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

doi:10.2807/1560-7917.ES.2024.29.2.2300200

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Impact of sex and gender on post-COVID-19 syndrome, Switzerland, 2020
Caroline E Gebhard^1,* , Claudia Sütsch^2,3,* , Pimrapat Gebert⁴ , Bianca Gysi¹ , Susan Bengs^2,3 , Atanas Todorov^2,3 , Manja Deforth⁵ , Philipp K Buehler⁶ , Alexander Meisel^2,3 , Reto A Schuepbach⁶ , Annelies S Zinkernagel⁷ , Silvio D Brugger⁷ , Claudio Acevedo⁷ , Dimitri Patriki⁸ , Benedikt Wiggli⁹ , Jürg H Beer^3,9 , Andrée Friedl⁹ , Raphael Twerenbold^10,11 , Gabriela M Kuster^10,12 , Hans Pargger¹ , Sarah Tschudin-Sutter¹³ , Joerg C Schefold¹⁴ , Thibaud Spinetti¹⁴ , Chiara Henze^2,3 , Mina Pasqualini^2,3 , Dominik F Sager^2,3 , Lilian Mayrhofer¹ , Mirjam Grieder¹ , Janna Tontsch¹ , Fabian C Franzeck¹⁵ , Pedro D Wendel Garcia⁶ , Daniel A Hofmaenner⁶ , Thomas Scheier⁷ , Jan Bartussek^6,16 , Ahmed Haider^2,3,17 , Muriel Grämer^2,3 , Nidaa Mikail^2,3 , Alexia Rossi^2,3 , Núria Zellweger¹ , Petra Opić¹ , Angela Portmann^2,3 , Roland von Känel¹⁸ , Aju P Pazhenkottil² , Michael Messerli² , Ronny R Buechel² , Philipp A Kaufmann² , Valerie Treyer² , Martin Siegemund¹ , Ulrike Held⁵ , Vera Regitz-Zagrosek¹⁹ , Catherine Gebhard^2,3
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Affiliations: ¹ Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland ² Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland ³ Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland ⁴ Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany ⁵ Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland ⁶ Institute of Intensive Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland ⁷ Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland ⁸ Department of Cardiology, University Hospital Zurich, Zurich, Switzerland ⁹ Department of Internal Medicine, Cantonal Hospital of Baden, Baden, Switzerland ¹⁰ Department of Cardiology, University Hospital Basel, Basel, Switzerland ¹¹ Department of Cardiology and University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, Hamburg, Germany ¹² Department of Biomedicine, University of Basel, Basel, Switzerland ¹³ Division of Infectious Diseases and Hospital Epidemiology, University of Basel, Basel, Switzerland ¹⁴ Department of Intensive Care Medicine, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland ¹⁵ Department of Informatics, University Hospital Basel, Basel, Switzerland ¹⁶ Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland ¹⁷ Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, and Department of Radiology, Harvard Medical School, Boston, Massachusetts, United States ¹⁸ Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland ¹⁹ Institute of Gender in Medicine (GiM), Charité - Universitätsmedizin Berlin, Berlin, Germany ^* These authors contributed equally

Correspondence:
Catherine Gebhard
Catherine.gebhard usz.ch
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Citation style for this article: Gebhard Caroline E, Sütsch Claudia, Gebert Pimrapat, Gysi Bianca, Bengs Susan, Todorov Atanas, Deforth Manja, Buehler Philipp K, Meisel Alexander, Schuepbach Reto A, Zinkernagel Annelies S, Brugger Silvio D, Acevedo Claudio, Patriki Dimitri, Wiggli Benedikt, Beer Jürg H, Friedl Andrée, Twerenbold Raphael, Kuster Gabriela M, Pargger Hans, Tschudin-Sutter Sarah, Schefold Joerg C, Spinetti Thibaud, Henze Chiara, Pasqualini Mina, Sager Dominik F, Mayrhofer Lilian, Grieder Mirjam, Tontsch Janna, Franzeck Fabian C, Wendel Garcia Pedro D, Hofmaenner Daniel A, Scheier Thomas, Bartussek Jan, Haider Ahmed, Grämer Muriel, Mikail Nidaa, Rossi Alexia, Zellweger Núria, Opić Petra, Portmann Angela, von Känel Roland, Pazhenkottil Aju P, Messerli Michael, Buechel Ronny R, Kaufmann Philipp A, Treyer Valerie, Siegemund Martin, Held Ulrike, Regitz-Zagrosek Vera, Gebhard Catherine. Impact of sex and gender on post-COVID-19 syndrome, Switzerland, 2020 . Euro Surveill. 2024;29(2):pii=2300200. https://doi.org/10.2807/1560-7917.ES.2024.29.2.2300200 Received: 03 Apr 2023; Accepted: 04 Oct 2023

SDG 5: Gender equality

Abstract

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.

Aim

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

Method

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).

Conclusion

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.

This work is licensed under a Creative Commons Attribution 4.0 International License.

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Impact of sex and gender on post-COVID-19 syndrome, Switzerland, 2020

Citation style for this article: <a href="/search?value1=Caroline+E+Gebhard&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gebhard Caroline E</a>, <a href="/search?value1=Claudia+S%C3%BCtsch&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sütsch Claudia</a>, <a href="/search?value1=Pimrapat+Gebert&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gebert Pimrapat</a>, <a href="/search?value1=Bianca+Gysi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gysi Bianca</a>, <a href="/search?value1=Susan+Bengs&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bengs Susan</a>, <a href="/search?value1=Atanas+Todorov&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Todorov Atanas</a>, <a href="/search?value1=Manja+Deforth&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Deforth Manja</a>, <a href="/search?value1=Philipp+K+Buehler&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Buehler Philipp K</a>, <a href="/search?value1=Alexander+Meisel&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Meisel Alexander</a>, <a href="/search?value1=Reto+A+Schuepbach&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schuepbach Reto A</a>, <a href="/search?value1=Annelies+S+Zinkernagel&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zinkernagel Annelies S</a>, <a href="/search?value1=Silvio+D+Brugger&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Brugger Silvio D</a>, <a href="/search?value1=Claudio+Acevedo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Acevedo Claudio</a>, <a href="/search?value1=Dimitri+Patriki&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Patriki Dimitri</a>, <a href="/search?value1=Benedikt+Wiggli&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wiggli Benedikt</a>, <a href="/search?value1=J%C3%BCrg+H+Beer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Beer Jürg H</a>, <a href="/search?value1=Andr%C3%A9e+Friedl&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Friedl Andrée</a>, <a href="/search?value1=Raphael+Twerenbold&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Twerenbold Raphael</a>, <a href="/search?value1=Gabriela+M+Kuster&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kuster Gabriela M</a>, <a href="/search?value1=Hans+Pargger&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pargger Hans</a>, <a href="/search?value1=Sarah+Tschudin-Sutter&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Tschudin-Sutter Sarah</a>, <a href="/search?value1=Joerg+C+Schefold&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Schefold Joerg C</a>, <a href="/search?value1=Thibaud+Spinetti&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Spinetti Thibaud</a>, <a href="/search?value1=Chiara+Henze&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Henze Chiara</a>, <a href="/search?value1=Mina+Pasqualini&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pasqualini Mina</a>, <a href="/search?value1=Dominik+F+Sager&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sager Dominik F</a>, <a href="/search?value1=Lilian+Mayrhofer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mayrhofer Lilian</a>, <a href="/search?value1=Mirjam+Grieder&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Grieder Mirjam</a>, <a href="/search?value1=Janna+Tontsch&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Tontsch Janna</a>, <a href="/search?value1=Fabian+C+Franzeck&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Franzeck Fabian C</a>, <a href="/search?value1=Pedro+D+Wendel+Garcia&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wendel Garcia Pedro D</a>, <a href="/search?value1=Daniel+A+Hofmaenner&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hofmaenner Daniel A</a>, <a href="/search?value1=Thomas+Scheier&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Scheier Thomas</a>, <a href="/search?value1=Jan+Bartussek&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bartussek Jan</a>, <a href="/search?value1=Ahmed+Haider&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Haider Ahmed</a>, <a href="/search?value1=Muriel+Gr%C3%A4mer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Grämer Muriel</a>, <a href="/search?value1=Nidaa+Mikail&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mikail Nidaa</a>, <a href="/search?value1=Alexia+Rossi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rossi Alexia</a>, <a href="/search?value1=N%C3%BAria+Zellweger&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Zellweger Núria</a>, <a href="/search?value1=Petra+Opi%C4%87&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Opić Petra</a>, <a href="/search?value1=Angela+Portmann&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Portmann Angela</a>, <a href="/search?value1=Roland+von+K%C3%A4nel&option1=author&noRedirect=true" class="nonDisambigAuthorLink">von Känel Roland</a>, <a href="/search?value1=Aju+P+Pazhenkottil&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pazhenkottil Aju P</a>, <a href="/search?value1=Michael+Messerli&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Messerli Michael</a>, <a href="/search?value1=Ronny+R+Buechel&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Buechel Ronny R</a>, <a href="/search?value1=Philipp+A+Kaufmann&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kaufmann Philipp A</a>, <a href="/search?value1=Valerie+Treyer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Treyer Valerie</a>, <a href="/search?value1=Martin+Siegemund&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Siegemund Martin</a>, <a href="/search?value1=Ulrike+Held&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Held Ulrike</a>, <a href="/search?value1=Vera+Regitz-Zagrosek&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Regitz-Zagrosek Vera</a>, <a href="/search?value1=Catherine+Gebhard&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gebhard Catherine</a>. Impact of sex and gender on post-COVID-19 syndrome, Switzerland, 2020 . <a href="/content/ecdc">Euro Surveill.</a> 2024;29(2):pii=2300200. <a href="https://doi.org/10.2807/1560-7917.ES.2024.29.2.2300200" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2024.29.2.2300200</a> Received: 03 Apr 2023;   Accepted: 04 Oct 2023

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Impact of sex and gender on post-COVID-19 syndrome, Switzerland, 2020

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