Higher premorbid serum testosterone predicts COVID-19-related mortality risk in men. Authors
MBBS Bu B Yeap, Ross J Marriott, Laurens Manning, Girish Dwivedi, Graeme J Hankey, Frederick C W Wu, PhD Jeremy K Nicholson, Kevin Murray
Objective Men are at greater risk from COVID-19 than women. Older, overweight men, and those with type 2 diabetes, have lower testosterone concentrations, and poorer COVID-19-related outcomes. We analysed associations of premorbid serum testosterone concentrations, not confounded by effects of acute SARS-CoV-2 infection, with COVID-19-related mortality risk in men.
Design UK Biobank prospective cohort study of community-dwelling men aged 40-69 years.
Methods
Supplemental data Higher premorbid serum testosterone predicts COVID-19-related mortality risk in men. Authors: Bu B. Yeap, Ross J. Marriott, Laurens Manning, Girish Dwivedi, Graeme J. Hankey, Frederick C.W. Wu, Jeremy K. Nicholson, Kevin Murray
Supplemental Methods
Variables of interest
Social, demographic, and lifestyle variables Educational attainment (qualifications) was categorised as below A-levels (high school), completed A-levels, completed college/university, or completed other professional qualification (not school/college/university). Townsend Deprivation Index scores were grouped into quintile categories, with Quintile 5 being the most disadvantaged. 1 Alcohol consumption was categorised using a simplification of categories used by Topiwala et al.: "low" (<14 units/week) including abstainers and men with safe levels of consumption, consistent with UK guidelines; "medium" (14-<30 units/week); "high" ≥30 units/week (1 unit=8 g pure alcohol). 2, 3 Diet categories were high red meat (beef, lamb and pork >3 times/week), low red meat (≤3/week), no red meat, which is a simplification of Bradbury et al. 4 Ethnicity categories were White or Not white (includes Asian, Black, Chinese, Mixed, Other). Vigorous and moderate physical activity undertaken per week was categorised to World Health Organization recommendations as sufficient: ≥75 minutes vigorous or ≥150 minutes moderate, or equivalent combination; insufficient: less..
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'abstract': '<jats:p><jats:underline>Objective</jats:underline>\n'
'</jats:p>\n'
'<jats:p>Men are at greater risk from COVID-19 than women. Older, overweight men, and those '
'with type 2 diabetes, have lower testosterone concentrations, and poorer COVID-19-related '
'outcomes. We analysed associations of premorbid serum testosterone concentrations, not '
'confounded by effects of acute SARS-CoV-2 infection, with COVID-19-related mortality risk in '
'men.\n'
'</jats:p>\n'
'<jats:p><jats:underline>Design</jats:underline>\n'
'</jats:p>\n'
'<jats:p>UK Biobank prospective cohort study of community-dwelling men aged 40-69 years.\n'
'</jats:p>\n'
'<jats:p><jats:underline>Methods</jats:underline>\n'
'</jats:p>\n'
'<jats:p>Serum total testosterone and sex hormone-binding globulin (SHBG) were measured at '
'baseline (2006-2010). Free testosterone values were calculated (cFT). Incidence of SARS-CoV-2 '
'infections and deaths related to COVID-19 were ascertained from 16 March 2020-31 January '
'2021, and modelled using time-stratified Cox regression.\n'
'</jats:p>\n'
'<jats:p><jats:underline>Results</jats:underline>\n'
'</jats:p>\n'
'<jats:p>In 159,964 men there were 5,558 SARS-CoV-2 infections and 438 COVID-19 deaths. '
'Younger age, higher body mass index, non-white ethnicity, lower educational attainment, and '
'socio-economic deprivation were associated with incidence of SARS-CoV-2 infections, but total '
'testosterone, SHBG, and cFT were not. Adjusting for potential confounders, higher total '
'testosterone was associated with COVID-19-related mortality risk (overall trend P=0.008; '
'hazard ratios, HR [95% confidence intervals] quintile 1, Q1 vs Q5 [reference]: 0.84 '
'[0.65-1.12], Q2:Q5 0.82 [0.63-1.10], Q3:Q5 0.80 [0.66-1.00], Q4:Q5 0.82 [0.75-0.93]). Higher '
'SHBG was also associated with COVID-19 mortality risk (P=0.008), but cFT was not (P=0.248).\n'
'</jats:p>\n'
'<jats:p><jats:underline>Conclusions</jats:underline>\n'
'</jats:p>\n'
'<jats:p>Middle-aged to older men with the highest premorbid serum total testosterone and SHBG '
'concentrations are at greater risk of COVID-19-related mortality. Men could be advised that '
'having relatively high serum testosterone concentrations does not protect against future '
'COVID-19-related mortality. Further investigation of causality and potential underlying '
'mechanisms is warranted.</jats:p>',
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