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Background  A case-control study was performed to examine age, gender, and ABO blood groups in 1014 Iraqi hospitalized cases with Coronavirus disease 2019 (COVID-19) and 901 blood donors (control group). The infection was molecularly diagnosed by detecting coronavirus RNA in nasal swabs of patients.    Results  Mean age was significantly elevated in cases compared to controls (48.2 ± 13.8  vs . 29.9 ± 9.0 year; probability [ p ] < 0.001). Receiver operating characteristic analysis demonstrated the predictive significance of age in COVID-19 evolution (Area under curve = 0.858; 95% CI: 0.841 – 0.875;  p  < 0.001). Males outnumbered females in cases (60.4  vs . 39.6%) and controls (56  vs . 44%). Stratification by age group (< 30, 30 – 39, 40 – 49 and ≥ 50 years) revealed that 48.3% of cases clustered in the age group ≥ 50 years. ABO blood group analysis showed that group A was the most common among cases, while group O was the most common among controls (35.5 and 36.7%, respectively). Blood groups A (35.5  vs . 32.7; corrected  p  [ pc ] = 0.021), A+AB (46.3  vs . 41.7%;  pc  = 0.021) and A+B+AB (68.0  vs . 63.3%;  pc  = 0.007) showed significantly elevated frequencies in cases compared to controls. Logistic regression analysis estimated odds ratios (ORs) of 1.53 (95% confidence interval [CI]: 1.16 - 2.02), 1.48 (95% CI: 1.14 - 1.93) and 1.50 (95% CI: 1.17 - 1.82) for blood groups A, A+AB and A+B+AB, respectively. Blood group frequencies showed no significant differences between age groups of cases or controls. Regarding gender, male cases were marked with increased frequency of group A (39.9  vs . 28.9%) and decreased frequency of group O (25.9  vs . 41.0%) compared to female cases. Independent re-analysis of ABO blood groups in male and female cases demonstrated that group A was increased in male cases compared to male controls (39.9  vs . 33.1%; OR = 1.65; 95% CI: 1.24 - 2.21;  pc  = 0.006). On the contrary, no significant differences were found between females of cases and controls.    Conclusions  The study results indicated that blood group A may be associated with an increased risk of developing COVID-19, particularly in males.

Association between ABO blood groups and susceptibility to COVID-19: profile of age and gender in Iraqi patients