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COVID-19: Why Men Are More Likely To Die Compared To Women

COVID-19 is a disease that doesn't discriminate between people. Be it a farmer or a prime minister, it has infected people from all walks of life. However, available data on COVID-19 suggests that men are more likely to get infected and die of the infection compared to women.

In countries like China, Italy, France and South Korea where there's a sex-specific record on deaths due to COVID-19, the mortality rate of males is 50 per cent greater than women. According to the WHO COVID-19 weekly surveillance report, 68 per cent of deaths in Europe is among men than in women. [1]

What Do Studies Say?

According to a report posted by The New York Times on 7 April, there were nearly 43 COVID-19 deaths for every one lakh men in the city in comparison to 23 COVID-19 deaths for every one lakh women. The report also says that 80 per cent of patients hospitalised at Mount Sinai Health Systems (Brooklyn) were men.

Another data from the United States says that out of 56 per cent COVID-19 tested women, only 16 per cent were found to be positive while out of 44 per cent COVID-19 tested men, 23 per cent were found to be positive.

A report based on Higher Health Institute of Rome says that out of 25,058 analysed cases, 8 per cent of men patients died of COVID-19 while the cases of women patients who have died were 5 per cent.

Why The Difference?

1. More chronic cases in men: According to Stephen Berger, a co-founder of Global Infectious Diseases and Epidemiology Network (GIDEON), COVID-19 is likely to infect men more than women as men are more prevalent to cardiovascular diseases, liver diseases and hypertension. These factors make them prone to the infection due to existing chronic diseases.

2. Smoking: Men are more likely to smoke than women which is why chronic lung diseases and other lung problems are greater in men compared to women. [2] According to the WHO, smokers or vapers are more vulnerable to SARS-CoV-2 due to lung damage, sharing of contaminated cigarettes as well as touching the mouth with contaminated hands, facilitating the transmission of COVID-19.

3. Air Pollution: In many countries and cultures, men are more engaged in outdoor work which exposes them more to extreme air pollution compared to women. According to a report published by Harvard University on 5 April, people who reside in high air pollution areas are more likely to get infected with COVID-19 than people staying at low polluted areas.[3] As men are more exposed to air pollution due to their work culture, there are elevated levels of COVID-19 deaths among men.

4. The X-chromosome: Women have two X-chromosomes while men have XY-chromosomes. The immune response is amplified in women due to the presence of double X-chromosomes compared to one X chromosome in men. This makes men weaker in immune response compared to women.

5. Estrogen: According to the Journal of immunology, the 2003 SARS has caused more male deaths compared to women. This is because females have an effective defence hormone named estrogen that causes an earlier attack on infections of any kind. The study was carried out on female mice to test the effect of estrogen on SARS. However, when the scientists blocked estrogen pathways, they found that female mice died sooner. [4]

6. Previous history: According to a report based on the 1918 Spanish flu, middle-aged adults (25-34 years) have largely died during this pandemic compared to women. This is because of the higher tuberculosis cases in men in the years following 1918. [5] Another study based on SARS also revealed that the mortality rate of men and women out of 1755 patients in Hong Kong was 170 males and 129 females. [6]

To Conclude

The high mortality rate among men due to COVID-19 has been reported by many countries. Yet, gender is not considered one of the risk factors of COVID-19. Many male behaviours show the increased exposure of infection in men, like more social interaction, handshaking and sporting events. The other reason could be men's casual attitude towards their health compared to women-some men may think they are brave and strong enough to fight off anything. Even if they have symptoms, they are unlikely to visit healthcare centres until the symptoms worsen and become life-threatening. These aspects make them even more prone to COVID-19.

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