Understanding the Impact of Sociocultural Gender on Post-acute Sequelae of COVID-19: a Bayesian Approach
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Abstract
Background
Women are overrepresented amongst individuals suffering from 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.
Methods and Findings
By using Bayesian models comprising >200 co-variates, we assessed the impact of social context in addition to biological data on PASC in a multi-centre prospective cohort study of 2927 (46% women) individuals in Switzerland. Women more often reported at least one persistent symptom than men (43.5% vs 32.0% of men, p<0.001) six (IQR 5–9) months after SARS-CoV-2 infection. Adjusted models showed that women with personality traits stereotypically attributed to women were most often affected by PASC (OR 2.50[1.25-4.98], p<0.001), in particular when they were living alone (OR 1.84[1.25-2.74]), had an increased stress level (OR 1.06[1.03-1.09]), had undergone higher education (OR 1.30[1.08-1.54]), preferred pre-pandemic physical greeting over verbal greeting (OR 1.71[1.44-2.03]), and had experienced an increased number of symptoms during index infection (OR 1.27[1.22-1.33]).
Conclusion
Besides gender- and sex-sensitive biological parameters, sociocultural variables play an important role in producing sex differences in PASC. Our results indicate that predictor variables of PASC can be easily identified without extensive diagnostic testing and are targets of interventions aiming at stress coping and social support.
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SciScore for 10.1101/2021.06.30.21259757: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: Eligible patients were adults aged ≥18 years who survived acute COVID-19 infection and fluent in German, English, French, or Italian and able to provide informed consent.
IRB: The study protocol was approved by the responsible ethics committee of the Canton of Basel (EKNZ, ethics approval #2020-01311).Sex as a biological variable Out of 2858 patients, 52 patients (8 women and 44 men) died during or after treatment for COVID-19, 7 did not meet inclusion criteria. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are …
SciScore for 10.1101/2021.06.30.21259757: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: Eligible patients were adults aged ≥18 years who survived acute COVID-19 infection and fluent in German, English, French, or Italian and able to provide informed consent.
IRB: The study protocol was approved by the responsible ethics committee of the Canton of Basel (EKNZ, ethics approval #2020-01311).Sex as a biological variable Out of 2858 patients, 52 patients (8 women and 44 men) died during or after treatment for COVID-19, 7 did not meet inclusion criteria. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Also, many previous reports have several limitations, including lack of an agreed-upon case definition and potential bias, as most reports excluded either outpatients or hospitalized patients. Re-hospitalisation due to persistent symptoms or complication of COVID-19 has been reported to occur in 9% to 20% of patients.17,18 The observed readmission rate of 5.5% in our study is lower than these estimates. Although we did not analyse the most common reasons for readmission, the lower re-hospitalization rate in our study likely reflects the lower acuity of illness in our cohort relating to differences in age and disease severity between study populations. Further research is needed to assess the extent to which improvements in the management of post-COVID-19 syndrome might reduce readmission rates. In our study, reduced exercise tolerance and/or resilience was the most commonly reported symptom occurring in 41% of women and 43% of men with post-COVID-19 syndrome. While differences in study populations and outcome measurement are likely to affect the comparability of studies on post-COVID-19 syndrome, a relatively high prevalence of chronic fatigue, dyspnoea or exercise intolerance, and psychological symptoms have consistently been noted across studies.19,20 In particular, neuropsychiatric symptoms including depression and anxiety, cognitive impairment, headache or olfactory dysfunction seem to persist in a substantial number of patients (32% of individuals in our study) which is ...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a protocol registration statement.
Results from scite Reference Check: We found no unreliable references.
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