Impact of sex and gender on post-COVID-19 syndrome, Switzerland, 2020, 2024, Gebhard et al.

Impact of sex and gender on post-COVID-19 syndrome, Switzerland, 2020
Caroline E Gebhard; Claudia Sütsch; Pimrapat Gebert; Bianca Gysi; Susan Bengs; Atanas Todorov; Manja Deforth; Philipp K Buehler; Alexander Meisel; Reto A Schuepbach; Annelies S Zinkernagel; Silvio D Brugger; Claudio Acevedo; Dimitri Patriki; Benedikt Wiggli; Jürg H Beer; Andrée Friedl; Raphael Twerenbold; Gabriela M Kuster; Hans Pargger; Sarah Tschudin-Sutter; Joerg C Schefold; Thibaud Spinetti; Chiara Henze; Mina Pasqualini; Dominik F Sager; Lilian Mayrhofer; Mirjam Grieder; Janna Tontsch; Fabian C Franzeck; Pedro D Wendel Garcia; Daniel A Hofmaenner; Thomas Scheier; Jan Bartussek; Ahmed Haider; Muriel Grämer; Nidaa Mikail; Alexia Rossi; Núria Zellweger; Petra Opić; Angela Portmann; Roland von Känel; Aju P Pazhenkottil; Michael Messerli; Ronny R Buechel; Philipp A Kaufmann; Valerie Treyer; Martin Siegemund; Ulrike Held; Vera Regitz-Zagrosek; Catherine Gebhard

Background
Women are overrepresented among individuals with post-acute sequelae of SARS-CoV-2 infection (PASC). Biological (sex) as well as sociocultural (gender) differences between women and men might account for this imbalance, yet their impact on PASC is unknown.

Aims
We assessed the impact of sex and gender on PASC in a Swiss population.

Methods
Our multicentre prospective cohort study included 2,856 (46% women, mean age 44.2 ± 16.8 years) outpatients and hospitalised patients with PCR-confirmed SARS-CoV-2 infection.

Results
Among those who remained outpatients during their first infection, women reported persisting symptoms more often than men (40.5% vs 25.5% of men; p < 0.001). This sex difference was absent in hospitalised patients. In a crude analysis, both female biological sex (RR = 1.59; 95% CI: 1.41–1.79; p < 0.001) and a score summarising gendered sociocultural variables (RR = 1.05; 95% CI: 1.03–1.07; p < 0.001) were significantly associated with PASC. Following multivariable adjustment, biological female sex (RR = 0.96; 95% CI: 0.74–1.25; p = 0.763) was outperformed by feminine gender-related factors such as a higher stress level (RR = 1.04; 95% CI: 1.01–1.06; p = 0.003), lower education (RR = 1.16; 95% CI: 1.03–1.30; p = 0.011), being female and living alone (RR = 1.91; 95% CI: 1.29–2.83; p = 0.001) or being male and earning the highest income in the household (RR = 0.76; 95% CI: 0.60–0.97; p = 0.030).

Conclusions
Specific sociocultural parameters that differ in prevalence between women and men, or imply a unique risk for women, are predictors of PASC and may explain, at least in part, the higher incidence of PASC in women. Once patients are hospitalised during acute infection, sex differences in PASC are no longer evident.

Link (Eurosurveillance)

 

I wonder whether they will feel inclined to do a follow-up study of LC in 2023, years since quarantine and lockdown. I suspect they won't.

 

It is hardly surprising that the impact of biological sex here mirrors all the other previous studies, and also what is seen in related conditions such as ME/CFS, but I must admit, from the abstract at least, the gender related discussion left me confused. Were they expecting perceived gender characteristics or perceived gender related personality traits to be a relevant factor in incidences or severity of Long Covid, independent of biological sex?

 

I'm not too sure there's any information on how the bland non-hospitalised data can be interpreted (I'm guessing there could be some other factors as well, maybe some questionnaires/methods nowadays viewed as standard were only ever standardised by testing them on males?)

Another possible explanation would be that females are for some reason more susceptible to long-lived ME/CFS type LC (similar to how they are more susceptible to autoimmune diseases), but I doubt their bland questionaire would have captured any of that.

On the other hand if someone is hospitalised with Covid (which skews towards elder males) with say lung damage or tissue damage that's a pretty sex independent phenomena which just takes a given number of weeks to resolve (or doesn't resolve equally badly).

I don't think that these type of studies really tell us anything, especially not if they never cared about a follow-up in the first place.