A solid foundation of research has shown that men are more likely to die of COVID-19 than women, but the reason for this disparity is still unknown.
Men, who make up about 49 percent of the U.S. population, account for 54.4 percent of the country's COVID-19 deaths, according to CDC data. Women make up nearly 51 percent of the population and account for 45.6 percent of deaths. This gap is even larger among people ages 65 to 84 who are at highest risk for severe COVID-19, Ezekiel Emanuel, MD, PhD, a professor of medical ethics and health policy at University of Pennsylvania in Philadelphia, wrote in a Nov. 2 op-ed for The New York Times.
Research also suggests men are more likely to be intubated or have longer hospital stays than women and see their vaccine-induced immunity fade quicker, Dr. Emanuel said.
While researchers are still unclear what factors account for these differences, Dr. Emanuel outlined several possible contributors to this disparity.
1. Vaccination rates. CDC data shows 47.7 percent of men are fully vaccinated against COVID-19, compared to 52.6 percent of women. "However, vaccination rates alone cannot account for all the worse Covid-19 outcomes among men, since the disparities in deaths and other complications predate the availability of the vaccines," Dr. Emanuel said.
2. Social factors. Some studies suggest social factors such as differing levels of conformity to public health guidelines, workforce participation, and smoking and drinking rates may be at play.
3. Underlying health conditions. Data shows men are more likely to have underlying health conditions such as heart disease or diabetes. These health issues, which put people at higher risk for severe COVID-19 or death, could be another factor that accounts for disparate outcomes between men and women, researchers say.
4. Biological differences. Many researchers also point to biological differences as another potential factor at play. A small study published last year in Nature found women produce a stronger immune response to COVID-19 than men. A separate study published in Biology of Sex Differences suggests differences in sex hormones may influence COVID-19 outcomes, as estrogen has immunoenhancing effects, while testosterone has immunosuppresive effects.
"The medical community needs to be more open to exploring sex differences in disease," Dr. Emanuel concluded. "One way to respond to the COVID-19 death rate disparity now is to target men for vaccines and boosters."