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COVID-19 mortality: A complex interplay of sex, gender, and ethnicity

Several studies have reported a higher rate of COVID-19 mortality in men compared with women. A higher rate of COVID-19 mortality has also been reported in Black, Asian and minority ethnic (BAME) groups, compared with White ethnicity, especially among healthcare providers. While some studies attempted to examine if existing disparities could be explained by socioeconomic variables as opposed to biologic differences, existing body of literature does not clearly answer whether the reported gender difference varies across the ethnic groups, and whether the ethnic difference varies in men and women. Studies that reported on gender difference adjusted for ethnicity assuming that the gender difference is fixed across the ethnic groups. Similarly, studies reporting on ethnic differences adjusted for gender assuming that the ethnic difference is fixed in men and women. We highlighted some of these methodological and analytic issues along with their limitations in answering some of these questions of immense public health importance.

Nazrul Islam, Kamlesh Khunti, Hajira Dambha-Miller, Ichiro Kawachi, Michael Marmot. COVID-19 mortality: A complex interplay of sex, gender, and ethnicity. European Journal of Public Health. 2020:ckaa150.