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Gebhard CE, Sütsch C, Gebert P, Gysi B, Bengs S, Todorov A, Deforth M, Buehler PK, Meisel A, Schuepbach RA, Zinkernagel AS, Brugger SD, Acevedo C, Patriki D, Wiggli B, Beer JH, Friedl A, Twerenbold R, Kuster GM, Pargger H, Tschudin-Sutter S, Schefold JC, Spinetti T, Henze C, Pasqualini M, Sager DF, Mayrhofer L, Grieder M, Tontsch J, Franzeck FC, Wendel Garcia PD, Hofmaenner DA, Scheier T, Bartussek J, Haider A, Grämer M, Mikail N, Rossi A, Zellweger N, Opić P, Portmann A, von Känel R, Pazhenkottil AP, Messerli M, Buechel RR, Kaufmann PA, Treyer V, Siegemund M, Held U, Regitz-Zagrosek V, Gebhard C. Impact of sex and gender on post-COVID-19 syndrome, Switzerland, 2020. Euro Surveill 2024; 29:2300200. [PMID: 38214079 PMCID: PMC10785203 DOI: 10.2807/1560-7917.es.2024.29.2.2300200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/04/2023] [Indexed: 01/13/2024] Open
Abstract
BackgroundWomen 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.AimWe assessed the impact of sex and gender on PASC in a Swiss population.MethodOur 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.ResultsAmong 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).ConclusionSpecific 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.
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Affiliation(s)
- Caroline E Gebhard
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
- These authors contributed equally
| | - Claudia Sütsch
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- These authors contributed equally
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Pimrapat Gebert
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bianca Gysi
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Atanas Todorov
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Manja Deforth
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Philipp K Buehler
- Institute of Intensive Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexander Meisel
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Reto A Schuepbach
- Institute of Intensive Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annelies S Zinkernagel
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Silvio D Brugger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Claudio Acevedo
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dimitri Patriki
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Benedikt Wiggli
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland
| | - Jürg H Beer
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland
| | - Andrée Friedl
- Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland
| | - Raphael Twerenbold
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Department of Cardiology and University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Gabriela M Kuster
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Hans Pargger
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University of Basel, Basel, Switzerland
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thibaud Spinetti
- Department of Intensive Care Medicine, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Chiara Henze
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Mina Pasqualini
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Dominik F Sager
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Lilian Mayrhofer
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Mirjam Grieder
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Janna Tontsch
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Fabian C Franzeck
- Department of Informatics, University Hospital Basel, Basel, Switzerland
| | - Pedro D Wendel Garcia
- Institute of Intensive Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel A Hofmaenner
- Institute of Intensive Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Scheier
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jan Bartussek
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
- Institute of Intensive Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ahmed Haider
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, and Department of Radiology, Harvard Medical School, Boston, Massachusetts, United States
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Muriel Grämer
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Nidaa Mikail
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Alexia Rossi
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Núria Zellweger
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Petra Opić
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Angela Portmann
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Valerie Treyer
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Siegemund
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ulrike Held
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Vera Regitz-Zagrosek
- Institute of Gender in Medicine (GiM), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
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