• Tamara Rushovich, Marion Boulicault, Jarvis T Chen, Ann Caroline Danielsen, Amelia Tarrant, Sarah S Richardson, and Heather Shattuck-Heidorn.
• Population Health Sciences Department, Harvard Graduate School of Arts and Sciences, Cambridge, MA, USA. trushovich@g.harvard.edu.
• J Gen Intern Med. 2021 Jun 1; 36 (6): 169617011696-1701.

BackgroundInequities in COVID-19 outcomes in the USA have been clearly documented for sex and race: men are dying at higher rates than women, and Black individuals are dying at higher rates than white individuals. Unexplored, however, is how sex and race interact in COVID-19 outcomes.ObjectiveUse available data to characterize COVID-19 mortality rates within and between race and sex strata in two US states, with the aim of understanding how apparent sex disparities in COVID-19 deaths vary across race.Design And ParticipantsThis observational study uses COVID-19 mortality data through September 21, 2020, from Georgia (GA) and Michigan (MI).Main MeasuresWe calculate age-specific rates for each sex-race-age stratum, and age-standardized rates for each race-sex stratum. We investigate the sex disparity within race groups and the race disparity within sex groups using age-standardized rate ratios, and rate differences.Key ResultsWithin race groups, men have a higher COVID-19 mortality rate than women. Black men have the highest rate of all race-sex groups (in MI: 254.6, deaths per 100,000, 95% CI: 241.1-268.2, in GA:128.5, 95% CI: 121.0-135.9). In MI, the COVID-19 mortality rate for Black women (147.1, 95% CI: 138.7-155.4) is higher than the rate for white men (39.1, 95% CI: 37.3-40.9), white women (29.7, 95% CI: 28.3-31.0), and Asian/Pacific Islander men and women. COVID-19 mortality rates in GA followed the same pattern. In MI, the male:female mortality rate ratio among Black individuals is 1.7 (1.5-2.0) while the rate ratio among White individuals is only 1.3 (1.2-1.5).ConclusionWhile overall, men have higher COVID-19 mortality rates than women, our findings show that this sex disparity does not hold across racial groups. This demonstrates the limitations of unidimensional reporting and analyses and highlights the ways that race and gender intersect to shape COVID-19 outcomes.

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