Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2021 Apr 29;16(4):e0250523.
doi: 10.1371/journal.pone.0250523. eCollection 2021.

Sex differences in the case-fatality rates for COVID-19-A comparison of the age-related differences and consistency over seven countries

Manfred S Green  1 , Dorit Nitzan  2 , Naama Schwartz  1 , Yaron Niv  3 , Victoria Peer  1
Affiliations
Comparative Study

Sex differences in the case-fatality rates for COVID-19-A comparison of the age-related differences and consistency over seven countries

Manfred S Green et al. PLoS One. .

Abstract

Background: Early in the COVID-19 pandemic, it was noted that males seemed to have higher case-fatality rates than females. We examined the magnitude and consistency of the sex differences in age-specific case-fatality rates (CFRs) in seven countries.

Methods: Data on the cases and deaths from COVID-19, by sex and age group, were extracted from the national official agencies from Denmark, England, Israel, Italy, Spain, Canada and Mexico. Age-specific CFRs were computed for males and females separately. The ratio of the male to female CFRs were computed and meta-analytic methods were used to obtained pooled estimates of the male to female ratio of the CFRs over the seven countries, for all age-groups. Meta-regression and sensitivity analysis were conducted to evaluate the age and country contribution to differences.

Results: The CFRs were consistently higher in males at all ages. The pooled M:F CFR ratios were 1.71, 1.88, 2.11, 2.11, 1.84, 1.78 and 1.49, for ages 20-29, 30-39, 40-49, 50-59, 60-69, 70-79, 80+ respectively. In meta-regression, age group and country were associated with the heterogeneity in the CFR ratios.

Conclusions: The sex differences in the age-specific CFRs are intriguing. Sex differences in the incidence and mortality have been found in many infectious diseases. For COVID-19, factors such as sex differences in the prevalence of underlying diseases may play a part in the CFR differences. However, the consistently greater case-fatality rates in males at all ages suggests that sex-related factors impact on the natural history of the disease. This could provide important clues as to the mechanisms underlying the severity of COVID-19 in some patients.

PubMed Disclaimer

Conflict of interest statement

No competing interests.

Figures

Fig 1
Fig 1. PRISMA flowchart describing the included and excluded data.
Fig 2
Fig 2. Forest plot of the ratio of the male to female CFRs (CFRR) in seven countries for each age group.
Fig 3
Fig 3. The pooled male to female CFRR (for seven countries) by age group together with the 95% CI lower and upper limits, derived from the meta-analysis.
See this image and copyright information in PMC

References

    1. Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al.. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol 2020. (In press). https://www.jacionline.org/article/S0091-6749(20)30495-4/pdf Accessed on June 17, 2020. 10.1016/j.jaci.2020.04.006 - DOI - PMC - PubMed
    1. Delivered by women, led by men: a gender and equity analysis of the global health and social workforce. 2019. World Health Organization. https://www.who.int/hrh/resources/health-observer24/en/. Accessed on April 25, 2020.
    1. Kim R, Nachman S, Fernandes R, Meyers K, Taylor M, LeBlanc D, et al.. Comparison of COVID-19 infections among healthcare workers and non-healthcare workers. PLoS One 2020;15:e0241956. 10.1371/journal.pone.0241956 - DOI - PMC - PubMed
    1. Korean Society of Infectious Diseases; Korean Society of Pediatric Infectious Diseases; Korean Society of Epidemiology; Korean Society for Antimicrobial Therapy; Korean Society for Healthcare-associated Infection Control and Prevention; Korea Centers for Disease Control and Prevention. Report on the Epidemiological Features of Coronavirus Disease 2019 (COVID-19) Outbreak in the Republic of Korea from January 19 to March 2, 2020. J Korean Med Sci 2020;35:e112. 10.3346/jkms.2020.35.e112 - DOI - PMC - PubMed
    1. A Dictionary of Epidemiology. Edited by Miquel Porta. Oxford University Press. 6th Edition. 2014.

Publication types

MeSH terms