Share on Pinterest
Experts say biology as well as behavior may be among the reasons more men than women are developing COVID-19 and dying from the disease. Getty Images
  • Several studies have shown that more men are dying from COVID-19 than women.
  • Experts say part of the reason is women tend to have stronger immune systems than men.
  • They add that men also tend to engage in more risky behavior such as ignoring physical distancing, and they don’t take symptoms as seriously.

All data and statistics are based on publicly available data at the time of publication. Some information may be out of date.

More men are dying from COVID-19 worldwide than women, and the potential reasons run the gamut from biology to bad habits.

A study published in April in Frontiers in Public Health reported that men and women were equally likely to contract the novel coronavirus.

However, the researchers also reported that men are significantly more likely to suffer severe effects of the disease.

The Chinese researchers said that in one large subset of COVID-19 patients, more than 70 percent of those who died were men.

They said they found similar results when they examined research from the 2003 outbreak of severe acute respiratory syndrome (SARS).

The study was backed up by other figures released since the COVID-19 pandemic began.

The World Health Organization (WHO) has reported that 63 percent of deaths related to COVID-19 in Europe have been among men.

A study by the Higher Health Institute of Rome in March found that among Italians hospitalized for the novel coronavirus, 8 percent of men died compared to 5 percent of women.

In New York City, men have been dying of coronavirus at almost twice the rate of women. The city’s health department reported in early April that 43 COVID-19 deaths for every 100,000 men, compared with 23 deaths for every 100,000 women.

The Centers for Disease Control and Prevention (CDC) currently isn’t reporting COVID-19 deaths by gender, but experts see no reason the trend would differ elsewhere in the country.

“Some of the underlying reasons why COVID-19 may be more deadly for men than women may include the fact that heart disease is more common in elderly men than in elderly women,” Dr. Stephen Berger, an infectious disease expert and co-founder of the Global Infectious Diseases and Epidemiology Network (GIDEON), told Healthline. “Studies also find that high blood pressure and liver disease are more prevalent in men and these all contribute to more negative outcomes with COVID-19.”

A study published on May 10 reported that men men have higher concentrations of angiotensin-converting enzyme 2 (ACE2) in their blood than women.

Since ACE2 enables the coronavirus to infect healthy cells, this may help to explain why men are more vulnerable to COVID-19 than women, the researchers reported.

The immune system may also be a factor.

“Genetics may also play a big role,” Berger said. “Women, because of their extra X chromosome, have a stronger immune system and response to infections than men.”

“You can’t get away from biology and genetics,” agreed Salvatore J. Giorgianni, PharmD, a pharmacist and senior science advisor for the Men’s Health Network, which advocates for the health of men and boys.

The phenomenon actually prompted the launch of two clinical trials in the United States.

In these trials, scientists are giving men with COVID-19 sex hormones such as estrogen to see if that will help them recover from the illness.

Males are culturally conditioned to think of themselves as strong, Giorgianni told Healthline, but “women are not the ‘weaker sex’ when it comes to immunity.”

Moreover, he noted, men have higher rates in 9 out of 10 of the leading causes of death in the United States.

That means they’re more likely to have preexisting conditions that can make COVID-19 more dangerous.

Behaviors that impact lung health, such as smoking, also may play a role in the disease’s deadly impact on men.

“In China, for example, smoking is largely a male habit, resulting in many men suffering from chronic lung disease,” Berger said. “This puts men at a much greater disadvantage should they get COVID-19.”

The WHO estimates that air pollution kills more than 4 million people annually by contributing to illnesses such as asthma, bronchitis, emphysema, lung and heart diseases, and respiratory allergies.

A recent study from the Harvard T.H. Chan School of Public Health in Massachusetts reported that people who live in areas with high levels of air pollution are also more likely to die of COVID-19 than those in less polluted areas.

Pollution could also be playing a role in elevated COVID-19 mortality rates among men.

“In most cultures, men are more likely to be engaged in outdoor work, exposing them to conditions associated with extreme climate and pollution,” Berger said. “This could directly impact their response to an infection like COVID-19.”

High-risk occupations deemed “essential” under pandemic emergency orders — notably first responders — also may be “disproportionately jobs men traditionally do,” Derek M. Griffith, PhD, director of the Institute for Research on Men’s Health at Vanderbilt University in Tennessee, told Healthline.

Higher rates of death among men in pandemics is not new.

Research on the worldwide flu of 1918, for example, found that non-elderly adult males died at a much higher rate than women, possibly because more men had a history of lung-damaging tuberculosis.

Male behavior during the pandemic also could be increasing their exposure to the novel coronavirus.

A Gallup poll taken between March 2 and 13 found that women were more concerned about COVID-19 than men were (by a 62 to 58 percent margin).

“It’s possible that men are more at risk because they tend to expose themselves more to larger crowds and social exchanges, including things like handshaking and sporting events,” Berger said.

“There are men with invincibility syndrome that underpins a lot of behaviors, and they tend to be less compliant” with pandemic-related restrictions such as physical distancing, Giorgianni said.

For other men, he said, the issue isn’t so much a cavalier attitude as simply being conditioned “to think of health as ‘not their job.’”

COVID-19 prevention messages aimed at men should focus on these traditional male roles, “not ignore millions of year of biology and natural selection,” Giorgianni said.

“Guys are very concerned for their families, so tell them don’t do it for yourself, do it for those who love you,” he said. “Even if they feel like they’re in good shape and can fight it off, they can still be a carrier can cause the death of their spouse or daughter or their dad.”

Griffith cautioned, however, that much remains unknown about COVID-19, including its different impact on men and women.

“It’s worth considering these factors, but it’s a little premature,” he said. “Most of these statements seem to assume we know more about this disease than we do.”

One thing that is well-proven, however, is that men tend to delay seeking healthcare and ignore or dismiss symptoms of illness.

“Many men see self-care as an admission of weakness,” David Ezell, chief executive officer of Darien Wellness, a mental health group in Connecticut, told Healthline. “We are taught to be self-sufficient and there for everyone but ourselves. That results in ignoring telltale symptoms of not only COVID but any life-threatening condition.”

Dr. Deborah Birx, the COVID-19 response coordinator for the Trump administration, noted at an April 9 briefing that 56 percent of people who have been tested for the illness are male compared to 44 percent female.

Of the men who were tested, 23 percent were positive for COVID-19, compared to 16 percent of women.

“It gives you an idea about how men often don’t present in the healthcare delivery system until they have greater symptomatology,” Birx said. “This is to all of our men out there, no matter what age group: If you have symptoms, you should make sure that you are tested.”