Primary Submission Category: Mortality
Global perspective on sex differences in COVID-19 mortality
Authors: Katarzyna Doniec Mine Kuhn Jennifer Dowd
Presenting Author: Katarzyna Doniec*
The goal of this study is to examine sex gaps in COVID-19 mortality from longitudinal and cross-country, comparative perspective. Earlier studies focused primarily on cumulative sex differences in Covid-19 mortality, comparing a small number of countries, mainly from the Global North. To address this gap, we used 2020-2022 official COVID-19 mortality data from 20 countries worldwide, located across four continents and representing 25% of the global population. We examined country-level monthly trends in sex- and age-disaggregated (20-59, 60-79 and 80+) mortality rates and cumulative deaths, as well as monthly trends in the mortality sex gap, operationalised either as a rate ratio (male mortality/female mortality) or a rate difference (male mortality – female mortality). Results demonstrate considerable variation in the magnitude of rate difference over time and between age groups and countries. On average, time trends in rate ratios correlated highly with the Covid-19 mortality rates of each country. The largest rate differences were observed in Brazil, the United States and Colombia. Regarding age differences, the largest rate differences, on average, were observed among the 60-79 group, but some countries deviated from this general pattern. The magnitude of rate ratios was comparable between age groups and for the majority of countries varied little over time. Finally, using a multilevel generalised least squares model, we found that male mortality rate, as compared to female, varied more over time and between countries. To conclude, cross-country sex differences in Covid-19 mortality are considerable, but our sample size (20) limits our capacity to investigate drivers of these trends via a conventional multiple regression analysis. Instead, we conducted a series of bivariate correlations between two types of the sex gap measures (rate ratio and rate difference) and GDP per capita, urbanization, smoking rates, female labour participation and gender equality.