The influence of sex and gender domains on COVID-19 cases and mortality

Both sex (a biological attribute) and gender (a complex social construct incorporating identity, roles, relations and institutionalized gender) may influence infectious disease risk and outcomes, and severe acute respiratory syndrome coronavirus 2 appears to be no exception. • We found institutionalized gender inequality (as measured by the United Nations Development Project’s Gender Inequality Index) to be positively associated with the male:female ratio reported cases of coronavirus disease 2019 (COVID-19) among countries that report sex-disaggregated data; males accounted for more cases in countries with higher gender inequality. • Institutionalized gender and culturally entrenched roles and norms may influence who is most at risk of acquiring infection or who is able to receive a test. • To understand how sex and gender affect disease risk and outcomes for COVID-19 will require expanded testing and collection of relevant data; this understanding will be crucial to managing the current pandemic.