Early evidence indicates that while males overall bear a higher burden of coronavirus, females have a higher relative-risk of Covid-19 mortality in India. Data till May 20 reveals that the overall case fatality rate (ratio of number of confirmed deaths as to the total confirmed cases) among males is 2.9 per cent, but is significantly higher among females, at 3.3 per cent.
A new study reported in the Journal of Global Health Science has said these findings call for equal, if not greater, attention toward females for Covid-19 care.
Researchers from Population Research Centre, Institute of Economic Growth, Delhi, Institute of Health Management Research, IIHMR University, Jaipur, Centre for Development Studies, Thiruvananthapuram, Harvard Centre for Population and Development Studies, Cambridge, USA and Department of Social and Behavioral Sciences, and Harvard T H Chan School of Public Health, Boston used crowdsourced data (https://www.covid19india.org/) to provide preliminary estimates for age-sex specific Covid-19 case fatality rate (CFR) for India.
They analysed the burden of the cases and deaths for age-sex categories, which showed that as of May 20, males share a higher burden (66 per cent) of Covid-19 infections than females (34 per cent), but the infection is more or less evenly distributed in under-five as well as elderly age groups. The CFR among males and females is 2.9 per cent and 3.3 per cent, respectively.
While early estimates from the Ministry of Health and Family Welfare indicated that three-fourth of all confirmed cases are males, researchers have said it was important to disaggregate the burden to understand whether the inference is valid for children as well as the elderly age group. In fact, a bulk of the evidence on age-sex patterns in Covid-19 mortality has focused on adults and the elderly, and very little is known about the age-sex specific relative risks and patterns of Covid-19 mortality in the country.
The World Health Organization world standard population structure standardized CFR for India is 3.34 per cent. The adjusted-CFR is estimated to be 4.8 per cent, researchers said.
“An important concern is to examine the overall as well as age-specific Covid-19 infection and mortality risk from a gender lens. Preliminary evidence from various countries suggests that men are at a greater risk of both infections as well as deaths, but these inferences should be carefully interpreted,” S V Subramanian, Professor of Population Health and Geography at Harvard University said in their study – ‘Equal Risk, Unequal Burden? Gender Differentials in Covid-19 Mortality in India’- published recently in the Journal of Global Health Science.
Covid-19 cases in India doubled from 1,019 to 2,059 in 4 days (March 29 to April 1), whereas it took 11 days (April 23 to May 3) for a two-fold increase in cases, from 21,373 to 42,546 and 13 days (May 5 to May 18) to increase from 49,405 to 1,00,327. According to the study data, till May 20, overall, females had 34.3 per cent share in total burden of Covid-19 infections.
The burden is more or less similar among under-five boys (51.5 per cent) and girls (48.5 per cent). The burden increases among males in the middle-age group and reaches a maximum of 70.4 per cent for the age group 30–39 years, and after that, the share of females in the total burden increases with age.
The burden among females is over 40 per cent for the age groups 70–79 years and above 80 years. The burden of females in the total Covid-19 deaths is 36.9 per cent. The absolute burden of deaths among females is higher than males, as opposed to the absolute burden among females in total number of infections. The difference in female burden in infections and deaths is 2.6 per cent. Females in the age group 30–39 years have the lowest burden of death (21.3 per cent) whereas elderly females above the age of 80 years contribute to 48.5 per cent in total death for this particular age group.
While females share a lower mortality burden than males in general there is no reported case of male mortality in the age group 5–19 years, and hence the entire burden is borne by females.
As per the data till May 20, children and adolescents (below age 20 years) account for 13.8 per cent share in total Covid-19 infections, but have relatively lower burden of 2.1 per cent in total Covid-19 deaths. Elderly people (aged 60 and above) account for 9.7 per cent share in total infection, but 51.6 per cent share in total deaths. Age-specific relative burden in deaths among males aged 60 years is 50.7 per cent whereas the same is 54.5 per cent among females. The population in the age group 20–59 years has a higher relative burden of 76.4 per cent in total cases, but account for 46.4 per cent share in total deaths. The relative burden of total cases is higher among the middle-aged population, but the relative burden in deaths is mostly borne by the elderly population, according to the data.
“There is increasing evidence that Covid-19 survival chances are sensitive to age-pattern and other co-morbidity conditions of the infected population. Besides, with the evolving nature of the pandemic and increasing number of cases, it is critical to track the CFR with all available information and add to our understanding on Covid-19 mortality risk among infected children and elderly population in India,” Professor Subramanian said. He also pointed out that further data and insights are necessary to understand whether the excess risk for males and females are associated with socioeconomic circumstances and gender bias in care-seeking
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