Why is the coronavirus killing nearly twice as many men as women in Spain?

With more than 40,000 cases and nearly 3,000 deaths, the profile of the people who are dying in Spain from the Covid-19 disease caused by the SARS-CoV-2 coronavirus is becoming clearer. The most common victim is male, above the age of 80 and with previous health conditions – in particular, heart related. That’s according to a report from the Carlos III Health Institute (ISCIII), which has analyzed 16,000 coronavirus cases, among which there were 566 deaths. The data reveals that while the disease only affects slightly more men than women (52%), the number of men who died from the disease in this data sample was nearly double that of the number of women: 376 versus 190.

With no clinical studies yet that elaborate on the risk factors, all the evidence so far is pointing to the influence of previous illnesses when it comes to mortality rates. This was explained on Monday by Fernando Simón, the director of the Health Ministry’s Coordination Center for Health Alerts, and one of the government’s most visible faces in Spain during the ongoing coronavirus crisis. “The illness affects certain risk groups more: those with high blood pressure, people with respiratory problems, diabetics – they all have higher mortality rates,” he explained. “[These illnesses] affect men more than women, which is why it is normal that they suffer higher death rates.”

According to the study, 74% of coronavirus patients who died or who required intensive care had some kind of previous condition

This theory is also supported by María del Mar Tomás, the spokesperson for the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), who adds that genetic factors that we don’t yet know about could also be playing a role. The same argument is supported by Germán Peces-Barba, the vice president of the Spanish Pneumology and Thoracic Surgery Society (SEPAR). “The fatality rates are closely associated to age and comorbidities, and in Spain older men have a lot more of these,” he explains. Some researchers are also pointing to differences in hormones and the immune system that could have a role in the body’s response to the coronavirus, but these are unproved speculations for now.

In the cases analyzed by the ISCIII, whose sample differs from the last report from the Health Ministry, 74% of coronavirus patients who died or who required intensive care had some kind of previous condition: 64% presented cardiovascular diseases, 19% had respiratory problems, and 16% some other kind of issue. In other countries, diabetes, cancer or immunosuppression issues have been shown to be a factor. The report also underlines the key factor of age: nearly 90% of those who died were over the age of 70 (19.8% between 70 and 79, and 68.9% 80 or over).

These results are in line with what other studies have shown in the most-affected countries, such as Italy, China and South Korea. Research published at the beginning of March pointed to chronic obstructive pulmonary disease as the illness that most increased the risk of needing intensive care after contracting the coronavirus, followed by hypertension and vascular diseases.

The illness affects certain risk groups more: those with high blood pressure, people with respiratory problems, diabetics

Fernando Simón, director of the Health Ministry’s Coordination Center for Health Alerts

This result is compatible with there being fewer patients in intensive care with respiratory illnesses than with cardiovascular issues, given that the latter are much more frequent. Something similar is happening with diabetes, which, in the view of Alfonso López Alba, the spokesperson for the Spanish Diabetes Society, is one of the main risk factors. “The fatality rate varies, but we know that it is around 0.9% and 3%,” he explains. “For diabetes sufferers, this rises to 7.3%, which multiplies the chance of dying from Covid-19 by two, in the best of cases, and by eight, in the worst.”

Another vulnerable group, cancer patients, could be at risk due to the treatment they are following. “Radiotherapy, chemo and palliative care can cause a reduced cellular response to the virus,” explains Tomás. But she insists that until clinical studies have been carried out, it will be impossible to determine with any certainty what it is that makes some people more vulnerable to the coronavirus than others.

English version by Simon Hunter.