Gender differences in COVID outcomes aren’t just biological

key takeaways

  • A new study finds that social factors influence gender differences in COVID-19 risk and outcomes.
  • While biology plays a role, sex-related biological differences alone do not contribute to the observed sex differences in COVID outcomes.
  • In addition to gender-related disparities, experts say it is also important to examine how structural gender inequality affects COVID disparities.

Since the start of the pandemic, researchers have observed that men with COVID-19 have worse outcomes than women. Statistics show that men are more likely to get sick and die from the coronavirus than women.

While there may be congenital sex-related biological differences that contribute to this difference, published in Social Sciences and Medicine Show that gender differences in COVID are complex.

Why is COVID-19 affecting men more than women?

what the researchers found

For research, The researchers used 13 months of data from the U.S. Gender/Sex COVID-19 Data Tracker, a project of the GenderSci Lab at Harvard University. The data were disaggregated by sex, meaning the researchers collected and analyzed data on men and women separately.

The researchers found that while men had higher COVID-19 mortality rates than women, the trends were not consistent. It varies widely by state and at different points in time throughout the pandemic.

Women experience prolonged COVID more frequently than men.

The study’s findings suggest that sex-related biological differences may not be the only driver of the gender differences researchers see in COVID risk and outcomes.

The researchers emphasize that social factors may be as relevant—if not more so—as sex is in shaping COVID differences.

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The role of social factors

Ann Caroline Danielson, MPH, a researcher at Harvard’s Gender Science Laboratory and one of the study’s authors, told VigorTip that the study showed that “gender disparities are striking across U.S. states and at different stages of the pandemic.

According to Danielson, this change “suggests that social context factors — which vary over time and geography — largely moderate the magnitude of gender differences.”

These environmentally sensitive social factors, such as one’s occupation, health behavior, and race/ethnicity, also influence gender differences in COVID to varying degrees.

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Health behaviors during a pandemic are influenced by a variety of factors, including gender. One study found that female retail shoppers were 1.5 times more likely to wear masks than male retail shoppers.

Women are also more likely than men to comply with public policy measures, such as wearing masks and social distancing restrictions.

These points illustrate how health behaviors affect COVID-19 risk. However, gender-related structural exposure differences may also be a major contributing factor.

Will we wear masks forever?


“Men hold the majority of jobs in many occupational categories, including transportation, manufacturing, and agriculture, which are associated with disproportionate levels of exposure and mortality,” Danielson noted.

According to Danielson, the inequality “may be due to high levels of face-to-face interaction, inadequate supplies of protective equipment, and unfavourable working conditions.”

Ann Caroline Danielson, MPH

Taking occupation as an example, the gender social structure disproportionately distributes the burden of COVID-19 mortality and contributes to the gender differences we observe in the data.

— Ann Caroline Danielson, MPH

Danielson added, “In the case of occupation, the social structure of gender disproportionately distributes the burden of COVID-19 mortality and contributes to the gender differences we observed in the data.”

However, it is important to note that women are disproportionately employed in the healthcare and food industries, as well as in the teaching profession. This leaves them significantly exposed to COVID.

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In addition to gender and employment factors, the study highlights regional differences in COVID outcomes.

For example, Massachusetts has higher mortality rates for health care, transportation and construction workers. Food and agricultural workers, transportation and manufacturing workers saw the highest increases in death rates in California.

In addition, differences in state-level mask regulations and employee business policies may also affect changes in state-level gender disparities.

The residential environment – including incarceration and homelessness – also contributed.

Men make up the majority of the homeless and incarcerated in the U.S. — groups that are at increased risk of contracting COVID. However, protections for these groups also vary from state to state.

Data-tracking tool takes a closer look at COVID-19 differences

Beyond gender-related differences

It would be detrimental to public health to assume that only sex-related biological factors contribute to gender differences in COVID.

If this perspective guides our understanding, interventions and research will not be able to capture the whole picture. They are ultimately not enough to address the change in gender differences or to help us understand it better.

One concern, according to Danielson, is that focusing only on gender-related factors “masks gender-related and other social factors” that may be as relevant as biological sex “in shaping vulnerability to COVID-19.” – if not more relevant.

Focusing on this “leads to a unidimensional understanding of gender differences, independent of social context,” which in turn “limits opportunities to identify and address the structural variables underpinning such differences,” Danielson added.

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We can’t ignore biology

While the study highlights how socioeconomic factors influence health disparities, it doesn’t mean we should completely ignore the role of biology.

Sabra L. Klein, Ph.D., a microbiologist and co-director of the Center for Women’s Health, Sexuality, and Gender Studies at the Johns Hopkins Bloomberg School of Public Health, told VigorTip that if we just focus on biology, “we’ll miss out that inequality also affects COVID results – it’s true.”

Dr. Sabra L. Klein

It is equally dangerous to turn in the opposite direction and say there are no biological differences between the sexes, and ignore the idea that biological differences can be regulators of health and disease.

—Sabra L. Klein, Ph.D.

However, Klein added, “It’s equally dangerous to go in the opposite direction and say there are no biological differences between the sexes, and ignore the idea that biological differences can be regulators of health and disease.”

Explore the role of biology

Researchers have been studying the role of biology in COVID outcomes.A study published in Open Forum Infectious Diseases An increased risk of dying from COVID in men was found to be associated with excess inflammation early in the disease.

This finding suggests that sex-specific inflammatory responses to SARS-CoV-2 infection may explain sex differences in COVID outcomes.

Klein points out that if you remove the inflammatory measure from the model, the sex differences in hospitalizations and deaths disappear — providing a testable hypothesis.

An animal study found that male hamsters infected with SARS-CoV-2 had higher rates of disease and morbidity compared with female hamsters. Male hamsters also had more pneumonia and lower recovery-related antibody responses.

According to Klein, these examples show that biology does play a role in gender differences in COVID outcomes — and it’s not the only conundrum.

Ann Caroline Danielson, MPH

It is my hope that our research will encourage deeper thinking about how gender and other multiple axes of social inequality play a role in the broader field of social determinants of COVID-19.

— Ann Caroline Danielson, MPH

Because we know that socioeconomic variables affect disease risk and outcomes, there is a need to provide comprehensive and transparent demographic data to researchers who are exploring how structural inequalities affect COVID disparities.

“I hope our research will encourage deeper thinking about how gender, and multiple other axes of social inequality, play a role in the broader field of social determinants of COVID-19,” Danielson said. “I also hope that the changes in gender disparity we observe across states and over time will guide future investigations into the underlying causes of this disparity.”

what does this mean to you

Research reveals how sex-related biological differences and social context factors play a role in increasing the risk of COVID-19 mortality in men.

That said, everyone needs to take precautions like wearing masks, getting vaccinated, and maintaining social distancing to keep us all safe.

How has the pandemic changed us?

The information in this article is current as of the date listed, which means that you may have updated information as you read this article. For the latest updates on COVID-19, visit our Coronavirus news page.