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Mortality in COVID-19 among women on hormone replacement therapy: a retrospective cohort study

Mortality in COVID-19 among women on hormone replacement therapy: a retrospective cohort study
Mortality in COVID-19 among women on hormone replacement therapy: a retrospective cohort study

Background: limited recent observational data have suggested that there may be a protective effect of oestrogen on the severity of COVID-19 disease. Our aim was to investigate the association between hormone replacement therapy (HRT) or combined oral contraceptive pill (COCP) use and the likelihood of death in women with COVID-19.

Methods: we undertook a retrospective cohort study using routinely collected computerized medical records from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care database. We identified a cohort of 1,863,478 women over 18 years of age from 465 general practices in England. Mixed-effects logistic regression models were used to quantify the association between HRT or COCP use and all-cause mortality among women diagnosed with confirmed or suspected COVID-19 in unadjusted and adjusted models.

Results: there were 5,451 COVID-19 cases within the cohort. HRT was associated with a reduction in all-cause mortality in COVID-19 (adjusted OR 0.22, 95% CI 0.05 to 0.94). There were no reported events for all-cause mortality in women prescribed COCPs. This prevented further examination of the impact of COCP.

Conclusions: we found that HRT prescription within 6 months of a recorded diagnosis of COVID-19 infection was associated with a reduction in all-cause mortality. Further work is needed in larger cohorts to examine the association of COCP in COVID-19, and to further investigate the hypothesis that oestrogens may contribute a protective effect against COVID-19 severity.

COVID-19, HRT, combined oral contraceptive pill, mortality
0263-2136
Dambha-Miller, Hajira
58961db5-31aa-460e-9394-08590c4b7ba1
Hinton, William
eed793d9-865a-41f0-8cad-72cfbddc828b
Wilcox, Christopher R
e2c4c36a-e2e5-43a5-9fd6-7198cc15dd53
Joy, Mark
4f3aea70-fa22-40a5-ae01-542f8b80cbec
Feher, Michael
4704c5d5-a6fe-41bb-9bc7-2f290c7b909f
Lusignan, Simon de
d3a4897a-91dd-4880-b273-f92c2fe6c42f
Dambha-Miller, Hajira
58961db5-31aa-460e-9394-08590c4b7ba1
Hinton, William
eed793d9-865a-41f0-8cad-72cfbddc828b
Wilcox, Christopher R
e2c4c36a-e2e5-43a5-9fd6-7198cc15dd53
Joy, Mark
4f3aea70-fa22-40a5-ae01-542f8b80cbec
Feher, Michael
4704c5d5-a6fe-41bb-9bc7-2f290c7b909f
Lusignan, Simon de
d3a4897a-91dd-4880-b273-f92c2fe6c42f

Dambha-Miller, Hajira, Hinton, William, Wilcox, Christopher R, Joy, Mark, Feher, Michael and Lusignan, Simon de (2022) Mortality in COVID-19 among women on hormone replacement therapy: a retrospective cohort study. Family Practice. (doi:10.1093/fampra/cmac041).

Record type: Article

Abstract

Background: limited recent observational data have suggested that there may be a protective effect of oestrogen on the severity of COVID-19 disease. Our aim was to investigate the association between hormone replacement therapy (HRT) or combined oral contraceptive pill (COCP) use and the likelihood of death in women with COVID-19.

Methods: we undertook a retrospective cohort study using routinely collected computerized medical records from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care database. We identified a cohort of 1,863,478 women over 18 years of age from 465 general practices in England. Mixed-effects logistic regression models were used to quantify the association between HRT or COCP use and all-cause mortality among women diagnosed with confirmed or suspected COVID-19 in unadjusted and adjusted models.

Results: there were 5,451 COVID-19 cases within the cohort. HRT was associated with a reduction in all-cause mortality in COVID-19 (adjusted OR 0.22, 95% CI 0.05 to 0.94). There were no reported events for all-cause mortality in women prescribed COCPs. This prevented further examination of the impact of COCP.

Conclusions: we found that HRT prescription within 6 months of a recorded diagnosis of COVID-19 infection was associated with a reduction in all-cause mortality. Further work is needed in larger cohorts to examine the association of COCP in COVID-19, and to further investigate the hypothesis that oestrogens may contribute a protective effect against COVID-19 severity.

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More information

e-pub ahead of print date: 17 May 2022
Published date: 17 May 2022
Keywords: COVID-19, HRT, combined oral contraceptive pill, mortality

Identifiers

Local EPrints ID: 469532
URI: http://eprints.soton.ac.uk/id/eprint/469532
ISSN: 0263-2136
PURE UUID: 092bc216-5545-44b2-acc4-e132212eb4c4
ORCID for Hajira Dambha-Miller: ORCID iD orcid.org/0000-0003-0175-443X

Catalogue record

Date deposited: 16 Sep 2022 16:50
Last modified: 17 Sep 2022 01:58

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Contributors

Author: William Hinton
Author: Mark Joy
Author: Michael Feher
Author: Simon de Lusignan

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