They do use cairo for rendering to a CGContext via cairo_quartz_surface_t which has traditionally not been all that great on macOS. Additionally they're dealing with colorspace transforms on more recent macOS along with some bugs in macOS that were causing non-native applications to do considerable damage/redraws.
If/when Inkscape moves to GTK 4, a lot of this will just go away. The new macOS backend (which I wrote) is considerably faster and defaults to using the OpenGL renderer (which I also write a large portion of) but is also considerably faster when using Cairo by removing Quartz/CGContext from the equation and using Pixman directly with IOSurface.
When using OpenGL, however, we have to emulate something like eglSwapBuffersWithDamage() to keep the compositor from over-compositing, but that was done with tessellation just fine.