An analysis of data from 34 countries revealed that, during and after the COVID-19 pandemic, absolute all-cause mortality among men exceeded that of women. However, relative excess mortality figures indicate that the gender gap narrowed significantly over time and following the rollout of mass vaccination. The study results have been published in the journal eClinicalMedicine.
It is generally believed that the gap in all-cause mortality between men and women in developed countries has narrowed in recent decades. However, epidemiologists note that the COVID-19 pandemic may have negatively affected this trend. Early in the pandemic, higher mortality rates among men were observed worldwide, a pattern typical of global crises. Despite numerous studies on sex-based differences in susceptibility to coronavirus infection, the true extent of the gender gap in mortality from the disease remains unclear.
A research team led by Katarzyna Doniec of the University of Oxford conducted the first comprehensive study of sex-based trends in excess mortality between February 2020 and July 2023. To do this, the scientists used data from 34 high-income countries, using mortality rates from the 2013–2019 period as a baseline. Excess mortality was assessed across 136 combinations of age groups and countries.
Overall, absolute excess mortality rates (from all causes) among men were higher during pandemic peaks in most countries, particularly during the pre-vaccination phase. However, relative mortality trends suggested that these sex-based differences partly reflected the higher baseline mortality rates among men. In the period prior to vaccination, the researchers observed significantly higher mortality among men in more than half (60 percent) of the age-group and country combinations. Monthly trends in all-cause mortality rates (per 100,000 person-years) by sex, age group, and country
Monthly trends in all-cause mortality rates (per 100,000 person-years) by sex, age group, and country
Katarzyna Doniec et al. / eClinicalMedicine, 2026
In the post-vaccination period, this pattern regarding men became less common, though it remained significant in approximately half of the age-group and country combinations (51 percent). By the onset of the endemic period (i.e., following the global pandemic phase), this situation remained significant in 23 percent of combinations. There were two exceptions to this pattern: countries with a delayed pandemic onset, such as Germany and South Korea—where the disadvantage for men intensified during the post-vaccination and endemic phases for certain age groups (15–64 and 65–74 years in Germany)—and countries with consistently low levels of excess mortality among both men and women, such as Iceland, Finland, Luxembourg, and New Zealand.
When assessing relative excess mortality—expressed as the ratio of observed deaths to expected deaths—the picture for men shifted somewhat. In the pre-vaccination period, elevated excess mortality among men was observed in only 28 percent of age-group and country combinations. In the post-vaccination phase, this proportion fell by half, to 14 percent. In some instances, this figure was higher among women; for example, during the post-vaccination phase among individuals aged 65–74 in Bulgaria and the USA. During the endemic period, there was little evidence of relative sex-based disparity. Monthly trends in all-cause excess mortality P-scores, broken down by sex, age group, and country (P-scores represent percentage deviations from expected all-cause mortality)
Monthly trends in all-cause excess mortality P-scores, broken down by sex, age group, and country (P-scores represent percentage deviations from expected all-cause mortality)
Katarzyna Doniec et al. / eClinicalMedicine, 2026
The authors concluded that the disadvantage faced by men was evident during months of high mortality in the pre-vaccination period; however, various statistical approaches revealed a notable narrowing of the gender gap. Doniec’s team suggests that the use of both absolute and relative metrics indicates that COVID-19 made only a minor contribution to long-term changes in sex-based differences in excess mortality.
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