## 5 Conclusions  
We quantified and contrasted COVID-19-attributable YPLL before the age of 75 between males and females in the U.S. and in each of the 50 U.S. states and D.C. from U.S. COVID-19 mortality data from the NCHS (as of 31 March 2021), estimating percentages of total YPLL by sex--contrasting them with their respective percent population shares--and age-adjusted male-to-female YPLL RRs. Our results reveal a virtually universal pattern across states of males experiencing disproportionately high COVID-19-attributable YPLL relative to females. To examine differences in the characterization of the disparities in the COVID-19 mortality burden between males and females when measuring mortality burden in terms of YPLL compared to death counts, we also calculated the corresponding percentages of total COVID-19 deaths by sex and estimated the corresponding age-adjusted male-to-female mortality RRs in the U.S. and in each of the 50 states and D.C. Comparing these two approaches to measuring mortality burden revealed that the estimated disparities are generally greater in magnitude when measuring mortality burden in terms of YPLL compared to death counts, reflecting a broad dual pattern of males dying from COVID-19 in the U.S. at higher rates and at systematically younger ages relative to females. As an epidemiological measure, YPLL offers a compelling illustration of the disproportionately high COVID-19 mortality burden experienced by males in the U.S. by explicitly incorporating age at death in quantifying mortality impact. More broadly, the COVID-19 pandemic offers lessons regarding the importance of cultivating public health environments in the U.S. and across the world that appropriately recognize the sex-specific needs of individuals as well as different patterns in risk factors, health behaviors, and responses to interventions between men and women. In particular, there is an immediate and urgent need to address COVID-19 vaccine hesitancy among men in the U.S. We urge public officials to update vaccine rollout plans with focused efforts to increase COVID-19 vaccinations among men. **Supplementary Materials:** The following are available online at [[https://www.mdpi.com/article](https://www.mdpi.com/article)]([https://www.mdpi.com/article](https://www.mdpi.com/article)) /10.3390/app11167403/s1, File S1: Cumulative COVID-19 death counts in the U.S. stratified by state, sex, and age group from the National Center for Health Statistics as of 31 March 2021, File S2: 2019 U.S. Census Bureau estimates of the U.S. population stratified by state, sex, and age, Table S1: Percent population shares by sex, total COVID-19 deaths by sex, percentages of total COVID-19 deaths by sex, conservative 95% interval estimates of total COVID-19-attributable YPLL before age 75 by sex, and conservative 95% interval estimates of the percentage of total COVID-19-attributable YPLL before age 75 by sex in the U.S. and in each state and D.C., Table S2: Conservative 95% interval estimates of age-adjusted mortality and YPLL rates by sex and conservative 95% interval estimates of age-adjusted male-to-female mortality and YPLL rate ratios in the U.S. and in each state and D.C.  
**Author Contributions:** Conceptualization, J.J.X. ; data curation, J.J.X. ; formal analysis, J.J.X. ; methodology, J.J.X. ; software, J.J.X. ; visualization, J.J.X. ; writing--original draft, J.J.X. ; writing--review and editing, J.J.X., J.T.C., T.R.B., R.S.B., M.A.S. and C.M.R. All authors have read and agreed to the published version of the manuscript. **Funding:** This research received no external funding. **Institutional Review Board Statement:** Not applicable. **Informed Consent Statement:** Not applicable. **Data Availability Statement:** The data presented in this study are available in the Supplementary Materials. **Conflicts of Interest:** T.R.B.