International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2026
Sex differences in COVID-19 infection and mortality in Hong Kong.
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Law Alexandra H T, Wong Jessica Y, Lin Yun, Cowling Benjamin J, Wu Peng
Аннотация
BACKGROUND: Sex differences in COVID-19 mortality have been widely reported. We examined infection and mortality patterns by sex across multiple COVID-19 epidemic waves in Hong Kong and investigated the contribution of vaccination status and pre-existing chronic conditions to the observed sex differences.
METHODS: We estimated age- and sex-specific incidence risks of cases, hospitalizations, and deaths per 100,000 population. Case-hospitalization risks, case-fatality risks (CFRs), and hospital-fatality risks were estimated with and without adjustment for vaccination status and pre-existing chronic conditions. We compared the sex ratio of COVID-19 mortality with that of other respiratory diseases during the pre-pandemic period (2000-2019).
RESULTS: Hong Kong recorded 2,876,110 COVID-19 cases and 12,737 deaths from January 2020 to January 2023, with males comprising 45.8% of cases and 59.1% of deaths. Infection risks were similar between sexes across all eight epidemic waves. Males consistently had higher CFRs and hospital-fatality risks in every wave. The elevated male mortality risk persisted after adjustment for vaccination and chronic comorbidities. The male-to-female ratio of COVID-19 mortality mirrored that observed for other respiratory diseases in the pre-pandemic period.
CONCLUSIONS: While SARS-CoV-2 infection risks were similar by sex, males experienced significantly higher mortality risks that remained after adjusting for known risk factors. COVID-19 shows a similar male-to-female mortality ratio to other respiratory diseases.
METHODS: We estimated age- and sex-specific incidence risks of cases, hospitalizations, and deaths per 100,000 population. Case-hospitalization risks, case-fatality risks (CFRs), and hospital-fatality risks were estimated with and without adjustment for vaccination status and pre-existing chronic conditions. We compared the sex ratio of COVID-19 mortality with that of other respiratory diseases during the pre-pandemic period (2000-2019).
RESULTS: Hong Kong recorded 2,876,110 COVID-19 cases and 12,737 deaths from January 2020 to January 2023, with males comprising 45.8% of cases and 59.1% of deaths. Infection risks were similar between sexes across all eight epidemic waves. Males consistently had higher CFRs and hospital-fatality risks in every wave. The elevated male mortality risk persisted after adjustment for vaccination and chronic comorbidities. The male-to-female ratio of COVID-19 mortality mirrored that observed for other respiratory diseases in the pre-pandemic period.
CONCLUSIONS: While SARS-CoV-2 infection risks were similar by sex, males experienced significantly higher mortality risks that remained after adjusting for known risk factors. COVID-19 shows a similar male-to-female mortality ratio to other respiratory diseases.