerbotten, RV-836351Knut och Alice Wallenbergs StiftelseTillgänglig från: 2022-02-24 Skapad: 2022-02-24 Senast uppdaterad: 2023-09-05Bibliografiskt granskad

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Sund, MalinFonseca-Rodríguez, OsvaldoJosefsson, AndreasFors Connolly, Anne-Marie

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Sund, MalinFonseca-Rodríguez, OsvaldoJosefsson, AndreasFors Connolly, Anne-Marie
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KirurgiInstitutionen för klinisk mikrobiologiWallenberg centrum för molekylär medicin vid Umeå universitet (WCMM)Urologi och andrologi
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