A new review article from Beth Israel Deaconess Medical Center (BIDMC) shows people who are biologically male are dying from COVID-19 at a higher rate than people who are biologically female. In a review published in Frontiers in Immunology, researcher-clinicians at BIDMC explore the sex-based physiological differences that may affect risk and susceptibility to COVID-19, the course and clinical outcomes of the disease, and response to vaccines.

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“The COVID-19 pandemic has revealed a striking gender bias with increased mortality rates in men compared with women across the lifespan,” said corresponding author Vaishali R. Moulton, MD, PhD, an assistant professor of medicine in the Division of Rheumatology and Clinical Immunology at BIDMC. “Apart from behavioral and lifestyle factors that differ between men and women, sex chromosome-linked genes, sex hormones and the microbiome control aspects of the immune responses to infection and are potentially important biological contributors to the sex-based differences we’re seeing in men and women in the context of COVID-19.”

Moulton and co-authors Nirupa Gadi, Samantha C. Wu and Allison P. Spihlman, all medical students in Moulton’s laboratory at BIDMC, acknowledge that demographic differences between men and women predispose each group to risk in different ways. Men, for example, are more likely to smoke cigarettes, a known risk factor for severe COVID-19, and are more likely to have cardiovascular disease and hypertension, important underlying comorbidities in COVID-19; while women are more likely to hold jobs in health care, increasing their potential exposure to the virus.