Men die of Covid-19 more often than women do.
Sex-based treatments for men, like estrogen injections or androgen blockers, could help reduce their risk of dying.
Sex differences in Covid-19 deaths over time in the United States suggest that the picture is more complicated.
The study found that the trends varied widely over time and by state, with men dying at a higher rate than women. Researchers said that social factors like job types, behavioral patterns and underlying health issues played a big role in the apparent sex differences.
Sarah Richardson is the director of the GenderSci Lab at Harvard University, which studies how biological sex interacts with cultural influences in society.
The Centers for Disease Control and Prevention began collecting and sharing sex data on Covid cases and deaths early in the Pandemic. Every Monday morning, her research group logs on to the lab's website and keeps track of each state's data. The only source of sex-based weekly Covid-19 data by state is the tracker.
The researchers were able to analyze Covid case rates and deaths in all 50 states and Washington, D.C. over a period of 55 weeks.
There were no significant differences in case rates between men and women. The death rates among men and women were often different, with men having higher death rates than women.
It depended on the state and the date. In Texas, men died at a higher rate every week. In New York, men died at a higher rate than women, but the gap was not as large as in Texas. In Connecticut, women died more than men in 22 weeks.
Connecticut and New York have different patterns but still experienced the same wave, according to Dr. Richardson.
The mortality rates for women in Rhode Island and Massachusetts were slightly higher over the course of 55 weeks. In Connecticut, the rates were roughly equal. The death rates in the rest of the country were higher for men.
The researchers said that sex differences in genes, hormones and immune responses are not likely to explain them.
The author of the new study said there would be no reason for biology to be that variable across time and space.
The researchers said that social and behavioral factors could explain many of the patterns.
Men are more likely to have jobs in transportation, factories, meatpacking plants, agriculture and construction, occupations with higher rates of Covid-19 exposure and deaths. Men are more likely to be homeless and to be in jail.
Women are more likely to report hand washing, mask wearing and complying with social distancing restrictions, all of which may lower their risk of contracting the virus. Women are more likely to get vaccinations.
The researchers thought that states with more public health restrictions might have reduced sex differences. In New York, where there was a higher number of male deaths in the first six weeks of the Pandemic, mortality rates evened out once restrictions were put in place. Better data collection, as well as under reporting of deaths in long-term care facilities, where the majority of residents are women, could explain the observed differences in New York.
Since older people are more likely to die of Covid and different states have different age distributions, Dr. Richardson's research group did not have access to age data for each sex. Before Covid, men had a lower life expectancy, possibly due to higher rates of certain chronic conditions, more risk-taking behaviors and more dangerous jobs. Richardson said that the disparity with Covid could be explained by the pre-existing mortality gap.
Independent experts said that the new findings shouldn't lead researchers to discount the role of biology.
Sabra Klein, a microbiologist and co-director of the Center for Women's Health, Sex and Gender Research, said that it's not possible to attribute observations about mortality from a complex disease like Covid. I don't think you can say it's all social and behavioral.
Dr. Klein found that men were more likely to die from Covid illness than women. There is a biological difference between men and this disparity could be accounted for by greater inflammatory responses.
Experiments looking at the effects of Covid in hamsters by sex can be useful since they don't include the social factors present in humans. Women produce a stronger immune response than men.
Other experts said that having access to more data on factors like race, income and education level would allow them to look at the differences in sex differences in a more nuanced way.
A public health psychologist and co-director of the Racial Justice Institute at Georgetown University said that they are doing a lot with a little.
He pointed to the health impacts of stress, financial burdens and discrimination that might underlie racial or gender differences in health outcomes but are difficult to quantify.
Dr. Griffith said that racial differences in Covid outcomes were similar. Black people were thought to have a lower risk of contracting the virus in the early stages of the epidemic. When the data showed that Black people in the U.S. had a higher risk of dying of Covid-19 than white people, the pendulum swung the other way, with some scientists speculating about innate genetic differences.
There is more recognition of the many factors that influence health disparity. He said that the assumption is that it must be biological in both cases.
The Harvard group hopes that other researchers will use its data set to analyze the impacts of states' differing public health policies.
Studies show that long Covid disproportionately affects women, yet the disease isn't tracked consistently at the state level. The researchers didn't have data on patients who were non conforming.
Dr. Richardson said that the data was not as rich as they would like.
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