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Does COVID-19 impact men worse than women?

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Data from around the world has demonstrated the fact that men are impacted more greatly than women by COVID-19. For example, men are more likely to be hospitalized with severe symptoms of the virus and have higher mortality rates than women; and this finding is consistent across age groups and geographies. Researchers have been trying to understand the causes of this and are developing hypotheses to explain the differences between the immune systems' response to COVID-19 in men and women. At this stage, they are exploring these disparities using biological, social, and behavioral lenses. Based on previous studies with similar viruses, data has illustrated that sex differences in immunity are caused by both genetic as well as hormonal differences between women and men. For example, in females, hormones such as estrogen and progesterone may be protective against the virus, yet it is possible testosterone does the opposite for men. In terms of underlying illnesses, the data also illustrates that men are more likely to suffer from hypertension, heart disease, and diabetes than women. Since the beginning of the pandemic, we have learned that these types of underlying conditions have been associated with a higher risk of complications from COVID-19. Behavioral factors may also explain this difference. For instance, females may be more likely to be frontline workers than men, which could create more risks for exposure. In terms of lifestyle, men tend to be more likely to be smokers, which is a risk factor for COVID-19 since it is a respiratory illness. From past studies, we also know that men are less likely to seek out medical care when there's a problem in comparison to women, which means they may interact with the health system at a later stage in the disease when symptoms are more severe. Similarly, in the case of COVID-19, men are less likely to engage in behaviors like mask-wearing and hand-washing, which may increase their risk of contracting the disease. Source: Dr. Sabra Klein (Johns Hopkins University)

This article was published on
July 3, 2020

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Data from around the world has demonstrated the fact that men are impacted more greatly than women by COVID-19. For example, men are more likely to be hospitalized with severe symptoms of the virus and have higher mortality rates than women; and this finding is consistent across age groups and geographies. Researchers have been trying to understand the causes of this and are developing hypotheses to explain the differences between the immune systems' response to COVID-19 in men and women. At this stage, they are exploring these disparities using biological, social, and behavioral lenses. Based on previous studies with similar viruses, data has illustrated that sex differences in immunity are caused by both genetic as well as hormonal differences between women and men. For example, in females, hormones such as estrogen and progesterone may be protective against the virus, yet it is possible testosterone does the opposite for men. In terms of underlying illnesses, the data also illustrates that men are more likely to suffer from hypertension, heart disease, and diabetes than women. Since the beginning of the pandemic, we have learned that these types of underlying conditions have been associated with a higher risk of complications from COVID-19. Behavioral factors may also explain this difference. For instance, females may be more likely to be frontline workers than men, which could create more risks for exposure. In terms of lifestyle, men tend to be more likely to be smokers, which is a risk factor for COVID-19 since it is a respiratory illness. From past studies, we also know that men are less likely to seek out medical care when there's a problem in comparison to women, which means they may interact with the health system at a later stage in the disease when symptoms are more severe. Similarly, in the case of COVID-19, men are less likely to engage in behaviors like mask-wearing and hand-washing, which may increase their risk of contracting the disease. Source: Dr. Sabra Klein (Johns Hopkins University)

Context and background

The disproportionate impact of COVID-19 on men have been shown in a number of studies and hospital data. To clarify, the number of cases has appeared relatively equal, but vulnerability to the virus and mortality have not. A recent study from The Journal of the American Medical Association (JAMA) found that of 5700 patients hospitalized with COVID-19 in the New York City area, 39.7% of patients were female while 60.3% were male, demonstrating significantly disparate hospitalization rates based on sex. Sex and gender-based discrepancies are commonly documented in scientific literature, and are helpful for understanding how and why a health condition or disease manifests. For instance, women are twice as likely as men to become depressed, and men are more likely to develop cardiovascular disease and diabetes. The gender dimensions of diseases are both physical as well as socially constructed. For example, higher estrogen levels in a women born biologically female is a determinant of health (biological), as is a higher likelihood to carry out domestic work (social). These dimensions also align with the terms sex and gender -- both of which are important to pay attention to in health. Sex describes primarily biological differences between men and women in origin, and gender describes differences primarily caused by social conditions, and can be thought as how one's chosen gender role and how they present. Public health efforts and policies have not always addressed the impacts of diseases across sex and gender, but doing so can help us to understand both the biological and social dimensions of diseases like COVID-19, including who is most at risk and how to mitigate adverse outcomes. 

Resources

  1. Q&A on Covid-19 - Johns Hopkins University (JHU)
  2. Research paper: Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area (JAMA)

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