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Sex differences in COVID-19 case fatality: do we know enough?

Global data indicate higher COVID-19 case fatality rates among men than women. Most countries with available data indicate a male to female case fatality ratio higher than 1·0, ranging up to 3·5 in some cases (appendix).1 However, the COVID-19 case fatality rate is higher in women than men in a few countries, such as India, which is one of the worst-affected countries. As of Sept 30, 2020, India had more than 6·4 million recorded COVID-19 cases.2 In India, the COVID-19 case fatality rate among men is 2·9% and 3·3% among women.3 Case fatality rates in Nepal, Vietnam, and Slovenia are also higher among women than men.1 These findings are surprising since global data have indicated that both biological factors (stronger immune responses) and behavioural risk factors (eg, smoking, and other lifestyle habits) place men at a greater risk for health complications and death as a consequence of COVID-19.4, 5 Such differential findings on the association between sex and COVID-19 case fatality between countries might reflect incomplete COVID-19 data across geographies, biases in case identification by sex, or higher risks for women in certain countries due to demographic factors or countries’ health profiles…

Dehingia, N., & Raj, A. (2020). Sex differences in COVID-19 case fatality: do we know enough?. The Lancet Global Health.

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