Sex Differences in Long COVID Prevalence Over One year After the Acute Phase, and Related Risk Factors. The GINA-COVID Cohort Study

Background: This 1-year cohort study aimed to track long COVID prevalence, identify associated risk factors, and assess its association with hospitalization. Methods: The GINA-COVID cohort study included 2698 COVID-19 patients from Spain, who reported persistent symptoms spontaneously mentioned in an open questionnaire one year after infection. We recorded symptom onset, duration, and recovery rates at 12 months. Hospitalization data were collected from the Catalan Health System. We performed descriptive statistics and logistic regression models stratified by sex to identify factors associated with long COVID, using multiple imputation for missing values and model selection via stepwise regression based on the Akaike Information Criterion. Results: Significant sex differences appeared, with females showing a two-fold higher risk of developing long COVID compared to males (OR=1.95; 95% CI, 1.68–2.29). Females reported higher prevalence and a greater number of persistent symptoms, with fatigue being the most common in both sexes (36% in females, 26% in males at 3 months). The recovery rate at 12 months was lower in females (23% vs. 34%, p<0.001). Hypertension emerged as the most significant protective factor for long COVID in females (OR=0.64; 95% CI, 0.48–0.84), whereas COVID-19 severity was the most influential risk factor in males (OR=2.34; 95% CI, 1.79–3.08). Despite these differences, the trajectory of persistent symptoms over time was similar between the sexes. Importantly, long COVID did not increase hospital admissions. Conclusion: Findings underscore the importance of sex-specific approaches in managing long COVID and suggest further investigation into hypertension’s protective role in females and disease severity’s impact in males.