Intersectionality of sex and race in COVID-19 mortality and vaccination inequities in Massachusetts

Abstract

Background: Inequities in COVID-19 incidence, morbidity, and mortality between racial and ethnic groups in the United States (U.S.) have been documented since the start of the pandemic in early 2020. Similarly, disparities by sex for COVID-19 morbidity and mortality have emerged, with men dying at a higher rate than women. Little research has been done to understand how the intersection of sex and race impacts COVID-19 inequities in Massachusetts (MA). This cross-sectional study examined how COVID-19 mortality rates (February 2020- May 2023) and vaccination rates (December 2020-February 2023) varied by sex across racial groups in MA.

Methods: Using Massachusetts Department of Public Health data of all COVID-19 mortality cases and primary series vaccinations in MA from 2020 to 2023, we calculated both age-specific and age-adjusted COVID-19 mortality rates in order to account for differences in age distributions across sex-race groups.

Results: Overall, men across all age-race groups consistently had a higher mortality rate compared to their female counterparts. The age-standardized mortality rate difference between White men and White women is the smallest, with the rate for White men being 1.3 times higher than White women. The age-standardized mortality rate between Hispanic men and Hispanic women varies the largest, with the rate for Hispanic men being 1.7 times higher than Hispanic women. Notably, Black women and White women have similar vaccination rates, yet the age-standardized mortality rate for Black women is 1.4 times the rate of White women.

Conclusions: Our findings show that there are disparities at the intersection of sex and race for COVID-19 mortality and vaccination in MA. This highlights the importance for targeted COVID-19 interventions at the intersection of sex and race and the need for detailed COVID-19 reporting by sex within race groups.

Keywords: COVID-19; Health disparities; Intersectionality; Vaccination.

Fig. 1

Age-standardized mortality rates are reported per 100,000 individuals, using the American Community Survey (ACS) 5-year Public Use Microdata Sample Vintage 2021 population estimates for each sex within race group. Within each race/ethnicity group, men had higher rates of age-standardized mortality compared to female counterparts

Fig. 2

Vaccination Rates are reported as rate per 100,000 individuals, using the American Community Survey (ACS) 5-year Public Use Microdata Sample Vintage 2021 population estimates for each sex within race group NH/PI = Native-Hawaiian, Pacific Islander AI/AN = American Indians and Alaska Natives