Covid-19 kills more men than women. Is it even more than the usual mortality, which also affects men more at the same age? And what are the reasons?
This article, written by Gilles Pison, National Museum of Natural History (MNHN) and France Mesle, National Institute for Demographic Studies (INED), is republished from The Conversation under a Creative Commons license. You can read the original article released March 28.
Covid-19 kills more men than women. Knowing that this is also true of general mortality: in France, at any age, a man has a higher risk of dying within the year than a woman of the same age.
In what the excess male mortality for Covid-19 deaths different from that usually observed for all deaths? And what are the reasons?
Excess male mortality in normal times
In France, at any age, a man has a higher risk of dying within a year than a woman of the same age. A 70-year-old man, for example, has twice the risk of a 70-year-old woman. Similarly at age 40, the risk is doubled, although much lower than at age 70, for both men and women.
Men are biologically more fragile than women, but differences come mainly from their activities and behaviors. Throughout life, they take more risks and engage in unhealthy behaviors more frequently, including smoking more and drinking more alcohol. Women, for their part, are generally more attentive to their health and consult doctors more often.
This results in an excess mortality of men compared to women for all causes of death in normal times. It is more or less important according to age with a profile with two “bumps” (see figure 1 below, in purple). It peaks at young adult ages – deaths, which are very infrequent at these ages, are mainly due to violent deaths (suicides and accidents, particularly traffic accidents) – and between 55 and 74 years of age.
Covid-19 has increased excess male mortality from the age of 50
Male excess mortality due to Covid-19 has a distinct profile (Figure 1, in red). It is less than that for all deaths before the age of fifty, but greater from the age group 55-64 years. At these ages, this could come from a greater risk for men of being contaminated, because of their behavior: less respect for barrier gestures, greater social interaction, less teleworking.
The comorbidities (hypertension, diabetes), more frequent among them from the age of fiftywould also lead to greater lethality (risk of dying when you are hit).
A bump in excess male mortality at ages 25-34 during the first wave of Covid-19
Excess male mortality in terms of Covid-19 deaths has evolved since the start of the pandemic (see Figure 2 below).
Whatever the period, it reaches a maximum around 65-74 years. But is added to 1is semester 2020 a first bump at 25-34 years old. It could be explained by more risky behavior among young men, a bit like accidental mortality. And also by the very high mortality from Covid-19 among young foreign adults.
The first wave was indeed especially deadly among foreign-born, especially those born in Africa or Asia. The latter often reside in the regions most affected by this wave (Ile-de-France, Grand Est) and carry out jobs that do not allow telework and expose a lot to infection. And among foreigners born in Africa or Asia mortality was higher in men than in women.
Vaccination reduced excess male mortality from Covid-19
That first bump at age 25-34 disappears or shrinks afterwardsthe partial resumption of activities then exposing men and women to the virus more equally.
The main hump, centered around 65-74, partially sags at the 2e semester 2021, possibly in connection with vaccination. At these ages, the proportion of unvaccinated people is higher in women than in men: more than 10% versus less than 8%.
This difference could be due to the fact that men were considered priorities for vaccination more often than women of the same age, due to more frequent comorbidities. would add a greater reluctance of women to vaccinate compared to men, which is not specific to that against Covid-19 but is also observed for other vaccines.
Men would thus have been more attentive to their health than women regarding vaccination against Covid-19 – or at least more respectful of health directives. An exception, therefore, because as mentioned above, they generally have behaviors that are less favorable to health than women.
France in international comparisons
Excess male mortality in deaths due to Covid-19 is in the average in France when compared to that observed in other countries (see Figure 3 below): it is higher in Italy and Spain than in France. in France, and less in England-Wales and the United States.
The age profiles are similar in the Latin countries (Italy, Spain, France), with a very marked bump between 60 and 70 years. The bump is less marked in England-Wales and the United States, where it tends to be observed at slightly younger ages.
Only finer analyses, which would take into account comorbidities and detailed vaccinations by sex and age, could make it possible to understand these profile differences. But this type of information is not currently available in all countries. Hopefully it will soon become so in order to better understand excess male mortality for Covid-19.
This text is adapted from an article published in March 2022 by the authors in the journal Population and Societies n° 598, “Covid-19 more deadly for men than for women”.