Sex disparities in COVID-19 outcomes in the United States: Quantifying and contextualizing variation.

This paper presents the first longitudinal study of sex disparities in COVID-19 cases and mortalities across U.S. states, derived from the unique 13-month dataset of the U.S. Gender/Sex COVID-19 Data Tracker. To analyze sex disparities, weekly case and mortality rates by sex and mortality rate ratios were computed for each U.S. state, and a multilevel crossed-effects conditional logistic binomial regression model was fitted to estimate the variation of the sex disparity in mortality over time and across states. Results demonstrate considerable variation in the sex disparity in COVID-19 cases and mortalities over time and between states. These data suggest that the sex disparity, when present, is modest, and likely varies in relation to context-sensitive variables, which may include health behaviors, preexisting health status, occupation, race/ethnicity, and other markers of social experience. • First report of findings from unique longitudinal dataset of sex-disaggregated COVID-19 data in U.S. states. • Sex disparities in COVID-19 are highly heterogeneous in magnitude and direction and vary across states and over time. • Gender-related and other social and contextual factors likely shape COVID-19 sex disparities. • Single-factor approaches are ill-positioned to explain patterns in sex disparities in COVID-19 outcomes. [ABSTRACT FROM AUTHOR]