Global Sex Disparity of COVID-19: A Descriptive Review of Sex Hormones and Consideration for the Potential Therapeutic Use of Hormone Replacement Therapy in Older Adults

The 2019-2020 SARS-related coronavirus-2 (SARS-CoV-2) pandemic has brought unprecedented challenges to healthcare sectors around the world. As of November 2020, there have been over 64 million confirmed cases and approaching 2 million deaths globally. Despite the large number of positive cases, there are very limited established standards of care and therapeutic options available. To date, there is still no Food and Drug Administration (FDA) approved vaccine for COVID-19, although there are several options in various clinical trial stages. Herein, we have performed a global review evaluating the roles of age and sex on COVID-19 hospitalizations, ICU admissions, deaths in hospitals, and deaths in nursing homes. We have identified a trend in which elderly and male patients are significantly affected by adverse outcomes. There is evidence suggesting that sex hormone levels can influence immune system function against SARS-CoV-2 infection, thus reducing the adverse effects of COVID-19. Since older adults have lower levels of these sex hormones, we therefore speculate, within rational scientific context, that sex steroids, such as estrogen and progesterone, needs further consideration for use as alternative therapeutic option for treating COVID-19 elderly patients. To our knowledge, this is the first comprehensive article evaluating the significance of sex hormones in COVID-19 outcomes in older adults.

Cross-sectional associations between the neighborhood built environment and physical activity in a rural setting: the Bogalusa Heart Study

BACKGROUND

Insufficient physical activity (PA) is a common health risk and more prevalent in rural populations. Few studies have assessed relationships between the built environment and PA in rural settings, and community policy guidance to promote PA through built environment interventions is primarily based on evidence from urban studies.

METHODS

Participants in the Bogalusa Heart Study, a longitudinal study in rural Louisiana, with International Physical Activity Questionnaire data from 2012 to 2013 and a valid residential address (N = 1245) were included. PA was summarized as the number of weekly metabolic equivalent (MET)-minutes of total, transportation, and leisure time PA. The Rural Active Living Assessment street segment audit tool and Google Street View were used to assess features of the built environment overall and in six categories (path features, pedestrian safety features, aesthetics, physical security, destinations and land use) that influence PA. Scores for street segment built environment (overall and in categories) were calculated, for segments and buffers of 0.25, 0.50, 1.00 and 1.50 miles. Associations between built environment scores and PA were assessed with generalized estimating equations.

RESULTS

Participants reported little weekly total, leisure time, and transportation PA (mean 470, 230 and 43 MET-minutes per week, respectively). A 1-point increase in the overall built environment score was associated with 10.30 additional weekly leisure time MET-minutes within a 1.50 mile buffer (p-value 0.05), with a similar magnitude observed for a 1.00-mile buffer. A 1-point increase in the aesthetic score was associated with significantly higher leisure time PA for all geographic units (from 22.21 to 38.75 MET-minutes weekly) when adjusted for individual covariates, but was attenuated and only significant for the segment of the residence after accounting for other neighborhood characteristics.

CONCLUSIONS

Significant associations between features of the environment (overall and aesthetic scores) with leisure time PA were observed among adults in this rural population. Built environment interventions in rural settings face additional barriers of lower population density and greater distances for infrastructure projects, and it is important to identify approaches that are both feasible for rural communities and can promote PA.

BODY TYPES AND ASSOCIATION WITH DEPRESSIVE SYMPTOMS AMONG OLDER ADULTS: FINDINGS FROM NHANES 2013-2016

Older Americans are increasingly affected by overweight and obesity now as compared to previous decades. We examine the prevalence rates and association of Depressive Symptoms (DS) across body types created using the National Heart, Lung, Blood Institute recommended body mass index /waist circumference (WC) anthropometric cut off values among older Americans. 3,132 participants, 50 years and older from the National Health and Nutrition Examination Survey (NHANES) 2013-2016 was used for this analysis. Six body types were created using the anthropometric cut off values- normal weight with normal WC, overweight with normal WC, obese with normal WC, normal weight with high WC, overweight with high WC, and obese with high WC. The PHQ-9 score was used to create DS categories (1-4, 5-9, 10-14, 15-19, ≥20). The relationship of body types to DS categories was assessed using weighted multinomial logistic regression. The mean (SD) sample age was 63.4 (9.2). Approximately 12.9% of participants had a PHQ-9 score of at least 10. After adjusting for age, gender, race/ethnicity and poverty-income ratio, overweight with high WC (OR 7.61, 95% CI 2.37-24.48) had high odds of moderately severe DS. Obese with high WC had high odds of mild DS (OR 1.76, 95% CI 1.22-2.52), moderate DS (OR 2.14, 95% CI 1.09-4.20) and moderately severe DS (OR 5.59, 95% CI 2.75-11.39) compared to normal weight with normal WC. We demonstrate an association of body types with DS in an aging American population and these findings would not be identified if anthropometric measures were examined separately.

DOES PARTICIPATING IN SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM IMPROVE THE SLEEP OF OLDER ADULTS?

Food insecurity among lower income adults is associated with adverse health outcomes including sleep disorders. Using data from the National Health and Nutrition Examination Survey (NHANES), 2005-2008, we explored the association between participation in the Supplemental Nutrition Assistance Program (SNAP), a safety net program addressing food insecurity, and sleep outcomes among older adults. Total sleep duration (<7 hours inadequate sleep, ≥7 hours adequate sleep) and sleep latency (10-20 mins normal sleep latency, ≤ 9 mins and ≥ 21mins abnormal sleep latency) were available for 805 participants 50 years and older and eligible for SNAP participation (≤130% federal poverty level). SNAP participation (yes/no) was assessed for the previous year. Sleep inadequacy was higher among SNAP participants (46.5%) compared to SNAP-eligible non-participants (36.3%), whereas the corresponding numbers for abnormal sleep latency were 71.8% and 64.1%. Binary logistic regression analysis showed no significant association between SNAP participation and inadequate sleep duration (OR=1.19, 95% CI 0.84-1.70) after adjusting for age, gender, race/ethnicity, education, and food security status. SNAP participation was also not associated with abnormal sleep latency (adjusted OR=1.49, 95% CI 1.00-2.23). SNAP participation was not protective against poor sleep outcomes among a sample of low-income, at risk of food insecurity older adults.