Examining the Global Burden of Long COVID by Sex

Women are more likely than men to be affected by Long COVID, according to the results of an analysis published in JAMA.¹

Given the relative recency with which COVID-19 developed, there is a lack of data surrounding Long COVID, the cluster of varying symptoms that some individuals experience after the acute phase of a SARS-CoV-2 infection. Researchers, therefore, set out to determine the proportion of men and women, both younger and older than 20 years of age, who experienced Long COVID symptoms in either 2020 or 2021, as well as evaluate their symptom severity and expected Long COVID symptom duration.

Investigators utilized data from 54 studies and 2 medical record databases inclusive of individuals across 22 countires who had symptomatic COVID-19. Participant data came from 44 published studies, 10 collaborating cohort studies, and 2 US electronic medical record databases.

The primary study outcome was the proportion of individuals with at least 1 of 3 self-reported Long COVID symptom clusters—persistent fatigue with bodily pain or mood swings, cognitive problems, or ongoing respiratory problems—for 3 months after COVID-19 infection.

The total cohort included 1.2 million individuals (mean age, 4-66 years; 26%-88% men). Results of modeled estimates showed that 6.2% of individuals who had symptomatic COVID-19 experienced at least 1 of the 3 Long COVID symptom clusters during the study period (95% uncertainty interval [UI], 2.4%-13.3%); 3.2% experienced persistitent fatigue with bodily pain and mood swings; 3.7% experienced ongoing respiratory problems; and 2.2% expericned cognitive problems—after adjusting for health status before COVID-19 infection. Ultimately, these comprised of an estimated 51%, 60.4%, and 35.4% of Long COVID cases.

Symptom clusters were more common in women older than 20 years of age than in men of the same age (10.6% vs 5.4%% 3 months after symptomatic COVID-19 infection. Across both sexes, individuals younger than age 20 were affected by Long COVID in approximately 2.8% of symptomatic COVID-19 cases.

Estimated mean duration of a Long COVID symptom cluster was 9 months (95% UI, 7-12 months) among individuals who were hospitalized, and 4 months (95% UI, 3.6-4.6 months) among those who were not. An estimated 15.1% continued experiencing symptoms at 12 months.

Study limitations include the wide 95% UI estimates, indicative of “limited and heterogenous data,” the need for multiple algorithms to achieve consistency, and assumptions about the similarity of the course of Long COVID across countries, among other limitations.

“The pattern of Long COVID symptoms by sex is distinct from that of severe acute SARS-CoV-2 infection, which tends to affect more males,” the researchers wrote. “This difference suggests that the underlying mechanism of Long COVID may be different from that of the severity of acute SARS-CoV-2 infection.”

Reference

1. Global Burden of Disease Long COVID Collaborators. Estimated global proportions of individuals with persistent fatigue, cognitive, and respiratory symptom clusters following symptomatic COVID-19 in 2020 and 2021. JAMA. 2022;328(16):1604-1615. doi: 10.1001/jama.2022.18931