COVID-19 mortality in women and men in sub-Saharan Africa: a cross-sectional study
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Abstract
Since sex-based biological and gender factors influence COVID-19 mortality, we wanted to investigate the difference in mortality rates between women and men in sub-Saharan Africa (SSA).
Method
We included 69 580 cases of COVID-19, stratified by sex (men: n=43 071; women: n=26 509) and age (0–39 years: n=41 682; 40–59 years: n=20 757; 60+ years: n=7141), from 20 member nations of the WHO African region until 1 September 2020. We computed the SSA-specific and country-specific case fatality rates (CFRs) and sex-specific CFR differences across various age groups, using a Bayesian approach.
Results
A total of 1656 deaths (2.4% of total cases reported) were reported, with men accounting for 70.5% of total deaths. In SSA, women had a lower CFR than men (mean C F R d i f f = −0.9%; 95% credible intervals (CIs) −1.1% to −0.6%). The mean CFR estimates increased with age, with the sex-specific CFR differences being significant among those aged 40 years or more (40–59 age group: mean C F R d i f f = −0.7%; 95% CI −1.1% to −0.2%; 60+ years age group: mean C F R d i f f = −3.9%; 95% CI −5.3% to −2.4%). At the country level, 7 of the 20 SSA countries reported significantly lower CFRs among women than men overall. Moreover, corresponding to the age-specific datasets, significantly lower CFRs in women than men were observed in the 60+ years age group in seven countries and 40–59 years age group in one country.
Conclusions
Sex and age are important predictors of COVID-19 mortality globally. Countries should prioritise the collection and use of sex-disaggregated data so as to design public health interventions and ensure that policies promote a gender-sensitive public health response.
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SciScore for 10.1101/2021.07.31.21261422: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitations of the study: Thus far, to the best of our knowledge, this is one of the largest studies exploring sex-specific differences in CFRs at regional and country level of SSA. Our data was derived from individual-level patient data, which included information on age and sex, for a consecutive duration of 120 days from …
SciScore for 10.1101/2021.07.31.21261422: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and limitations of the study: Thus far, to the best of our knowledge, this is one of the largest studies exploring sex-specific differences in CFRs at regional and country level of SSA. Our data was derived from individual-level patient data, which included information on age and sex, for a consecutive duration of 120 days from 20 SSA countries. Due to data unavailability, we were only able to include 20 from the 47 member states comprising the WHO African region. A particular strength of our study included our choice of prior. Our sensitivity analysis indicated that our prior was robust, since the results from all priors considered produced similar results. Among the 20 countries, only four countries had low sample sizes in some age categories, suggesting strong statistical validity and accuracy among the remaining 16 countries. Our study however, goes not without limitations. Our dataset was solely limited to age and sex; other gender-relevant indicators, such as presence of comorbidities, socioeconomic status, and immunological conditions were not available for analysis, preventing us from conducting further analyses on gender-related health inequities. Furthermore, gendered hospital admissions and differential treatment for men and women in clinical settings could act as a confounding source of bias to COVID-19 case and death reporting, impacting our CFR results. Due to lack of data, we could not address this. Moreover, case definition, surveillance capacity (e....
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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