Sex differences in COVID-19 mortality: A large US-based cohort study (2020–2022)

Samer A Kharroubi; Marwa Diab-El-Harake; Samer A Kharroubi; Marwa Diab-El-Harake

doi:10.3934/publichealth.2024045

AIMS Public Health

2024, Volume 11, Issue 3: 886-904. doi: 10.3934/publichealth.2024045

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Research article

Sex differences in COVID-19 mortality: A large US-based cohort study (2020–2022)

Samer A Kharroubi ^{1,2
,
,},
Marwa Diab-El-Harake ¹

1.
Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, P.O.BOX: 11-0236, Riad El Solh 1107-2020 Beirut, Lebanon
2.
School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, S1 4DA, Sheffield, UK

Received: 01 April 2024 Revised: 15 May 2024 Accepted: 29 May 2024 Published: 09 July 2024

Background
In the present study, we aim to assess the trend in mortality in COVID-19 by time and sex in a large cohort using Datavant's Death Index database. The main objectives of this study are to analyze mortality cases over time, which are categorized by sex and age, and to identify potential reasons for the observed differences.
Methods
This is a retrospective cohort containing information on deceased individuals in the United States and Canada (n = 4,384,265). We included adult male and female patients with a clinical diagnosis of COVID-19 (January–December 2022) (ICD-10 code: U07.1). Mortality cases for males and females were presented over a three-year period of COVID-19 pandemic. Sex ratios presenting the change of mortality cases over time was also computed as the number of diagnosed males over female patients. Sex-differences in the mortality rates were illustrated by age groups.
Results
In 2020, mortality cases increased to reach up to 200,000 cases per day and fluctuated due to social and/or cultural events in the US. In 2021, mortality cases reached the highest peak over the time period despite the US vaccine rollout due to holiday gatherings during November and December 2021, as well as the spread of a more contagious strain of the virus. In 2022, mortality cases decreased due to widespread vaccinations and a rise in natural immunity following the first Omicron surge. Furthermore, the proportion of COVID-19 cases in males and females remained stable during the pandemic; however, the number of diagnosed male patients markedly increased during the first months of 2022. Gender discrepancies suggest the role of various factors such as occupation, underlying comorbidities, and behavioral and immunological factors.
Conclusion
Our study highlights higher mortality rates observed among males, suggesting that several factors may contribute to such differences, including social, behavioral, and biological factors. Our findings highlight the importance of implementing sex-specific treatment approaches in COVID-19 patients.
- sex differences,
- COVID-19,
- mortality,
- Healthjump data,
- US cohort
Citation: Samer A Kharroubi, Marwa Diab-El-Harake. Sex differences in COVID-19 mortality: A large US-based cohort study (2020–2022)[J]. AIMS Public Health, 2024, 11(3): 886-904. doi: 10.3934/publichealth.2024045

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Abstract

Background

In the present study, we aim to assess the trend in mortality in COVID-19 by time and sex in a large cohort using Datavant's Death Index database. The main objectives of this study are to analyze mortality cases over time, which are categorized by sex and age, and to identify potential reasons for the observed differences.

Methods

This is a retrospective cohort containing information on deceased individuals in the United States and Canada (n = 4,384,265). We included adult male and female patients with a clinical diagnosis of COVID-19 (January–December 2022) (ICD-10 code: U07.1). Mortality cases for males and females were presented over a three-year period of COVID-19 pandemic. Sex ratios presenting the change of mortality cases over time was also computed as the number of diagnosed males over female patients. Sex-differences in the mortality rates were illustrated by age groups.

Results

In 2020, mortality cases increased to reach up to 200,000 cases per day and fluctuated due to social and/or cultural events in the US. In 2021, mortality cases reached the highest peak over the time period despite the US vaccine rollout due to holiday gatherings during November and December 2021, as well as the spread of a more contagious strain of the virus. In 2022, mortality cases decreased due to widespread vaccinations and a rise in natural immunity following the first Omicron surge. Furthermore, the proportion of COVID-19 cases in males and females remained stable during the pandemic; however, the number of diagnosed male patients markedly increased during the first months of 2022. Gender discrepancies suggest the role of various factors such as occupation, underlying comorbidities, and behavioral and immunological factors.

Conclusion

Our study highlights higher mortality rates observed among males, suggesting that several factors may contribute to such differences, including social, behavioral, and biological factors. Our findings highlight the importance of implementing sex-specific treatment approaches in COVID-19 patients.

Acknowledgments

The authors would like to thank the Health Care Cost Institute, Datavant and the COVID-19 Research Database Grant Accelerator Program, Bill and Melinda Gates Foundation, for funding this study. The authors would also like to thank Ms. Jennifer Brock and the covid-19 research database for their time and effort in resolving technical issues and other related issues in data management and analysis of the Healthjump COVID-19 Research Database.
The present study is funded by the Health Care Cost Institute, Datavant and the COVID-19 Research Database Grant Accelerator Program, Bill and Melinda Gates Foundation (Project Number CORONAVIRUSHUB-D-21-00081).

Conflict of interest

The authors declare no conflict of interest.

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