Covid-19 sex based differences and inequality?

[RedToothBrush]

Some figures which are concerning and need more explanation.

The ONS figures record the following:

Our latest data on weekly deaths registrations include deaths involving COVID-19. In the three weeks up to 27 March, there were 647 deaths in England and Wales involving COVID-19 (397 men and 250 women).

The majority of deaths involving COVID-19 have been among people aged 65 years and over (568 out of 647), with 41% (233) of these occurring in the over-85 age group.

Our figures are based on deaths registered in the stated period and include all deaths where “COVID-19” was mentioned on death certificates. They differ from those published by the Department of Health and Social Care (DHSC), which are based on deaths occurring to date among hospital patients who have tested positive for COVID-19.

That's 38.6% women to 61.4% men.

Concerning is the Department of Health figures for deaths in hospital don't appear to be recording sex. I can't find a data set from the Doh directly recording this information. (if anyone can let me know)

What we do know is that there is research into those admitted to critical care by sex.

This states that 27% are women v 73% men. For non covid-19 viral pneumonia you'd expect a 46:54 split.

The sex differences in covid-19 deaths (men more likely to need critical care and to die) have been found consistently across multiple countries. Are you suggesting that China, Italy, France, USA etc. are also mis-recording figures for the same reasons as the UK?

Could the non icu deaths be elderly ladies with dnr’s... as women live longer, does that mean there are a higher proportion of women than men in the over 70 age group?

Are you suggesting that China, Italy, France, USA etc. are also mis-recording figures for the same reasons as the UK?

Health inequality does exist across the world with how disease presents differently in women often being overlooked.

So yes, its a possibility.

Yes I agree that elderly women with DNR could be a big factor - particularly with care homes.

My issue with that is that in the uk, women are not being given palliative care in care homes, meaning they aren't getting proper medical attention in many cases even if that is palliative.

All the resources are going on expanding critical care - which seems to be disproportionality benefitting men. And when it comes to the other flip side of that carers can't even get PPE meaning that there will be predominately elderly women, who might have several years of life left, who are being let down and may die as a result.

Women, globally, are regarded as less important in terms of protecting their health.

I'm not staying that anyone is mis-recording figures as it goes. I'm saying that the information we get from sex based data gives us a clearer picture of who is benefiting from the measures in place and who is being overlooked.

Is it something to do with the immune fighting genes being on the X chromosome. Of which we have two. Or is that bollocks?

“55.4% of women admitted to critical care recover versus 47.8% of men.

So we know that men are much more likely to die in critical care than women. But this does not tally with the percentage of women recorded with covid-19 on their death certificate.“ (which you listed as 38.6% deaths are women and 61.4% men)

Well they wouldn’t tally would they because they are % measured against different populations.

The first, 55.4% of women recovering in critical care is measuring against the 100% of women who are admitted to critical care. The second, number 38.6% is measuring against the 100% of women AND men who die of COVID. Therefore the 44.6% of women in critical care that die, equal the 38.6% of ALL the men AND women in critical care that do not survive.

They do NOT suggest that “lots of women aren’t making it to critical care” What they suggest is that more men are dying during critical care than women. Which they are because the stats show that only 47.8% of the men admitted to critical care survive.

Health inequality does exist across the world with how disease presents differently in women often being overlooked.

Have we any evidence that covid-19 presents differently in women than men? I know that's true for heart attacks but I've never heard it to be the case for infectious disease.

All the resources are going on expanding critical care - which seems to be disproportionality benefitting men.

Well yes, because men are more likely to need such care. But is there any evidence that women are being denied such care if they need it?

I agree about the need for palliative care. Unfortunately we can't save everyone from dying, but we can save them from avoidable pain. But palliative care would also disproportionately benefit men (because they are disproportionately more likely to die).

I agree we need sex-based statistics. But they may not show what you expect them to show.

Is it something to do with the immune fighting genes being on the X chromosome. Of which we have two.

There's evidence from historical epidemics and famines that women are more likely to survive than men, which suggests a more robust immune system (famine-related death is more likely due to disease rather than directly from starvation).

OTOH, women are more likely to suffer auto-immune illness.

Have we any evidence that covid-19 presents differently in women than men? I know that's true for heart attacks but I've never heard it to be the case for infectious disease.

We can't in the UK, because the NHS study into what symptoms people have, isn't asking for sex. This is DESPITE knowing there is a significant difference in how the virus is affecting men and women. Its a massive oversight.

I agree we need sex-based statistics. But they may not show what you expect them to show.

I very much agree with that. If we aren't studying it though, we wouldn't find out whether what we expect is either right OR wrong!

You are also drawing your statistics from different samples so you cannot really draw any conclusions on whether any women who should have had critical care did not get it.

The death rate split of 38.6% and 61.4% is from a sample of 647 deaths in the three weeks before March.

The 27% to 73% critically ill by sex is a 2,246 sample of critically ill admissions in a single 24hr period.

Don’t know where you got the recovery statistics from? Couldn’t really see the second picture you posted.

But anyway, you can’t mix and match different statistics from different sample populations taken at different times. You have to analyse statistics taken from the same sample population over the same time period.

I am aware of this, but I still think that a difference of 10% between the two sets of figures is something that needs greater exploration.

Which we can't do if we aren't getting proper information about the male / female breakdown in every data set and data collection method.

The point is there is a gap here, which we should be considering more to ensure there isn't something we are missing.

The virus does appear to have a male / female difference of some kind. The absence of trying to explore this for as full explanation as possible strikes me to put it bluntly - complete madness.

I agree we do need to continue to track sex of patients.
But the difference of 10% between two figures that are not at all connected is irrelevant. Its an apples to oranges comparison. It’s like taking the sex % of cancer patients at one hospital and then comparing it to the sex % of cancer deaths in another hospital a year later.

So far, the data does show health inequality favouring women though. Death is the ultimate poor outcome and more men are dying than women even though we catch COVID in equal numbers. It does need to be researched and so they should be tracking sex throughout everything.

This is a really important observation, Red.

And, gee, how did I know before even bothering to read that Plan would find a way to downplay this? When your motivated reasoning is that obvious and transparent - and especially when the motivations concerned are so transparently contemptible- you should be ignored by everyone.

Of course it is important that the population who have received critical care are proportionately far more male than the population who died. OBVIOUSLY the populations are different, that's the entire point.

The difference is clearly statistically significant - so the question is why aren't these two samples drawn from the same population?

Benign hypothesis: women who get Covid are older and therefore less likely to be ventilated and less likely to be allocated a critical care bed- but is this a benign hypothesis, really? If women are likely to survive ventilation at an older age than men, then that should be taken into consideration by doctors. Doctors should have a cut-off for the "critical care admission" decision based on "likeliness to survive" not on age alone. Of course everyone is flying by the seat of their pants and there isn't a formula available yet for making good decisions, but whatever criteria doctors are using, they are disproportionately allowing women to die.

Less benign hypothesis: this is straight up medical neglect of women compared to men, an extensively documented phenomenon.

I suspect it's something in between the two. But it seems like the criteria on whether to admit someone into critical care, and when to ventilate them, should be formalised fast, and sex should be one of the relevant variables.

women who get Covid are older and therefore less likely to be ventilated and less likely to be allocated a critical care bed

AFAIK, the NHS has not yet started rationing critical care beds. Certainly they weren't in March when these figures were taken. I know in Italy they had to triage patients because they hadn't enough ventilators to keep up with the surge, but I don't think the UK has reached that stage yet (hopefully we keep ahead of that curve).

this is straight up medical neglect of women compared to men, an extensively documented phenomenon.

Given that men are more likely to die, you could make an argument in the opposite direction, that men were being neglected in favour of women. I don't believe this is the case, it's more likely biological or lifestyle factors. But it would actually be a more logical argument.

There are plenty of feminist issues around this outbreak (childcare, protection of NHS staff). But to say that women are being neglected in a situation where men are more likely to die... It's like the reverse of "what about the menz?"

But it would actually be a more logical argument.

It actually wouldn't, you're confused. But I suppose it's good that you offered an opportunity to clear up the confusion before a bunch of more belligerently confused people made the same mistake.

Men are more likely to die of covid for biological reasons - nothing to do with the choices doctors make.

Women who die of covid are less likely to have been in critical care. This means that if you're a woman who needs treatment to save you from dying, you're less likely to get it than if you're a man who needs treatment to save you from dying.

That is unquestionably an issue of medical neglect. If this pattern holds up in other data, there is no question as to whether the neglect is happening and the only question is whether there are some semi-benign reasons for it.

. It's nothing like "what about the menz?" Doctors shouldn't be neglecting female patients to even up the death rates - I'm not suggesting that they are doing that of course. I am saying that by your argument we'd have no right to complain if they were doing that.

@DreadPirateLuna , I have MS - an autoimmune fuck up in my system and apparently women are much more likely to get MS for that reason.

Men are more likely to die of covid for biological reasons - nothing to do with the choices doctors make.

Agree that is most likely the case.

Women who die of covid are less likely to have been in critical care.

The evidence for that (as outlined above) is really flimsy. You can't just compare the % of deaths over a 3 week period to the % in ICU at any one time. Covid-19 patients may be in ICU for an extended period; those in ICU today include those who might die tomorrow as well as those who might die next week. The figures are not comparable.

If it turns out that women are being denied treatment, I'll be just as outraged as you are. But I'm not seeing evidence for that.

I have MS - an autoimmune fuck up in my system and apparently women are much more likely to get MS for that reason.

Sorry to hear that. A friend of my family has MS and it's not fun. A strong immune system unfortunately has downsides. Hope you are getting good treatment and taking care of yourself.

If you have a 95 year old woman catching covid-19 in a care home (and it will be mostly women in care homes, because men die younger), then I'd expect that they'd die there, rather than be brought to hospital.

At least that was my experience of my grandmothers dying a few years ago. both were over 100 and neither wanted to die in hospital.

Clearly a 60-something your old in otherwise reasonable health is different and you would hope they receive medical care in hospital.

In terms of the OP I would suggest looking at the sex ratios of people aged 80+ in the UK, which is I believe around 59% female, and compare the covid-19 death age pyramid, where more than 50% of deaths are aged 80+

Doctors should have a cut-off for the "critical care admission" decision based on "likeliness to survive" not on age alone.

They do though. The NICE triage algorithm is based on frailty score, which isn't age related. It's health based.

There are more elderly women than men. The likelihood of having more severe co morbidities in old age is higher but in that case you are ruling out based on likelihood to not survive ITU rather than discriminating based on age or sex.

Fact is men are roughly twice as likely to die from this than women. It takes a special kind of person to try to argue that women are suffering more than men in this case.