Why more men die of COVID-19

Men are also more likely to develop certain rare complications from some COVID-19 vaccines and to experience a faster decline in measures of immunity once vaccinated. The reasons remain unclear. Historically, women have been largely excluded from medical studies, and health issues that predominantly affect women have been under-researched. This is both morally wrong and medically foolish because it limits physicians’ ability to deliver optimal care. Rather than ignore sex differences in COVID-19 outcomes, scientists should pay attention to them to better understand the disease and how to treat it.

Data from the Centers for Disease Control and Prevention shows that in the United States, women account for 45.6 percent of COVID-19 deaths so far and men account for 54.4 percent. (Men make up slightly less than half the U.S. population.) Among Americans ages 65 to 84 — the group at highest risk for severe COVID-19 — the gap is even larger: 57.9 percent of deaths have occurred among men and 42.1 percent among women. According to the Brookings Institution, at least 65,000 more men than women have died of COVID-19 in the United States. Globally, the death rate has been about 50 percent higher for men.

A July 2021 study found that compared to women, men with COVID-19 had an almost 50 percent higher rate of respiratory intubation and a 22 percent longer hospital stay. Certain complications from COVID-19 vaccines, though rare, seem to happen more often among men than women. A recent study from Israel on the Pfizer-BioNTech vaccine showed that the incidence of myocarditis — inflammation of the heart muscle — was nearly 18 times as high among men as among women over age 16.

There is also evidence that immunity from the Pfizer vaccine wanes more rapidly among men. Another recent study from Israel found that six months after the second dose of the vaccine, levels of antibodies were “substantially lower among men than among women.” Among men age 65 and older, certain antibody levels after vaccination were 46 percent lower than among vaccinated women of the same age.

What might account for these differences? Some think the higher COVID-19 death rates among men are due to lower vaccination rates. Just over 50 percent of American men are fully vaccinated, compared to 55 percent of women. However, vaccination rates alone cannot account for all the worse COVID-19 outcomes among men, since the disparities in deaths and other complications predate the availability of the vaccines. Some researchers suggest that the higher death rate among men is spurious, an unrelated curiosity. Others contend that factors like adherence to mask wearing or underlying health conditions most likely explain the differences. Early on, for example, it was suggested that this sex difference might be traced to higher rates of smoking among men in China, where the disparity was first observed. Work and other social factors like masking might have a role, though women make up a very high proportion of essential workers and are more likely to hold jobs as home health aides and nursing home caregivers, which can expose them to COVID-19.