Women face a greater risk for long COVID vs. men
Key takeaways:
- Women had greater long COVID risk than men when researchers considered demographic and socioeconomic factors.
- Nonpregnant women and those aged 40 to 54 years faced even higher risks.
Women have a 31% or higher risk for symptoms of long COVID compared with men, according to a new cohort study published in JAMA Network Open.
Factors that influenced the risk for long COVID included pregnancy, age and menopause, while the results “show that patients and health care teams should consider the differences in long COVID risk as it relates to sex assigned at birth,” Dimpy P. Shah, MD, PhD, an assistant professor of population health sciences at the Joe R. and Teresa Lozano Long School of Medicine at the University of Texas Health San Antonio, said in a press release.
“Understanding these differences can help us recognize and treat patients with long COVID more effectively,” she added.
Healio previously reported that the risk for long COVID substantially declined over the course of the COVID-19 pandemic with each new variant of SARS-CoV-2 but remains significant.
In the current analysis, part of the NIH’s Researching COVID to Enhance Recovery (RECOVER) initiative, Shah and colleagues assessed the differences in long COVID risk linked to sex assigned at birth using the data of 12,276 participants (73% women; mean age, 46 years) who experienced a SARS-CoV-2 infection.
The analysis included participants who had a study visit 6 months or longer after their initial infection.
The researchers used propensity score matching to estimate long COVID RRs and risk differences, whereas long COVID development was determined through a self-reported symptom-based questionnaire and scoring guideline at the first study visit.
They found that women had a higher risk for long COVID in the analysis’ full model (RR = 1.31; 95% CI, 1.06-1.62) — which included demographic and clinical characteristics and social determinants of health — and in the reduced model (RR = 1.44; 95% CI, 1.17-1.77), which included only age, race and ethnicity.
The researchers observed the association across all age groups except those aged 18 to 39 years.
The long COVID risk tied to female sex became even greater when study investigators restricted the analysis to nonpregnant participants (RR = 1.5; 95% CI, 1.27-1.77).
Shah and colleagues also pointed out that among adults aged 40 to 54 years, postmenopausal women and non-postmenopausal women had a 42% (RR = 1.42; 95% CI, 0.99-2.03) and 45% (RR = 1.45; 95% CI, 1.15-1.83) increased risk for long COVID, respectively, vs. men.
The researchers noted a possible explanation behind the findings could be that “there is immune activation with menopausal transition, as is seen in individuals with HIV infection.”
Additionally, “both higher levels of estrogen and relatively lower levels of testosterone have been associated with high risk of long COVID in nonpregnant females,” they wrote.
Shah and colleagues suggested that sex steroid-based therapies could be used to mitigate symptoms of long COVID in females.
Ultimately, the analysis “gives us new knowledge and builds on other studies that also looked at sex assigned at birth and long COVID,” Shah said in the release. “Because of the size of the RECOVER study and the diversity of participants, we had a special opportunity to look at sex assigned at birth while also considering things like vaccination status, autoimmune disease, diabetes, BMI and COVID variant.”
She added that that the data hopefully “encourages other researchers to explore why there are differences in the risk of developing long COVID based on your assigned sex at birth.”
References:
- Females have a 31% higher associated risk of developing long COVID, UT Health San Antonio-led RECOVER study shows. Available at: https://news.uthscsa.edu/females-have-a-31-higher-associated-risk-of-developing-long-covid-ut-health-san-antonio-led-recover-study-shows/. Published Jan. 22, 2025. Accessed Jan. 24, 2025.
- Shah D, et al. JAMA Netw Open. 2025;doi:10.1001/jamanetworkopen.2024.55430.