Studies note higher risk of long COVID in women, differences among minority kids

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Health (NIH) Researching COVID to Enhance Recovery (RECOVER)–Adult study find women substantially more likely to develop long COVID after infection than are men. 

And a second study published yesterday in Nature Communications shows racial and ethnic differences in long COVID-symptoms and conditions among pediatric patients. 

Self-assessments 6 months after infection

RECOVER is the largest cohort followed up in a natural history study of long COVID, the authors said, with participants seen at 83 sites across the United States. Included in today's study were participants who enrolled in RECOVER from October 2021 to July 2024. 

The study was based on self-assessments made 6 months after COVID-19 infection. A total of 12,276 participants made the assessments, among them 8,969 women (73%) with an average age of 46 at the time of infection. 

Long COVID was based on the presence of several symptoms present 30 days or more after infection, including postexertional malaise, fatigue, brain fog, dizziness, heart palpitations, loss of or change in smell or taste, thirst, chronic cough, chest pain, shortness of breath, and snoring or sleep apnea. 

31% higher risk in women

Compared to the women, the men in the study were older, less likely to be overweight or have asthma, and less likely to report mental health conditions. Men, however, were more likely to report hospitalization during acute infection (10% compared to 7%).

Overall, 21% of women and 16% of men reported long COVID, and the risk ratio (RR) for female sex associated with long COVID was 1.31 (95% confidence interval [CI], 1.06 to 1.62), or a 31% higher risk.

The sex-based association was age, pregnancy, and menopausal status dependent, however. Menopausal women were not at increased risk, suggesting a hormonal component may be at platy.

Female sex was associated with a 1.31-times higher risk of long COVID in our primary analysis full model with matching on demographic and enrollment factors.

"Female sex was associated with a 1.31-times higher risk of long COVID in our primary analysis full model with matching on demographic and enrollment factors, social determinants of health, and hospitalization and vaccination status during first infection," the authors wrote. 

Differing long-COVID symptoms in minority kids

In the Nature Communications study, also based on data from the RECOVER trial, 225,723 children and adolescents with COVID-19 from March 2020 to October 2022 were included. Girls accounted for 50.2% of participants, 48.3% were white, 20.3% were Black, and 26.6% were Hispanic. Asian American Pacific Islanders (AAPIs) accounted for 4.8% of participants. 

AAPI patients showed an increase in the risk of developing at least one long-COVID–related condition and any syndromic conditions, both in severe and non-severe COVID-19 cases, the authors said. 

Overall, Hispanic children showed a greater incidence of respiratory signs and symptoms (RR 1.16, 95% CI 1.02 to 1.33), compared to White patients. Among those with non-severe acute COVID-19, Hispanic patients displayed a higher incidence of myocarditis (RR, 4.28; 95% CI, 1.53 to 11.98) and abnormal liver enzyme (RR, 2.06; 95% CI, 1.08 to 3.94) compared with White patients.

Among pediatric patients with severe symptoms, Black children were more likely to report increased cognitive function issues with long COVID. Hispanic kids reported more hair loss, and AAPI children had higher risk of dysautonomia.

There were no significant differences observed for patients aged 5 and under among racial groups. 

"Understanding these differences is crucial for developing targeted interventions to ensure equitable healthcare access and outcomes for all pediatric populations," the authors concluded. "The increased risk among minority racial/ethnic pediatric patients may necessitate targeted follow-up care and support for the minority racial/ethnic population."

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