A LARGE cohort study has revealed that women are at a significantly higher risk of developing long COVID compared to men, especially between the ages of 40–55 years.
The study used data from the National Institutes of Health (NIH) Researching COVID to Enhance Recovery (RECOVER)-Adult cohort, including 12,276 individuals across 83 sites in 33 USA states, Washington, D.C., and Puerto Rico. Of the participants, 73% (8,969) were female, and the average age at infection was 46 years. All participants had SARS-CoV-2 infections and were followed for at least 6 months post-infection. Using a self-reported symptom questionnaire and propensity score matching, researchers assessed the risk of long COVID while accounting for factors such as age, race, ethnicity, clinical characteristics, and social determinants of health.
Females demonstrated a 31% higher risk of long COVID in the full analysis model (risk ratio [RR]: 1.31; 95% CI: 1.06–1.62) and a 44% higher risk in the reduced model (RR: 1.44; 95% CI: 1.17–1.77) compared to males. Notably, the sex-based difference was absent among younger adults aged 18–39 years (RR: 1.04; 95% CI: 0.72–1.49) but was more pronounced in nonpregnant females (RR: 1.50; 95% CI: 1.27–1.77). Among women aged 40–54 years, the risk was similar in menopausal (RR: 1.42; 95% CI: 0.99–2.03) and non-menopausal participants (RR: 1.45; 95% CI: 1.15–1.83).
The study highlights the need for further research into the biological mechanisms behind these sex-based differences. Understanding the role of factors like hormonal changes and immune responses may guide the development of targeted treatments and improved risk stratification strategies.
Ada Enesco, EMJ
Reference
Shah DP et al; RECOVER Consortium. Sex differences in long COVID. JAMA Netw Open. 2025;8(1):e2455430.
