Open Access Maced J Med Sci. 2022 Apr 16; 10(E):643-646. 643 Scientifc Foundation SPIROSKI, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2022 Apr 16; 10(E):643-646. https://doi.org/10.3889/oamjms.2022.8709 eISSN: 1857-9655 Category: E - Public Health Section: Public Health Epidemiology Age and Sex Diferences in COVID-19 Clinical Symptom: Analysis of 19,588 Indonesian Cases Liganda Endo Mahata 1,2 * , Mutia Lailani 3 , SM Rezvi 1 , Syandrez Prima Putra 1,4 * , Andani Eka Putra 1,4 1 Center for Diagnostic and Research on Infectious Disease (PDRPI), Faculty of Medicine, Universitas Andalas, Padang, Indonesia; 2 Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Andalas, Padang, Indonesia; 3 Department of Physiology, Faculty of Medicine, Universitas Andalas, Padang, Indonesia; 4 Department of Microbiology, Faculty of Medicine, Universitas Andalas, Padang, Indonesia Abstract BACKGROUND: Asymptomatic COVID-19 cases are potential for SARS-CoV-2 outbreaks source, yet the feasible predictive factors are unclear. AIM: Our study aimed to determine the age and sex diferences in the presence of COVID-19 clinical symptoms at the initial diagnosis. METHODS: We examined the results of individual frst-time quantitative reverse transcription-polymerase chain reaction (q-RT-PCR) of 19,588 COVID-19 positive cases registered at the Center for Diagnostic and Research on Infectious Disease Laboratory (PDRPI Lab), Faculty of Medicine, Universitas Andalas, Padang, Indonesia, from April 2020 to December 2020. Asymptomatic cases were those who had no symptoms at the initial confrmation while symptomatic had. The diferences of age (classifed into fve age groups) and sex (female or male) were evaluated in both cases to see their signifcance. RESULTS: A total of 12,790 (65.30%) of COVID-19 cases were asymptomatic. The COVID-19 patients had average age (mean ± SD) of 37.12 ± 17.22 years old (y.o.). Younger adults (20–39 y.o.; 42.01%; average age (mean ± SD) 29.51 ± 5.52 y.o.) were the most afected, followed by adults (40–59 y.o.; 32.09%; average age (mean ± SD) 49.29 ± 5.63 y.o.), children (≤19 years; 15.30%; average age (mean ± SD) 11.82 ± 5.70 y.o.), older adults (60–79 years; 9.90%; average age (mean ± SD) 65.76 ± 4.86 y.o.), and elderly (≥80 years; 0.71%; average age (mean ± SD) 83.31 ± 3.65 y.o.). Female cases (53.23%; average age (mean ± SD) 34.92 ± 16.57 y.o.) were more prevalent than males (46.77%; average age (mean ± SD) 41.26 ± 17.65 y.o.), with a signifcant mean age diference (P < 0.001). The odds of being asymptomatic were increased in the younger age group (adults OR as the reference; children OR 0.471, 95% CI 0.426–0.519; younger adults OR 0.68, 95% CI 0.639–0.734; older adults OR 1.766, 95% CI 1.594–1.957; and elderly OR 1.981, 95% CI 1.412–2.780; P < 0.001). Females were more likely than males to be asymptomatic (OR 1.105, 95% CI 1.042–1.172). Conclusions: The younger age and the female sex are associated with asymptomatic COVID-19 cases in the earliest molecular diagnosis. Edited by: Slavica Hristomanova-Mitkovska Citation: Mahata LE, Lailani M, Rezvi SM, Putra SP, Putra AE. Age and Sex Diferences in COVID-19 Clinical Symptom: Analysis of 19,588 Indonesian Cases. Open Access Maced J Med Sci. 2022 Apr 16; 10(E):643-646. https://doi.org/10.3889/oamjms.2022.8709 Keywords: COVID-19; Age; Sex; Symptom; Asymptomatic *Correspondence: Liganda Endo Mahata, Department of Pharmacology and Therapeutics, Faculty of Medicine, Universitas Andalas, Padang, Indonesia. E-mail: ligandaendomahata@med.unand.ac.id Received: 22-Jan-2022 Revised: 04-Mar-2022 Accepted: 06-Apr-2022 Copyright: © 2022 Liganda Endo Mahata, Mutia Lailani, SM Rezvi, Syandrez Prima Putra, Andani Eka Putra Funding: The funding was received from Faculty of Medicine, Universitas Andalas, with grant number 678/ UN16.02.D/PP/2021. Competing Interests: The authors have declared that no competing interests exist Open Access: This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial 4.0 International License (CC BY-NC 4.0) Introduction By the beginning of August 2021, the SARS-CoV-2 that led to the coronavirus disease 2019 (COVID-19) had infected 202 million people and killed 4 million (the World Health Organization, 2021a) [16]. At the same time, Indonesia was heavily affected by the virus, with 12.444 new deaths (the World Health Organization, 2021b) [17]. Early detection of an infected individual is the main challenge to control the disease and cut off the viral transmission (Gao et al. , 2021) [4]. To date, COVID- 19 is best diagnosed with SARS-CoV-2 nucleic acid detection by quantitative reverse transcription- polymerase chain reaction (q-RT-PCR) (Banko et al. , 2021) [2]. Targeted q-RT-PCR test in a community should increase the probability of COVID-19 case finding, especially in a prevalent population (Sen- Crowe, McKenney and Elkbuli, 2021) [11]. The COVID-19 clinical manifestations are highly variable from mild to critical. The most predictive symptoms were dyspnea, cough, and fever (Jain and Yuan, 2020) [6]. However, some patients with positive q-RT-PCR confrmation have no typical clinical symptoms or signs. These asymptomatic cases mostly have the potential to be a source of new outbreaks (Teherán et al., 2020; and Ralli et al., 2021) [13]. Therefore, it is essential to fnd other predictive factors that contribute to targeting the asymptomatic COVID- 19 cases. The fnding should help the health workers and policymakers to control viral transmission efciently, especially in limited resources. Several studies have reported age and sex as the predictive factors for incidence, clinical manifestation, and fatality rates of COVID-19 (Ghisolf et al., 2020; Mesas et al., 2020; and O’Brien, Du, and Peng, 2020) [5], [8], [9]. Meanwhile, none of these fndings adequately evaluate the age and sex diferences in