Sex-differences in mortality rates and underlying conditions for COVID-19 deaths in England and Wales

Abstract

Background: Limited national data exists on the prevalence and distribution of underlying conditions among COVID-19 deaths between sexes and across age groups. Methods: All adult (=18 years) deaths recorded in England and Wales (1st March 2020 to 12th May 2020) were retrospectively analyzed. We compared 1) the prevalence of underlying health conditions between COVID and non-COVID related deaths during the COVID-19 pandemic and 2) the age-standardized mortality rate (ASMR) of COVID-19 compared with other primary causes of death, stratified by sex and age group.
Results: Of 144,279 adult deaths recorded during the study period, 36,438 (25.3%) were confirmed COVID cases. Women represented 43.2% (n=15,731) of COVID deaths compared to 51.9% (n=55,980) in non-COVID deaths. Overall, COVID deaths were younger nonCOVID deaths (82 vs. 83 years). ASMR of COVID-19 was higher than all other common primary causes of death, across age groups and sexes, except for cancers in women between the ages of 30-79 years. A linear relationship was observed between ASMR and age amongst COVID-19 deaths, with persistently higher rates in men than women across all age groups. The most prevalent reported conditions were hypertension, dementia, chronic lung disease and diabetes, and these were higher amongst COVID deaths. Pre-existing ischemic heart disease was similar in COVID (11.4%) and non-COVID (12%) deaths. Conclusions: In a nationwide analysis, COVID-19 infection was associated with higher agestandardized mortality than other primary causes of death, except cancer in women of select age groups. COVID-19 mortality was persistently higher in men and increased with advanced age.