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Observational Study
. 2021 Jun;36(6):1696-1701.
doi: 10.1007/s11606-021-06699-4. Epub 2021 Apr 5.

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

Tamara Rushovich  1   2 , Marion Boulicault  3   4 , Jarvis T Chen  5 , Ann Caroline Danielsen  5 , Amelia Tarrant  6 , Sarah S Richardson  6   7 , Heather Shattuck-Heidorn  8
Affiliations
Observational Study

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

Tamara Rushovich et al. J Gen Intern Med. 2021 Jun.

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.

Keywords: COVID-19; health inequities; intersectionality; race/ethnicity; sex/gender.

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Conflict of interest statement

None of the authors have any conflicts of interest to declare.

Figures

Figure 1
Figure 1
Age-Standardized COVID-19 Mortality Rate by Race and Sex in Georgia and Michigan USA. Asian/PI, Asian or Pacific Islander. Age-standardized rates were calculated using direct standardization and the 2000 US population as the standard.
See this image and copyright information in PMC

References

    1. Harvard GenderSci Lab. US Gender/Sex COVID-19 Data Tracker. Published 2020. https://www.genderscilab.org/gender-and-sex-in-covid19. Accessed July 6, 2020.
    1. Krieger N, Waterman PD, Chen JT. COVID-19 and overall mortality inequities in the surge in death rates by zip code characteristics: Massachusetts, January 1 to May 19, 2020. Am J Public Health. 2020;110(12):1850–1852. doi: 10.2105/AJPH.2020.305913. - DOI - PMC - PubMed
    1. Yancy CW. COVID-19 and African Americans. J Am Med Assoc. 2020;323(19):1891–1892. doi: 10.1001/jama.2020.6548. - DOI - PubMed
    1. Krieger N. Epidemiology and the web of causation: Has anyone seen the spider? Soc Sci Med. 1994;39(7):887–903. doi: 10.1016/0277-9536(94)90202-X. - DOI - PubMed
    1. Crenshaw KW. Demarginalising the intersection of race and sex: A black feminist critique of anti-discrimination doctrine, feminist theory, and anti-racist politics. Univ Chic Leg Forum. 1989;1(8):139–167. doi: 10.4324/9781315582924-10. - DOI

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