Evaluation of difference of severity and mortality of Covid-19 disease in terms of gender: A review paper

Covid-19 disease is caused by infection with the SARS-COV-2 virus. The prevalence of the disease is almost similar between men and women, but the mortality rate is higher in men than women. This study assesses the cellular and molecular aspects involved in the difference of severity and mortality of Covid-19 disease between men and women.

papers published in Science direct, Google, Google scholar and Pubmed databases during 2019 to 2021 based on keywords individually or in combination including "COVID-19", "SARS-COV-2", " "sex differences", "gender", "gender differences", "severity" and "mortality" were collected and after deleting similar papers and irrelevant papers, the rest were assessed.

The majority of studies have shown that the prevalence of Covid-19 disease is approximately equal between men and women, while the severity of the disease and the resulting mortality in men are significantly higher than in women.

A combination of genetic and immunological factors, differences in hormone secretion, and lifestyle can be considered as factors which differences in disease severity, and mortality between the sexes. Stronger innate and specific immune systems in women, escape from X-chromosome inactivation in areas of immune-related genes, and the estrogen-boosting effect on the female immune system can be important factors in low mortality of Covid-19 disease in women compared to men. In addition, environmental factors such as smoking can affect the severity and mortality of Covid-19 disease, which is more common in men.