Abstract:

Gender/sex comparisons of COVID-19 case fatality rates are subject to systematic bias owing to differential testing rates. Nonrandom COVID-19 testing in the population means that there is considerable uncertainty around CFR estimates in men and women. Specifically, widespread lower testing among men compared with women likely artificially inflates the CFR among men, as demonstrated by a predictive, inverse relationship between testing skew and CFR ratio. The more disparate testing becomes between men and women, the greater the observed sex disparity in CFR; when testing becomes more similar, observed CFRs become more similar. The case study of COVID-19 offers an important teachable and generalizable example for women's health scholars of the caution that is needed in interpreting sex disparities in CFRs.

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