Women who were taking hormone replacement therapy (HRT) for at least 6 months before COVID-19 infection had a 22% reduced risk of mortality.
The ongoing pandemic has proven that all people are equally susceptible to contracting COVID-19. Interestingly, however, men tend to have more severe disease, with higher rates of hospitalization and death. Women who are younger or have higher estrogen levels are less likely to experience severe COVID-19.
One study, published in Family Practice, noted women’s greater immune response to viral infection. The investigators explored the association between hormone replacement therapy (HRT) or combined oral contraceptive pill (COCP) usage and the likelihood of death in women with COVID-19.
The retrospective cohort study utilized computerized medical records, collected from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Center (RSC) primary care database. The final cohort included 1863478 adult women (18 years and older) from 465 general medical practices across rural and urban England. The women had 1 or more HRT or COCP prescriptions within 6 months before COVID-19 infection.
Using mixed-effects logistics regression models, the investigators quantified the association between HRT or COCP use and all-cause mortality among women with confirmed or suspected COVID-19 infection. Confirmed cases were defined by a positive RT-PCR test via a nasal or pharyngeal swab, while suspected cases were diagnosed radiologically or clinically (based upon Public Health England’s recommendations).
The average age of the cohort was 59.0 years, and self-reported ethnicity was 64.8% white. Of the 1863478 women in the study, 5451 contracted COVID-19. HRT use was associated with a 22% reduction in all-cause mortality in COVID-19. There were no reported all-cause mortalities in women prescribed COCPs, preventing assessment of the impact of birth control on COVID-19 mortality risk reduction.
The risk of all-cause mortality was higher in COVID-19 among women who were older, underweight, from larger households, with hypertension, or on immunosuppressants. Notably, however, women with asthma and on HRT had a significantly lower risk of mortality (58% risk reduction).
“We hope that this study can provide reassurance to patients and clinicians that there is no indication to stop hormone replacement therapy because of the pandemic,” said Christopher R. Wilcox, an author of the study.
The investigators recommended further study into the association between combined oral contraceptive pills and COVID-19 mortality with a larger cohort. They suggested more research to support their hypothesis that oestrogens may protect against severe or fatal COVID-19.