XLV vs. ITOT

Last updated Jun 9, 2026

XLV (State Street Health Care Select Sector SPDR ETF) and ITOT (iShares Core S&P Total U.S. Stock Market ETF) are both exchange-traded funds - XLV is a Health & Biotech Equities fund tracking the Health Care Select Sector Index, while ITOT is a Large Cap Blend Equities fund tracking the S&P Total Market Index. Both are passively managed. Over the past 10 years, XLV returned 9.65%/yr vs 14.81%/yr for ITOT. A 0.72 correlation means they provide meaningful diversification when combined. XLV charges 0.08%/yr vs 0.03%/yr for ITOT.

Performance

XLV vs. ITOT - Performance Comparison

The chart below illustrates the hypothetical performance of a $10,000 investment in State Street Health Care Select Sector SPDR ETF (XLV) and iShares Core S&P Total U.S. Stock Market ETF (ITOT). The values are adjusted to include any dividend payments, if applicable.

Returns By Period

In the year-to-date period, XLV achieves a -0.98% return, which is significantly lower than ITOT's 9.09% return. Over the past 10 years, XLV has underperformed ITOT with an annualized return of 9.65%, while ITOT has yielded a comparatively higher 14.81% annualized return.

XLV

• 1D: -0.24%
• 1M: 6.38%
• YTD: -0.98%
• 6M: 1.65%
• 1Y: 15.62%
• 3Y*: 7.16%
• 5Y*: 6.05%
• 10Y*: 9.65%

ITOT

• 1D: 0.31%
• 1M: 0.42%
• YTD: 9.09%
• 6M: 8.99%
• 1Y: 24.90%
• 3Y*: 21.07%
• 5Y*: 12.25%
• 10Y*: 14.81%

*Multi-year figures are annualized to reflect compound growth (CAGR)

XLV vs. ITOT - Yearly Performance Comparison

	2026 (YTD)	2025	2024	2023	2022	2021	2020	2019	2018	2017
XLV State Street Health Care Select Sector SPDR ETF	-0.98%	14.50%	2.47%	2.07%	-2.08%	26.04%	13.30%	20.45%	6.28%	21.77%
ITOT iShares Core S&P Total U.S. Stock Market ETF	9.09%	17.00%	23.80%	26.12%	-19.47%	25.68%	20.71%	30.67%	-5.33%	21.37%

Correlation

The correlation between XLV and ITOT is 0.35, which is low. Their price movements are largely independent, making them effective diversification partners.

	Correlation
Correlation (1Y) Calculated over the trailing 1-year period	0.35
Correlation (3Y) Calculated over the trailing 3-year period	0.48
Correlation (5Y) Calculated over the trailing 5-year period	0.58
Correlation (10Y) Calculated over the trailing 10-year period	0.65
Correlation (All Time) Calculated using the full available price history since Jan 26, 2004	0.72

Over the past year, the correlation between XLV and ITOT has dropped to 0.35 - well below their long-term average of 0.72, suggesting their price drivers have been diverging.

XLV vs. ITOT - Sectors Allocation Comparison

Sectors	XLV	ITOT
Healthcare	100.0%	9.0%
Basic Materials	-	2.1%
Communication Services	-	10.3%
Consumer Cyclical	-	10.1%
Consumer Defensive	-	4.7%
Energy	-	3.7%
Financial Services	-	12.1%
Industrials	-	9.5%
Real Estate	-	2.4%
Technology	-	33.8%
Utilities	-	2.3%

Return for Risk

XLV vs. ITOT — Risk / Return Rank

Compare risk-adjusted metric ranks to identify better-performing investments over the past 12 months.

XLV

XLV Risk / Return Rank: 32
XLV Sharpe Ratio Rank: 32
XLV Sortino Ratio Rank: 34
XLV Omega Ratio Rank: 31
XLV Calmar Ratio Rank: 33
XLV Martin Ratio Rank: 28

ITOT

ITOT Risk / Return Rank: 67
ITOT Sharpe Ratio Rank: 68
ITOT Sortino Ratio Rank: 66
ITOT Omega Ratio Rank: 67
ITOT Calmar Ratio Rank: 62
ITOT Martin Ratio Rank: 75

The rank (0–100) shows how this investment's returns compare to the risk taken. Higher = better. Based on the past 12 months of data, combining Sharpe, Sortino, and other metrics used by quantitative funds and institutional investors.

XLV vs. ITOT - Risk-Adjusted Trends Comparison

This table presents a comparison of risk-adjusted performance metrics for State Street Health Care Select Sector SPDR ETF (XLV) and iShares Core S&P Total U.S. Stock Market ETF (ITOT). Risk-adjusted metrics are performance indicators that assess an investment's returns in relation to its risk, enabling a more accurate comparison of different investment options.

	XLV	ITOT	Difference
Sharpe ratio: Return per unit of total volatility	1.05	2.01	-0.96
Sortino ratio: Return per unit of downside risk	1.68	2.71	-1.04
Omega ratio: Gain probability vs. loss probability	1.19	1.36	-0.17
Calmar ratio: Return relative to maximum drawdown	1.50	2.81	-1.31
Martin ratio: Return relative to average drawdown	3.60	12.79	-9.19
Data is calculated on a 1-year rolling basis and updated daily. The trend shows the change in the indicator over the past month.

XLV vs. ITOT - Sharpe Ratio Comparison

The current XLV Sharpe Ratio is 1.05, which is lower than the ITOT Sharpe Ratio of 2.01. The chart below compares the historical Sharpe Ratios of XLV and ITOT, calculated using daily returns over the previous 12 months. A higher Sharpe Ratio indicates better risk-adjusted performance relative to the risk-free rate.

Sharpe Ratios by Period

	XLV	ITOT	Difference
Sharpe Ratio (1Y) Calculated over the trailing 1-year period	1.05	2.01	-0.96
Sharpe Ratio (5Y) Calculated over the trailing 5-year period	0.41	0.71	-0.30
Sharpe Ratio (10Y) Calculated over the trailing 10-year period	0.58	0.81	-0.23
Sharpe Ratio (All Time) Calculated using the full available price history	0.46	0.57	-0.10

Drawdowns

XLV vs. ITOT - Drawdown Comparison

The maximum XLV drawdown since its inception was -39.17%, smaller than the maximum ITOT drawdown of -55.20%. Use the drawdown chart below to compare losses from any high point for XLV and ITOT.

Drawdown Indicators

	XLV	ITOT	Difference
Max Drawdown Largest peak-to-trough decline	-39.17%	-55.20%	+16.03%
Max Drawdown (1Y) Largest decline over 1 year	-10.47%	-8.90%	-1.57%
Max Drawdown (3Y) Largest decline over 3 years	-17.11%	-19.44%	+2.33%
Max Drawdown (5Y) Largest decline over 5 years	-17.11%	-25.36%	+8.25%
Max Drawdown (10Y) Largest decline over 10 years	-28.40%	-35.00%	+6.60%
Current Drawdown Current decline from peak	-4.32%	-2.65%	-1.67%
Average Drawdown Average peak-to-trough decline	-7.12%	-6.97%	-0.15%
Ulcer Index Depth and duration of drawdowns from previous peaks	4.35%	1.95%	+2.40%

Volatility

XLV vs. ITOT - Volatility Comparison

State Street Health Care Select Sector SPDR ETF (XLV) has a higher volatility of 5.02% compared to iShares Core S&P Total U.S. Stock Market ETF (ITOT) at 3.91%. This indicates that XLV's price experiences larger fluctuations and is considered to be riskier than ITOT based on this measure. The chart below showcases a comparison of their rolling one-month volatility.

Volatility by Period

	XLV	ITOT	Difference
Volatility (1M) Calculated over the trailing 1-month period	5.02%	3.91%	+1.11%
Volatility (6M) Calculated over the trailing 6-month period	10.66%	9.56%	+1.10%
Volatility (1Y) Calculated over the trailing 1-year period	14.99%	12.49%	+2.50%
Volatility (5Y) Calculated over the trailing 5-year period, annualized	14.76%	17.40%	-2.64%
Volatility (10Y) Calculated over the trailing 10-year period, annualized	16.58%	18.29%	-1.71%

XLV vs. ITOT - Expense Ratio Comparison

XLV has a 0.08% expense ratio, which is higher than ITOT's 0.03% expense ratio. However, both funds are considered low-cost compared to the broader market, where average expense ratios usually range from 0.3% to 0.9%.

Dividends

XLV vs. ITOT - Dividend Comparison

XLV's dividend yield for the trailing twelve months is around 1.64%, more than ITOT's 1.00% yield.

Position	TTM	2025	2024	2023	2022	2021	2020	2019	2018	2017	2016	2015
ITOT iShares Core S&P Total U.S. Stock Market ETF	1.00%	1.11%	1.23%	1.47%	1.66%	1.18%	1.41%	1.88%	2.14%	1.69%	1.83%	2.01%
XLV State Street Health Care Select Sector SPDR ETF	1.64%	1.60%	1.67%	1.59%	1.47%	1.33%	1.49%	2.17%	1.57%	1.47%	1.60%	1.43%

Frequently Asked Questions

Can I hold both XLV and ITOT in my portfolio?

XLV and ITOT have a correlation of 0.35, meaning they provide meaningful diversification benefit when combined. Depending on your allocation goals, holding both could reduce overall portfolio risk.

Which is riskier, XLV or ITOT?

XLV has higher volatility (5.02%) compared to ITOT (3.91%). In terms of maximum drawdown, XLV dropped -39.17% vs ITOT's -55.20%.

Which ETF is better, XLV or ITOT?

On 10-year performance, ITOT leads with 14.81% vs 9.65% for XLV. On fees, ITOT is cheaper at 0.03% per year. On volatility, ITOT has been the lower-risk option at 3.91%. The better choice depends on whether you care most about return, fees, risk, or income.

Which ETF has performed better, XLV or ITOT?

Over the 10-year period, ITOT has performed better with a 14.81% return vs 9.65%. Past performance does not guarantee future results, so compare this with risk, fees, and fund exposure.

Which ETF is cheaper, XLV or ITOT?

ITOT is cheaper with a 0.03% expense ratio, compared with 0.08% for XLV.

Which ETF pays a higher dividend yield, XLV or ITOT?

XLV has the higher dividend yield at 1.64%, compared with 1.00% for ITOT.

What is the main difference between XLV and ITOT?

XLV is categorized as Health & Biotech Equities, while ITOT is Large Cap Blend Equities. XLV tracks Health Care Select Sector Index, while ITOT tracks S&P Total Market Index. They also come from different issuers: State Street and iShares. Their fees differ too: 0.08% for XLV and 0.03% for ITOT.

Which has better risk-adjusted returns?

ITOT currently has the higher Sharpe Ratio (2.01 vs 1.05), meaning it's delivered slightly more return per unit of risk over the trailing 12 months. However, this ranking shifts over time - use the Risk/Return Score above for a more comprehensive view that combines Sharpe, Sortino, and other measures used by quantitative funds.