Abstract
Males are at higher risk relative to females of severe outcomes following COVID-19 infection. Focusing on COVID-19-attributable mortality in the United States (U.S.), we quantified and contrasted years of potential life lost (YPLL) attributable to COVID-19 by sex based on data from the U.S. National Center for Health Statistics as of 31 March 2021, specifically by contrasting male and female percentages of total YPLL with their respective percent population shares and calculating age-adjusted male-to-female YPLL rate ratios, both nationally and for each of the 50 states and the District of Columbia. Using YPLL before age 75 to anchor comparisons between males and females and a novel Monte Carlo simulation procedure to perform estimation and uncertainty quantification, our results reveal a near-universal pattern across states of higher COVID-19-attributable YPLL among males compared to females. Furthermore, the disproportionately high COVID-19 mortality burden among males is generally more pronounced when measuring mortality burden in terms of YPLL compared to death counts, reflecting dual phenomena of males dying from COVID-19 at higher rates and at systematically younger ages relative to females. The U.S. COVID-19 epidemic also offers lessons underscoring the importance of cultivating a public health environment that recognizes sex-specific needs as well as different patterns in risk factors, health behaviors, and responses to interventions between men and women. Public health strategies incorporating focused efforts to increase COVID-19 vaccinations among men are particularly urged.
Highlights
Licensee MDPI, Basel, Switzerland.Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1], the beta-coronavirus that causes what is known as coronavirus disease 2019 (COVID-19), was first identified in an outbreak in Wuhan, Hubei province, China, in December 2019
years of potential life lost (YPLL) rate ratios (RRs), respectively, to examine potential differences in the characterization of the disparities when measuring mortality burden in terms of YPLL compared to death counts
When the interval estimate of the age-adjusted male-to-female YPLL RR is completely above the interval estimate of the ageadjusted male-to-female mortality RR, the male-female disparity in the COVID-19 mortality burden is statistically discernably greater in magnitude when measuring mortality burden in terms of YPLL compared to death counts as a result of males dying at systematically and statistically discernably younger ages relative to females after accounting for differences in their population age distributions
Summary
Licensee MDPI, Basel, Switzerland.Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1], the beta-coronavirus that causes what is known as coronavirus disease 2019 (COVID-19), was first identified in an outbreak in Wuhan, Hubei province, China, in December 2019. Standard analyses and commentaries contrasting the male and female population level COVID-19 mortality burdens typically involve calculating the percentage of total deaths by sex—contrasting them with their respective percent population shares—and/or calculating male and female (age-adjusted) mortality rates [16,17,18]. The GenderSci Lab COVID Project at Harvard University [18] tracks the number of male and female COVID-19 deaths by state, calculating the percentage of total deaths by sex as well as crude and age-adjusted male and female mortality rates for each state. Because COVID-19 case fatality rates are considerably higher among individuals in older age groups, COVID-19 death counts and mortality rates for both males and females are predominantly determined by data from COVID-19 decedents in older age groups. Younger individuals are susceptible to death from COVID-19, which in principle represent greater unrealized years of life, economic productivity, and broader contributions to society compared to decedents of greater age
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