Sex disparity in COVID-19 infection in the Philippines: a biocultural study

Contenido principal del artículo

Maxine Allyson B. Castro
Jewelyn Marie R. Tabion
Richard Jonathan O. Taduran


Biological sex and socio-cultural factors have been interrelated in epidemiological studies and clinical care. This study aimed to assess sex differences in susceptibility to COVID-19 in the Philippines. COVID-19 numbers of cases until February 28, 2021, were collected from the Philippines' Department of Health (DOH). The student's t-test was used to analyze the data per administrative region and age group. News articles were collected from reputable media outlets in the Philippines. Biological and socio-cultural differences were considered. A significant sex difference (p ≤ 0.05) was observed in the age groups of 30-39, 40-49, and 50-59 years old, which indicates that males in the said age clusters in the Philippines are more susceptible to COVID-19. Sex-specific mechanisms that may disproportionately affect either sex were associated with differences in immune responses, hormones, and underlying medical conditions. Furthermore, gendered lifestyles in the Philippines that involve social gatherings such as cockfighting, gambling, and boxing are dominated by the male population and could directly transmit the disease. Sex disparities linked to the susceptibility of COVID-19 emphasize the importance of gender-based research for risk-reduction strategies and effective public health measures in the Philippines.

Detalles del artículo

Cómo citar
Castro, M., Tabion , J., & Taduran, R. (2022). Sex disparity in COVID-19 infection in the Philippines: a biocultural study. Quaestiones Disputatae: Temas En Debate, 14(29), 106-136. Recuperado a partir de


ABS-CBN News. (2020a). Those without face masks in the barangay in QC were arrested. []. [Acceseed on 24 May, 2021].
ABS-CBN News. (2020b). 5 arrested for cockfighting in Dapitan City. []. [Acceseed on 24 May, 2021].
ABS-CBN News. (2020c). Retired general, policeman, politician, arrested for alleged cockfighting in Batangas. []. [Acceseed on 24 May, 2021].
ABS-CBN News. (2020d). Cockpit opened despite quarantine in Davao del Sur raided; 4 arrested. []. [Acceseed on 24 May, 2021].
ABS-CBN News. (2020e). 3 barangay officials surrendered after being found in the cockpit of a cemetery. []. [Acceseed on 24 May, 2021].
ABS-CBN News. (2020f). Barangay in Manila placed under 'total shutdown' due to boxing, gambling while on lockdown. []. [Acceseed on 24 May, 2021].
ABS-CBN News. (2020g). Lady doing laundry in front of her house without a face mask was penalized. []. [Acceseed on 24 May, 2021].
ABS-CBN News. (2020h). DOH disrupted by crowd in Manila Bay: 'The virus is not gone yet'. []. [Acceseed on 24 May, 2021].
Agcaoili, D., Chingkoe, C., Cuerpo, C., Diomampo, J., & Yu, A. (2019). Cockfighting (Sabong). Ateneo Ethnographies. []. [Acceseed on 24 May, 2021].
Agrawal, H., Das, N., Nathani, S., Saha, S., Saini, S., Kakar, S. S., & Roy, P. (2020). An Assessment on Impact of COVID-19 Infection in a Gender Specific Manner. Stem Cell Reviews and Reports, 17, 1–19.
Alberts, B., Johnson, A., Lewis, J., Raff, M., Roberts, K., & Walter, P. (2002). Helper T Cells and Lymphocyte Activation. In: Molecular Biology of the Cell (4th ed.). New York: Garland Science.
Bagaoisan, A. (2020a). Man without face mask, carrying suspected illegal drugs in Taguig. ABS-CBN News. []. [Acceseed on 24 May, 2021].
Bagaoisan, A. (2020b). A man without a face mask, apprehended after being caught with an ice pick in Pasay. ABS-CBN News. []. [Acceseed on 24 May, 2021].
Bagaoisan, A. (2020c). 7 men, caught in an illegal cockfighting in Muntinlupa. ABS-CBN News. []. [Acceseed on 24 May, 2021].
Bunders, M. J., & Altfeld, M. (2020). Implications of Sex Differences in Immunity for SARS-CoV-2 Pathogenesis and Design of Therapeutic Interventions. Immunity, 53(3), 487–495.
Cabadsan, J. (2019). Lived Experiences of Countryside Couples with Husband Engaged in Cockfighting. Journal of Academic Research, 4(1), 22–30.
Cai, G. (2020). Bulk and single-cell transcriptomics identify tobacco-use disparity in lung gene expression of ACE2, the receptor of 2019-nCov. MedRxiv. []. [Acceseed on 24 May, 2021].
Calalo, A. (2020). Caloocan mayor orders village chief, 3 councilmen in illegal cockfight to surrender or face manhunt. The Manila Times. [] [Acceseed on 24 May, 2021].
Cancer Treatment Centers of America. (2017). What's the Difference between B-Cells and T-Cells? []. [Acceseed on 24 May, 2021].
Centers for Disease Control and Prevention. (2020). Certain Medical Conditions and Risk for Severe COVID-19 Illness. []. [Acceseed on 24 May, 2021].
Channappanavar, R., Fett, C., Mack, M., Ten Eyck, P., Meyerholz, D., & Perlman, S. (2017). Sex-Based Differences in Susceptibility to Severe Acute Respiratory Syndrome Coronavirus Infection. The Journal of Immunology, 198(10), 4046–4053.
Chu, D., Akl, E., Duda, S., Solo, K., Yaacoub, S., &Schünemann, H. (2020). Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. The Lancet, 395(10242), 1973–1987.
Conti, P., & Younes, A. (2020). Coronavirus COV-19/SARS-CoV-2 affects women less than men: clinical response to viral infection. Journal of Biological Regulators and Homeostatic Agents, 34(2).
Cyders, M. A., & Smith, G. T. (2008). Clarifying the role of personality dispositions in risk for increased gambling behavior. Personality and Individual Differences, 45(6), 503–508.
Day, P. (2018). Cockfighting thrives in full view in Philippines. Nikkei Asia. []. [Acceseed on 24 May, 2021].
Department of Health. (2018). Lifestyle-related Diseases. []. [Acceseed on 24 May, 2021].
Department of Health. (2020). DOH confirms first 2019-ncov case in the country; assures public of intensified containment measures. []. [Acceseed on 24 May, 2021].
Department of Science and Technology - Food and Nutrition Research Institute. (2016). Philippine Nutrition Facts and Figures 2015: Clinical and Health Survey. [] [Acceseed on 24 May, 2021].
Forthal, D. (2014). Functions of Antibodies. Microbiology Spectrum, 2(4), 25–48.
Galvez, D. (2020). DOH: Majority of COVID-19 cases are from working age group. INQUIRER. []. [Acceseed on 24 May, 2021].
Gao, K., Shi, X., & Wang, W. (2017). The life-course impact of smoking on hypertension, myocardial infarction and respiratory diseases. Scientific Reports, 7(1), 4330–4336.
Gebhard, C., Regitz-Zagrosek, V., Neuhauser, H., Morgan, R., & Klein, S. (2020). Impact of sex and gender on COVID-19 outcomes in Europe. Biology of Sex Differences, 11, 29.
Geducos, A. (2020a). Cockfighting still prohibited. Manilla Bulletin. []. [Acceseed on 24 May, 2021].
Geducos, A. (2020b). Palace: Cop arrested for cockfighting will be sacked. Manilla Bulletin. []. [Acceseed on 24 May, 2021].
Geertz, C. (2005). Deep play: notes on the Balinese cockfight. Daedalus, 134(4), 56–86.
Global Health 5050. (2021). The COVID-19 Sex-Disaggregated Data Tracker. The Sex, Gender and COVID-19 Project. []. [Acceseed on 24 May, 2021].
Grasselli, G., Zangrillo, A., Zanella, A., Antonelli, M., Cabrini, L., Castelli, A., Cereda, D., Coluccello, A., Foti, G., Fumagalli, R., Iotti, G., Latronico, N., Lorini, L., Merler, S., Natalini, G., Piatti, A., Ranieri, M. V., Scandroglio, A. M., Storti, E., Cecconi, M., & Pesenti, A. (2020). Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA, 323(16), 1574–1581.
Griffith, D., Sharma, G., Holliday, C., Enyia, O., Valliere, M., Semlow, A., Stewart, E., & Blumenthal, R. (2020). Men and COVID-19: A Biopsychosocial Approach to Understanding Sex Differences in Mortality and Recommendations for Practice and Policy Interventions. Preventing Chronic Disease, 17, 200247.
Grover, N. (2020). Covid-19 antibodies reduce faster in men than women – study. The Guardian. []. [Acceseed on 24 May, 2021].
Halili-Jao, N. (2017). When is gambling an addiction? Philstar. []. [Acceseed on 24 May, 2021].
Hepworth, M., Hardman, M., & Grencis, R. (2010). The role of sex hormones in the development of Th2 immunity in a gender-biased model of Trichurismuris infection. European Journal of Immunology, 40(2), 406–416.
Hing, N., Russell, A., Tolchard, B., & Nower, L. (2015). Risk Factors for Gambling Problems: An Analysis by Gender. Journal of Gambling Studies, 32(2), 511–534.
International Diabetes Federation. (2019). IDF Diabetes Atlas Ninth edition 2019. []. [Acceseed on 24 May, 2021].
International Diabetes Federation. (2021). COVID-19 and diabetes. []. [Acceseed on 24 May, 2021].
Jewell, T. (2019). Risk Factors of Having High or Low Estrogen Levels in Males. Healthline. []. [Acceseed on 24 May, 2021].
Junio, L. (2019). Heart disease still leading cause of death in Philippines. Philippine News. []. [Acceseed on 24 May, 2021].
Knapp, S. (2013). Diabetes and Infection: Is There a Link? A Mini-Review. Gerontology, 59(2), 99–104.
Korean Society of Infectious Diseases, Korean Society of Pediatric Infectious Diseases, Korean Society of Epidemiology, Korean Society for Antimicrobial Therapy, Korean Society for Healthcare-associated Infection Control and Prevention, & Korea Centers for Disease Control and Prevention. (2020). Report on the Epidemiological Features of Coronavirus Disease 2019 (COVID-19) Outbreak in the Republic of Korea from January 19 to March 2, 2020. Journal of Korean Medical Science, 35(10), e112.
Ladrero, C., & Española, S. (2017). Top causes of mortality and morbidity in the Philippines, 1960-2013. SPMC Journal of Health Care Services, 3(1), 3.
Li, L., Huang, T., Wang, Y., Wang, Z., Liang, Y., Huang, T., Zhang, H., Sun, W., & Wang, Y. (2020). COVID‐19 patients' clinical characteristics, discharge rate, and fatality rate of meta‐analysis. Journal of Medical Virology, 92(6), 577–583.
Li, M.-Y., Li, L., Zhang, Y., & Wang, X.-S. (2020). Expression of the SARS-CoV-2 cell receptor gene ACE2 in a wide variety of human tissues. Infectious Diseases of Poverty, 9, 45.
Liu, J., Zhang, L., Chen, Y., Wu, Z., Dong, X., Teboul, J.-L., Zhang, S., Ye, X., Liu, Y., Wang, T., Du, H., Li, W., & Chen, D. (2020). Association of sex with clinical outcomes in COVID-19 patients: A retrospective analysis of 1190 cases. Respiratory Medicine, 173, 106159.
Malig, J. (2020). 21 arrested for holding illegal cockfight in Bulacan amid lockdown. Rappler. []. [Acceseed on 24 May, 2021].
Manar, M. (2020). Cockfighting aficionado from North Cotabato tested positive for COVID-19. Manila Bulletin. []. [Acceseed on 24 May, 2021].
Marquez, C. (2020). Cops file raps vs woman who tried to enter Caloocan brgy under total lockdown. INQUIRER. []. [Acceseed on 24 May, 2021].
Marticio, M. (2020). 5 cockfighting enthusiasts nabbed for violating quarantine in Eastern Visayas. Manila Bulletin. []. [Acceseed on 24 May, 2021].
Merez, A. (2020). Manila City files charges vs. barangay chairman involved in cockfighting. ABS-CBN News. []. [Acceseed on 24 May, 2021].
Office of the President of the Philippines. (2020). Community Quarantine Over the Entire Luzon and Further Guidelines for the Management of the Coronavirus Disease 2019 (COVID-19) Situation: GOVPH. Official Gazette of the Republic of the Philippines. []. [Acceseed on 24 May, 2021].
Onder, G., Rezza, G., & Brusaferro, S. (2020). Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy. JAMA, 323(18), 1775–1776.
Opal, S., & DePalo, V. (2000). Anti-Inflammatory Cytokines. Chest, 117(4), 1162–1172.
Palabrica, R. (2019). More Filipinos of working age. INQUIRER. []. [Acceseed on 24 May, 2021].
Pascual, J. (2020). People were caught for holding a party in Manila North Cemetery. ABS-CBN News. []. [Acceseed on 24 May, 2021].
Pearce, K. (2020). Why COVID-19 poses greater risks for men than women. MedicalXpress. []. [Acceseed on 24 May, 2021].
Peñalba, E. (2020). Cockfighting in later life: A qualitative inquiry into elderly Filipinos' gambling experiences. Agathos, 11(1), 231–242. []. [Acceseed on 24 May, 2021].
Perez, A. (2020a). Several individuals in Cebu City cockfight event were charged for violating quarantine protocols. ABS-CBN News. []. [Acceseed on 24 May, 2021].
Perez, A. (2020b). 53 arrested for illegal cockfighting in Valenzuela. ABS-CBN News. []. [Acceseed on 24 May, 2021].
Philippine Academy of Family Physicians. (2009). Promoting Physical Activity Module 4. []. [Acceseed on 24 May, 2021].
Philippine Statistics Authority. (2017). 17.3 Million Filipino Adults are Current Tobacco Smokers (Final Results from the 2009 Global Adult Tobacco Survey). []. [Acceseed on 24 May, 2021].
Philippine Statistics Authority. (2019). Sixty percent of the population 15 years old and over are in the labor force. []. [Acceseed on 24 May, 2021].
Philippine Statistics Authority. (2021). Registered Deaths in the Philippines, 2019. []. [Acceseed on 24 May, 2021].
Pradhan, A., & Olsson, P.-E. (2020). Sex differences in severity and mortality from COVID-19: are males more vulnerable? Biology of Sex Differences, 11, 53.
Qiu, F., Liang, C.-L., Liu, H., Zeng, Y.-Q., Hou, S., Huang, S., Lai, X., & Dai, Z. (2017). Impacts of cigarette smoking on immune responsiveness: Up and down or upside down? Oncotarget, 8(1), 268–284.
Rappler. (2020). 11 coronavirus deaths from Matina cockfight derby – DOH. []. [Acceseed on 24 May, 2021].
Recuenco, A. (2020a). PNP hunts down Cebu barangay captain for organizing cockfighting amid the COVID-19 threat. Manila Bulletin. []. [Acceseed on 24 May, 2021].
Recuenco, A. (2020b). 6 arrested in Quezon for cockfighting amid strict quarantine rules. []. [Acceseed on 24 May, 2021].
Recuenco, A. (2020c). Anti-narcotics cop arrested for hosting cockfighting in Pasig City. Manila Bulletin. []. [Acceseed on 24 May, 2021].
Richardson, S., Hirsch, J., Narasimhan, M., Crawford, J., McGinn, T., & Davidson, K. (2020). Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA, 323(20), 2052–2059.
Ritchie, H., & Roser, M. (2019). Smoking. Our World in Data. []. [Acceseed on 24 May, 2021].
Ropero, G. (2020). 'Mass gathering': DOH says packed Rizal Memorial did not follow virus measures. ABS-CBN News. []. [Acceseed on 24 May, 2021].
Santa Clara County Public Health Department. (2020). Information about Social Distancing. []. [Acceseed on 24 May, 2021].
Schoonenboom, J., & Johnson, R. (2017). How to Construct a Mixed Methods Research Design. Kölner Zeitschrift Für Soziologie Und Sozialpsychologie, 69(S2), 107–131.
Scully, E., Haverfield, J., Ursin, R., Tannenbaum, C., & Klein, S. (2020). Considering how biological sex impacts immune responses and COVID-19 outcomes. Nature Reviews Immunology, 20(7), 442–447.
Simpson, R. (2020). Exercise, Immunity and the COVID-19 Pandemic. American College of Sports Medicine. []. [Acceseed on 24 May, 2021].
Sison, J., Divinagracia, R., & Nailes, J. (2020). Asian management of hypertension: Current status, home blood pressure, and specific concerns in the Philippines (a country report). The Journal of Clinical Hypertension, 22(3), 504–507.
Sriram, K., Insel, P., & Loomba, R. (2020). What is the ACE2 receptor, how is it connected to coronavirus, and why might it be key to treating COVID-19? The experts explain. The Conversation. []. [Acceseed on 24 May, 2021].
Takahashi, T., Ellingson, M., Wong, P., Israelow, B., Lucas, C., Klein, J., Silva, J., Mao, T., Oh, J. E., Tokuyama, M., Lu, P., Venkataraman, A., Park, A., Liu, F., Meir, A., Sun, J., Wang, E., Casanovas-Massana, A., Wyllie, A., Vogels, C. B. F., Earnest, R., Lapidus, S., Ott, I. M., Moore, A. J., Yale IMPACT Research Team, Shaw, A., Fournier, J. B., Odio, C. D., Farhadian, S., Cruz, C. D., Grubaugh, N. D., Schulz, W. L., Ring, A. M., Ko, A. I., Omer, S. B., & Iwasaki, A. (2020). Sex differences in immune responses that underlie COVID-19 disease outcomes. Nature, 588(7837), 315–320.
Talabong, R. (2020). Manila barangay to be placed on total lockdown after holding boxing match. Rappler. []. [Acceseed on 24 May, 2021].
Tiangco, M. (2020). Barangay chairman, five others, arrested for cockfighting in Manila. Manila Bulletin. []. [Acceseed on 24 May, 2021].
Tocmo, H. (2020). A man infected with COVID-19 in the cockpit promises to stop gambling. ABS-CBN News. []. [Acceseed on 24 May, 2021].
Womersley, K., Ripullone, K., Peters, S. A. E., & Woodward, M. (2020). Covid-19: Male disadvantage highlights the importance of sex disaggregated data. BioMedJournal, 370, m2870.
Wong, G., Zane, N., Saw, A., & Chan, A. K. (2013). Examining Gender Differences for Gambling Engagement and Gambling Problems Among Emerging Adults. Journal of Gambling Studies, 29(2), 171–189.
World Health Organization. (2016). Philippines – Diabetes country profiles, 2016. []. [Acceseed on 24 May, 2021].
World Health Organization. (2020a). Novel Coronavirus (2019-nCoV) Situation Report - 1. []. [Acceseed on 24 May, 2021].
World Health Organization. (2020b). Coronavirus disease 2019 (COVID-19) Situation Report – 89. []. [Acceseed on 24 May, 2021].
World Health Organization. (2021a). WHO Coronavirus (COVID-19) Dashboard. []. [Acceseed on 24 May, 2021].
World Health Organization. (2021b). Philippines: WHO Coronavirus Disease (COVID-19) Dashboard. []. [Acceseed on 24 May, 2021].
Wu, Z., & McGoogan, J. (2020). Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China. JAMA, 323(13), 1239–1242.
Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., Xiang, J., Wang, Y., Song, B., Gu, X., Guan, L., Wei, Y., Li, H., Wu, X., Xu, J., Tu, S., Zhang, Y., Chen, H., & Cao, B. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet, 395(10229), 1054–1062.