Sex differences in the mortality rate for coronavirus disease 2019 compared to other causes of death: an analysis of population-wide data from 63 countries

Abstract

Men are more likely than women to die due to coronavirus disease 2019 (COVID-19). An open question is whether these sex differences reflect men’s generally poorer health and lower life expectancy compared to women of similar ages or if men face a unique COVID-19 disadvantage. Using age-specific data on COVID-19 mortality as well as cause-specific and all-cause mortality for 63 countries, we compared the sex difference in COVID-19 mortality to sex differences in all-cause mortality and mortality from other common causes of death to determine the magnitude of the excess male mortality disadvantage for COVID-19. We found that sex differences in the age-standardized COVID-19 mortality rate were substantially larger than for the age-standardized all-cause mortality rate and mortality rate for most other common causes of death. The excess male mortality disadvantage for COVID-19 was especially large in the oldest age groups. Our findings suggest that the causal pathways that link male sex to a higher mortality from a SARS-CoV-2 infection may be specific to SARS-CoV-2, rather than shared with the pathways responsible for the shorter life expectancy among men or sex differences for other common causes of death. Understanding these causal chains could assist in the development of therapeutics and preventive measures for COVID-19 and, possibly, other coronavirus diseases. Supplementary Information The online version contains supplementary material available at 10.1007/s10654-022-00866-5.

SARS-CoV-2 variant with the spike protein mutation F306L in the southern border provinces of Thailand

“…A wide range of behavioral and biological factors have been proposed as plausible (non-mutually exclusive) explanations for the sex disparities in COVID-19 severity and outcomes, including sex differences in social, cultural, hygiene, and economic behaviors; differential prevalence of medical conditions associated with a higher risk of COVID-19 fatality, such as diabetes, hypertension, chronic cardiovascular disease, and respiratory disease; and effects of sex hormones on, for instance, virus entry and priming, as well as immune and inflammatory responses 31 , 33 . Nevertheless, it should be noted that the degree of sex differences in COVID-19 fatalities differed widely among countries 35 , 36 , and similar to the present study, some studies found no differential COVID-19 fatalities between sexes. For example, a study of an Italian cohort showed that death rates were not significantly different between males and females after adjusting for various confounding factors, including age and disease severity at hospital presentation 39 .…”

Large and unequal life expectancy declines during the COVID-19 pandemic in India in 2020

“…Civil registration data in NFHS-5 subsample states that had high rates of pre-pandemic death registration for females and males (see Table S-1 for the states that meet this criteria) also showed larger increases in mortality between 2019 and 2020 for females compared to males in most states, as shown in Figure S-3. These patterns are in stark contrast to the global pattern of a greater increase in mortality during the COVID-19 pandemic for males compared to females (35,1,20). Such a large female disadvantage in the impact of the pandemic as observed in India has not been documented in any country.…”

“…Our findings demonstrate that the toll of the pandemic was experienced unevenly within India. Whereas in most countries, losses to life expectancy were greater for males than females (19,20), we document a loss in life expectancy among females that is one year more than for males. A larger mortality increase among females relative to males is also evident in India's vital statistics in subsample states that have high rates of male and female death registration.…”

“…Figure S-4 shows results from an Arriaga decomposition, decomposing the age-specific contribution (for abridged life table age groups) of changes in life expectancy between 2019 and 2020 for males and females separately. For females, we see a large contribution of childhood ages (0-4), young adulthood (15)(16)(17)(18)(19)(20)(21)(22)(23)(24), and older ages (50+). For males, we see a large contribution of childhood ages, and also of older working ages (40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59).…”

Impacto directo e indirecto del COVID-19 en la esperanza de vida al nacer de Chile en el año 2020

“…Nuestras hipótesis apuntan a encontrar una disminución significativa de la e(0), con una diferencia mayor entre la e(0) esperada y observada para los hombres que respecto a las mujeres, dado que la evidencia internacional señala un mayor impacto directo del COVID-19 para esta subpoblación 11 , 12 , 13 . Además, esperamos encontrar impactos indirectos del COVID-19 en la mortalidad, causando variaciones significativas en otras causas de muerte, ya que han sido estudiados casos donde ciertas causas de muerte han disminuido producto de las restricciones de movilidad y otras medidas impuestas durante la pandemia 14 .…”