I investigate a cohort of 6,865 adult in-hospital deaths for two sample periods with high disease prevalence using split file, staged multivariate logistic regression
Another posibility is that women were more likely to seek treatment and thus got the diagnostic -- men were more likely to 'tough it out'. We should see this pattern for other diseases, too, if the behaviour is typical. Do we?
Yes, that would do it but it wouldn't explain why they changed their risk aversion behaviour between the first and second waves. It is entirely possible for me to exclude COVID cases and look at, say, incidence of cancer or cardiac (though they're not exactly free from bias in this regard).
That could be changing attitudes towards the 'stay home to protect the NHS' message, which is why I would be interested in seeing how the diagnosis of other things went during those periods of time. Nothing but curiosity, here.
Good point! I've just run some models for 2017 - 2019. Women did the same back then when it concerned acute respiratory, chronic respiratory and cancer but not with any cardiac condition. How much of this is biology and how much expectation we can only guess. I'll do the same for the two study periods and see what we get - this might be worth typing up for part 4.
The other assumption we are making here is that the people who got the diagnosis were in hospital reporting respiratory infection symptoms, and not here for some other reason, like a broken arm, and tested positive for covid as well as their original problem. In Sweden, in the first wave, those people were a significant fraction of those who got a covid diagnosis in Stockholm hospitals. If this segment is significant then we need to look at how many women were there for pregnancy related things. Given that 'giving birth' is also seasonal, but different seasons, then that might be influencing things.
Correct - we have no idea when they got swabbed and when and why they were admitted. We must also bear in mind that a cancer case isn't necessarily just a cancer case, so the diagnostic boundaries are smeared like crazy. It is possible to look at pure cases of this or that but the numbers dwindle to very few and the models fall apart. It is also possible to identify issues surrounding pregnancy.
Just run some models for non-COVID cases for the first and second waves and they didn't change their behaviour for cancer, but they did change it for major CNS issues, so it's going to be a mixed bag coming down to personal assessment of risk.
As I recall, chaps die younger, mainly of heart issues and occupational/lifestyle related cancers, women die older, usually of diabetes, falls/osteoporosis, and dementia?
Yep, that's how it was in our hospital. Older women developed heart valve problems leading to heart failure and chaps got nobbled early on by ischaemic/atherosclerotic heart disease.
1. Women picked their kids up from school and got it from kids, until school closures came around.
2. Women still did all the shopping and got it from other women at the grocery store while men sat around at home. After several weeks of that the women had had enough and men started sharing the shopping.
3. Women ask to be swabbed more than men who don't know how to read the news. (Or maybe they swab everyone?)
Yep, we've got another of those dirty great rafts under the numbers! I've got some more models coming out that explore the sex thing that I'll get typed up for part 4 (see my comments).
There are a number of papers finding much higher female proportions in long covid and some suggestion that this is based on tendency toward hypochondria. Perhaps that helps explain your gender finding here? https://pubmed.ncbi.nlm.nih.gov/34763058/
Also please don't forget that the prevalence data collected in the UK is of course subject to the false positive paradox for any screening testing, so actual prevalence is probably 10-20% of the alleged prevalence figures.
Just thinking about who was being tested in first wave. 83% of care home staff are women, 69% of nhs staff are women, female care home residents to male 23 to 10 and 58% of key workers are women. Women consult gps more than men, men 50% less likely to seek medical attention so when tests were harder to access a person had to have a bit of motivation to be tested or were forced to through work protocols (testing once or twice a week in care homes once tests were available). By the second wave we had tests coming out of our ears in the community so a symptomatic male had to work hard not to be tested. Also people by then were testing for all sorts of reasons like going on holiday, coming back from holiday, going home for Christmas. Many of those tests were forced on people.
Re: early Long Covid and women, I’ll add this just for reference from early on, although I’m not sure what make of it. Another also suggested re hormones….What are the differences, if any, re: long covid and post viral fatigue? Also we have many cases of long covid/PASC/post vaccine syndrome or whatever to call it ?
“Professor Chris Brightling, a professor of respiratory medicine at the University of Leicester and the chief investigator for the PHOSP-COVID study, said white women aged between 40 and 60, who have at least two long-term health conditions, were said to have the most severe prolonged reactions.
He said: "While the profile of patients being admitted to hospital with Covid-19 is disproportionately male and from an ethnic minority background, our study finds that those who have the most severe prolonged symptoms tend to be white women aged approximately 40 to 60 who have at least two long term health conditions, such as asthma or diabetes."
"We are learning more about Long Covid all the time and have given £20 million research funding to support innovative projects, with clinics established across the country to help improve the treatment available."
Gotta reverse this typo: "with young males at slightly higher risk and older females at slightly higher risk,"
Bummer! Sorted...
Another posibility is that women were more likely to seek treatment and thus got the diagnostic -- men were more likely to 'tough it out'. We should see this pattern for other diseases, too, if the behaviour is typical. Do we?
Yes, that would do it but it wouldn't explain why they changed their risk aversion behaviour between the first and second waves. It is entirely possible for me to exclude COVID cases and look at, say, incidence of cancer or cardiac (though they're not exactly free from bias in this regard).
That could be changing attitudes towards the 'stay home to protect the NHS' message, which is why I would be interested in seeing how the diagnosis of other things went during those periods of time. Nothing but curiosity, here.
Good point! I've just run some models for 2017 - 2019. Women did the same back then when it concerned acute respiratory, chronic respiratory and cancer but not with any cardiac condition. How much of this is biology and how much expectation we can only guess. I'll do the same for the two study periods and see what we get - this might be worth typing up for part 4.
The other assumption we are making here is that the people who got the diagnosis were in hospital reporting respiratory infection symptoms, and not here for some other reason, like a broken arm, and tested positive for covid as well as their original problem. In Sweden, in the first wave, those people were a significant fraction of those who got a covid diagnosis in Stockholm hospitals. If this segment is significant then we need to look at how many women were there for pregnancy related things. Given that 'giving birth' is also seasonal, but different seasons, then that might be influencing things.
Correct - we have no idea when they got swabbed and when and why they were admitted. We must also bear in mind that a cancer case isn't necessarily just a cancer case, so the diagnostic boundaries are smeared like crazy. It is possible to look at pure cases of this or that but the numbers dwindle to very few and the models fall apart. It is also possible to identify issues surrounding pregnancy.
a graph of men seen and women seen over time(for anything at all) might be revealing. Or show nothing, which would itself be of note.
Just run some models for non-COVID cases for the first and second waves and they didn't change their behaviour for cancer, but they did change it for major CNS issues, so it's going to be a mixed bag coming down to personal assessment of risk.
As I recall, chaps die younger, mainly of heart issues and occupational/lifestyle related cancers, women die older, usually of diabetes, falls/osteoporosis, and dementia?
Yep, that's how it was in our hospital. Older women developed heart valve problems leading to heart failure and chaps got nobbled early on by ischaemic/atherosclerotic heart disease.
Okay, from half-court in the wind:
1. Women picked their kids up from school and got it from kids, until school closures came around.
2. Women still did all the shopping and got it from other women at the grocery store while men sat around at home. After several weeks of that the women had had enough and men started sharing the shopping.
3. Women ask to be swabbed more than men who don't know how to read the news. (Or maybe they swab everyone?)
Yep, we've got another of those dirty great rafts under the numbers! I've got some more models coming out that explore the sex thing that I'll get typed up for part 4 (see my comments).
There are a number of papers finding much higher female proportions in long covid and some suggestion that this is based on tendency toward hypochondria. Perhaps that helps explain your gender finding here? https://pubmed.ncbi.nlm.nih.gov/34763058/
Smashing stuff! Lovely to have flesh put on my numerical bones. In part 4 you'll see this coming out in the wash.
Also please don't forget that the prevalence data collected in the UK is of course subject to the false positive paradox for any screening testing, so actual prevalence is probably 10-20% of the alleged prevalence figures.
Indeed, which is why I chose two small time periods to minimise this and don't rely on published prevalence studies.
At least you got the biscuits baked :) Small thing, last para of Stage One '...during periods ..of.. greater disease...' Thanks for the summary.
Ta - it's amazing what slips through even after three proof readings!
Just thinking about who was being tested in first wave. 83% of care home staff are women, 69% of nhs staff are women, female care home residents to male 23 to 10 and 58% of key workers are women. Women consult gps more than men, men 50% less likely to seek medical attention so when tests were harder to access a person had to have a bit of motivation to be tested or were forced to through work protocols (testing once or twice a week in care homes once tests were available). By the second wave we had tests coming out of our ears in the community so a symptomatic male had to work hard not to be tested. Also people by then were testing for all sorts of reasons like going on holiday, coming back from holiday, going home for Christmas. Many of those tests were forced on people.
Re: early Long Covid and women, I’ll add this just for reference from early on, although I’m not sure what make of it. Another also suggested re hormones….What are the differences, if any, re: long covid and post viral fatigue? Also we have many cases of long covid/PASC/post vaccine syndrome or whatever to call it ?
“Professor Chris Brightling, a professor of respiratory medicine at the University of Leicester and the chief investigator for the PHOSP-COVID study, said white women aged between 40 and 60, who have at least two long-term health conditions, were said to have the most severe prolonged reactions.
He said: "While the profile of patients being admitted to hospital with Covid-19 is disproportionately male and from an ethnic minority background, our study finds that those who have the most severe prolonged symptoms tend to be white women aged approximately 40 to 60 who have at least two long term health conditions, such as asthma or diabetes."
"We are learning more about Long Covid all the time and have given £20 million research funding to support innovative projects, with clinics established across the country to help improve the treatment available."
https://www.itv.com/news/2021-03-24/long-covid-70-of-patients-still-suffering-five-months-after-leaving-hospital-study-reveals