Black women are more likely to die of COVID-19 than white men: disputing the claim of “sex differences” in COVID-19 mortality
Authors: Heather Shattuck-Heidorn and Tamara Rushovich
Today in the Journal of General Internal Medicine, the GenderSci Lab publishes “Sex Disparities in COVID-19 Mortality Vary Across US Racial Groups,” the first analysis of the sex disparity in COVID-19 outcomes across racial groups in the United States. We also cover these findings in our op-ed at the Boston Globe. Our findings are stark. Black men are far more likely to die than any other group; but Black women have over 3 times higher mortality rates than white or Asian/Pacific Islander men (Figure 1). Further, the sex disparity within race varies widely. As can be seen in Michigan, the sex disparity is far greater among Black people than among white people.
Figure 1: COVID-19 mortality rate by race and sex
As others have extensively demonstrated, the reason for the racial disparities in COVID-19 mortality in the US clearly lies in structural inequities (for more on this, see Pirtle and Wright’s concept of structural gendered racism and this excellent review by Yearby & Mohaptra).
However, the sex disparity in COVID-19 outcomes has overwhelmingly been viewed as driven by innate, sex-linked processes. Hypotheses have focused on gonadal hormones such as testosterone or estrogens, as well as sex-linked genetics and evolutionarily deep sex differences in immune response, to explain greater male mortality from COVID-19, with scientists even proposing differential vaccine and treatment strategies for men and women. However, when both sex and racial group are considered, the impoverishment of a strictly biological sex-based causal model for the sex-disparity becomes clear.
As we have argued since the beginning of the pandemic, there is little reason to primarily consider innate sex as underpinning the tendency for more men to die of COVID-19 than women. Evidence from prior coronavirus pandemics, and ample evidence from the current COVID-19 pandemic, such as the large variation across time and space in the male:female mortality rate and the lack of “excess” male mortality above the baseline male:female difference in mortality, points to the strong role of social factors in determining this outcome. Our finding here of vastly different male:female mortality rates across racial groups in the United States also indicates that the sex-disparity in mortality among COVID patients is largely rooted in social factors. Our data demand an intersectional (as from the work of Black feminists and critical race theorists) analysis of how the social and structural categories of race and gender act to influence exposure and susceptibility to COVID-19.
“When both sex and racial group are considered, the impoverishment of a strictly biological sex-based causal model for the sex-disparity becomes clear.”
A limitation of our analysis is that currently only two US states report the data needed to conduct a race-by-sex analysis. Since July 2020, we have published a regularly updated Report Card which tracks state reporting of demographic variables in relation to COVID-19 outcomes. Little has changed since the earlier days of the pandemic, and most states do not adequately report simple demographic variables such as race, sex, and age in a format that allows for analysis of interactions. While reporting at the federal level has improved, there is still a need to expand the variables available in the publicly downloadable datasets. As this most recent publication proves, such data is absolutely critical to designing effective interventions as we continue to understand the effects of the pandemic across our society.
RECOMMENDED CITATION:
Shattuck-Heidorn, H. Rushovich, T. “Black women are more likely to die of COVID-19 than white men: disputing the claim of “sex differences” in COVID-19 mortality” GenderSci Blog, April, 5, 2021. Retrieved from: genderscilab.org/blog/black-women-are-more-likely-to-die-of-covid-19-than-white-men-disputing-the-claim-of-sex-differences-in-covid-19-mortality
STATEMENT OF INTELLECTUAL LABOR:
All authors provided substantive contributions to the ideas expressed in this blog post and participated in the preparation of the post.
CONTACT:
Questions, interested in collaborating with the GenderSci Lab, or media inquiry? Email us at: genderlab@fas.harvard.edu.