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Riddle of higher COVID-19 mortality risk for men
Since the beginning of the COVID-19 pandemic, which was triggered by the novel coronavirus SARS-CoV-2, it has become apparent that more men are affected by the course of the disease than women. Even among the deaths, two thirds of all those affected are men, although both sexes are infected equally often. Experts compile reasons for the gender difference.
The numbers are now clear: men die more often from coronavirus disease. But why? Scientists are assuming various assumptions.
Men are more at risk of coronavirus than women
Men have a poorer prognosis for coronavirus disease than women. They often develop COVID-19 and die more often. What initially appeared to be a phenomenon from China with its large number of smoking men is now confirmed worldwide.
Data from the "Global Health 50/50" research initiative from more than 20 countries show that women are infected just as frequently as men. However, the distribution of death rates is around one third to two thirds.
More men affected in Germany too
"We see that here in Germany too. We have a large number of male patients, ”says Clemens Wendtner, chief physician at the Clinic for Infectious Diseases at Munich Clinic Schwabing, who treated the very first corona patients in Germany in February. Christoph Spinner from the Klinikum rechts der Isar at the Technical University of Munich (TUM) also says: "It definitely affects more men."
According to the situation report by the Robert Koch Institute (RKI) on June 21, at least twice as many men as women died across all age groups up to the 70- to 79-year-olds. Only then does the relationship initially adjust and reverse from the age group of 90 to 99 year olds, but possibly because there are more elderly women than men. The reasons at the RKI are that there are many unanswered questions. It would still take a long time before a reliable assessment was possible.
The cause could be a healthier lifestyle
A guess: The often less healthy lifestyle of men. Men of the older generation in particular, who paid less attention to diet and lifestyle, could suffer more from previous illnesses. It is also conceivable that men simply go to the doctor later - and therefore delay illnesses longer.
ACE2 receptor more common in men
Above all, the so-called ACE2 receptor, via which the Sars-CoV-2 virus can penetrate into the lungs, is under discussion - according to a study, it occurs in men in higher concentrations. The team at the University Medical Center Groningen examined the relationship between ACE2 and chronic heart failure and found the gender difference. The reason for the higher concentration of ACE2 in men is not known, the researchers write in the "European Heart Journal".
The enzyme that appears in the lungs, kidneys, blood vessels, heart and gastrointestinal tract is considered the entry point for coronaviruses - for simple colds as well as for the diseases caused by coronaviruses COVID-19, Sars and Mers. Men were also more affected at Mers, says Bernhard Zwißler, director of the Clinic for Anaesthesiology at the LMU Clinic. It is currently being investigated whether the administration of ACE inhibitors as antihypertensive agents leads to the fact that cells increasingly form the ACE2 receptor and are therefore more susceptible to infection. This is conceivable, but it has not been proven so far.
Cardiovascular disease more common in men
Cardiovascular disease is a risk factor for COVID-19 anyway - and men are more affected than women. “From a global perspective, men die more often from cardiovascular diseases. But we don't know if that's the key, ”explains Spinner. He also sees a possible explanation in the different regulation of the ACE2 receptor, but also warns caution when interpreting the previous findings.
Does estrogen protect against severe courses?
Some experts also see the female hormone estrogen with its protective mechanism of action or the stronger immune system of women as factors for the different courses - without there being clear evidence here. According to virologists, the fact that the immune system of women generally reacts faster and more strongly than that of men to viral infections can also be seen in other viral diseases, such as the flu, Sars and Mers - or simple colds.
Jokes about the "runny nose" seem to contain a real essence. For this, women are more likely to suffer from autoimmune diseases in which the immune system overshoots and attacks their own cells - a possible complication even with COVID-19. Countless studies are currently underway on COVID-19 worldwide, including the gender differences. The doctors hope that clarifying this question will also open up new ways of treatment. (vb; source: Sabine Dobel, dpa)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Graduate editor (FH) Volker Blasek
- LMU Clinic: Two months of intensive care for Covid-19 patients at the LMU Clinic in Munich (published: May 13th, 2020), lmu-klinikum.de
- Global Health 50/50: COVID-19: Data disaggregated by age and sex (as of June 3, 2020), globalhealth5050.org
- RKI: Current situation report of the RKI on COVID-19 (published: June 22, 2020), rki.de
- Iziah E Sama, Alice Ravera, Bernadet T Santema, et al .: Circulating plasma concentrations of angiotensin-converting enzyme 2 in men and women with heart failure and effects of renin – angiotensin – aldosterone inhibitors; in: European Heart Journal, 2020, academic.oup.com