Sex Disparities in COVID-19 Mortality Vary Across US Racial Groups

Abstract

Background Inequities in COVID-19 outcomes in the USA have been clearly documented for sex and race: men are dying at higher rates than women, and Black individuals are dying at higher rates than white individuals. Unexplored, however, is how sex and race interact in COVID-19 outcomes. Objective Use available data to characterize COVID-19 mortality rates within and between race and sex strata in two US states, with the aim of understanding how apparent sex disparities in COVID-19 deaths vary across race. Design and Participants This observational study uses COVID-19 mortality data through September 21, 2020, from Georgia (GA) and Michigan (MI). Main Measures We calculate age-specific rates for each sex-race-age stratum, and age-standardized rates for each race-sex stratum. We investigate the sex disparity within race groups and the race disparity within sex groups using age-standardized rate ratios, and rate differences. Key Results Within race groups, men have a higher COVID-19 mortality rate than women. Black men have the highest rate of all race-sex groups (in MI: 254.6, deaths per 100,000, 95% CI: 241.1–268.2, in GA:128.5, 95% CI: 121.0-135.9). In MI, the COVID-19 mortality rate for Black women (147.1, 95% CI: 138.7–155.4) is higher than the rate for white men (39.1, 95% CI: 37.3–40.9), white women (29.7, 95% CI: 28.3–31.0), and Asian/Pacific Islander men and women. COVID-19 mortality rates in GA followed the same pattern. In MI, the male:female mortality rate ratio among Black individuals is 1.7 (1.5–2.0) while the rate ratio among White individuals is only 1.3 (1.2–1.5). Conclusion While overall, men have higher COVID-19 mortality rates than women, our findings show that this sex disparity does not hold across racial groups. This demonstrates the limitations of unidimensional reporting and analyses and highlights the ways that race and gender intersect to shape COVID-19 outcomes.

Sex Differences in Immunity to Viral Infections

“…Reporting of the sex of animals and primary cells as well as comparing immunological responses between the sexes in preclinical research is necessary ( 174 ). The COVID-19 pandemic has raised awareness about the significance of sex as a biological variable and how sex intersects with other variables, including age and race ( 45 , 89 , 91 , 175 ). Intersectional approaches are going to be necessary to better understanding outcomes of viral infections as well as treatments for infection, with knowledge that both will likely differ between the sexes.…”

Beyond a Zero-Sum Game: How Does the Impact of COVID-19 Vary by Gender?

“…In the United Kingdom, data from England and Wales shows Black women are 4.3 times more likely to die from a COVID-19-related death than white women (Office for National Statistics, 2020). Similar data from the US shows disproportionate rates of COVID-19 related deaths among black women, compared to white men (Rushovich et al, 2021). In Hong Kong, foreign domestic workers were ineligible to receive government COVID-19 support, even as large numbers lost their jobs when their employers left the city (Milhaud, 2020).…”

National Population-Level Disparities in COVID-19 Mortality Across the Intersection of Race/Ethnicity and Sex in the United States

“…The study by Rushovich et al (2021) (20) was the first to investigate population-level disparities in COVID-19 mortality outcomes by race and sex jointly in the U.S. Their analysis centered around Michigan and Georgia, the only states that, at their time of writing, publicly provided the necessary stratified data to facilitate such analyses. Specifically, Rushovich et al calculated COVID-19 mortality rates for each race-sex-age stratum, COVID-19 age-adjusted mortality rates for each race-sex stratum, and associated mortality rate ratios (RR) and rate differences (RD) to quantify disparities.…”