ABSTRACT
Overall, men have died from COVID-19 at slightly higher rates than women. But cumulative estimates of mortality by sex may be misleading. We analyze New York State COVID-19 mortality by sex between March 2020 and August 2021, demonstrating that 72.7% of the total difference in the number of COVID-19 deaths between women and men was accrued in the first seven weeks of the pandemic. Thus, while the initial surge in COVID-19 mortality was characterized by stark sex disparities, this article shows that disparities were greatly attenuated in subsequent phases of the pandemic. Investigating changes over time could help illuminate how contextual factors contributed to the development of apparent sex disparities in COVID-19 outcomes.
Subject(s)
COVID-19 , Male , Female , Humans , COVID-19/epidemiology , New York/epidemiology , PandemicsABSTRACT
After COVID‐19 vaccination a number of currently and formerly menstruating people reported changes in menstrual bleeding and menstrual symptoms. Media highlighted these experiences, but much of the focus was on changes in regularly menstruating cis‐gendered women and unnecessary concerns about fertility. This was despite ample evidence of vaccine safety for people who were currently pregnant or conceived after vaccination. An overlooked phenomenon was reports of periods, spotting, or other unexpected vaginal bleeding in people who usually do not menstruate, including people assigned female at birth who are transmasculine, trans men, agender, non‐binary, and other gender diverse identities. We present preliminary descriptions of post‐vaccine menstrual experiences of a vaccinated, non‐menstruating, gender diverse sample. Methods We conducted an online survey to characterize the menstrual experiences of a diverse group of currently and formerly menstruating people from April 7, 2021 through Oct 7, 2021. From over 160,000 responses, we identified 552 people between the ages of 18 and 45 who 1) reported they usually do not menstruate;2) reported using testosterone and/or gender‐affirming hormones (some did not specify testosterone);and 3) were not cis women. In addition to demographic characteristics (e.g., age, gender), we asked multiple‐choice and open‐ended questions about current menstrual status (including why they do not menstruate), hormone medications, contraceptive use, and menstrual symptoms after being vaccinated. Here, we combine experiences for both doses of the vaccine for analysis and group period, spotting, and other menstrual bleeding into one category called “breakthrough bleeding”. Results In this sample (n=552, age=25.6 +/‐ 5.7 (mean +/‐SD)), most respondents (84%, 463/552) selected more than one gender, with the most common for this subsample being transgender (n=460), man or man identified (n=373), non‐binary (n=241), and genderqueer/gender non‐conforming (n=124). 33% of respondents (180/552) reported breakthrough bleeding after vaccination, 9% (52/552) reported chest or breast soreness, and 46% (254/552) reported having other symptoms they would usually associate with a period. In response to the open‐ended question about other period related symptoms, respondents reported common symptoms such as cramping and bloating. A number of respondents also used the open‐ended text boxes to report negative mental health in response to their period symptoms, including anxiety, depression, gender dysphoria, panic attacks, and suicidal ideation. Conclusions Many gender diverse people who received vaccines for COVID‐19 experienced symptoms that are usually associated with menstruation, including unexpected bleeding. Because menstruation is usually considered in relation to fertility, other important aspects of this physiology are overlooked and this impacts people beyond fertile women. Attentiveness to menstruation beyond fertility and more inclusive use of gender in clinical trials is important to prepare people for potential side effects, address medically underserved populations, and reduce vaccine hesitancy.
ABSTRACT
Early in 2021, many people began sharing that they experienced unexpected menstrual bleeding after SARS-CoV-2 inoculation. We investigated this emerging phenomenon of changed menstrual bleeding patterns among a convenience sample of currently and formerly menstruating people using a web-based survey. In this sample, 42% of people with regular menstrual cycles bled more heavily than usual, while 44% reported no change after being vaccinated. Among respondents who typically do not menstruate, 71% of people on long-acting reversible contraceptives, 39% of people on gender-affirming hormones, and 66% of postmenopausal people reported breakthrough bleeding. We found that increased/breakthrough bleeding was significantly associated with age, systemic vaccine side effects (fever and/or fatigue), history of pregnancy or birth, and ethnicity. Generally, changes to menstrual bleeding are not uncommon or dangerous, yet attention to these experiences is necessary to build trust in medicine.
ABSTRACT
This paper presents the first longitudinal study of sex disparities in COVID-19 cases and mortalities across U.S. states, derived from the unique 13-month dataset of the U.S. Gender/Sex COVID-19 Data Tracker. To analyze sex disparities, weekly case and mortality rates by sex and mortality rate ratios were computed for each U.S. state, and a multilevel crossed-effects conditional logistic binomial regression model was fitted to estimate the variation of the sex disparity in mortality over time and across states. Results demonstrate considerable variation in the sex disparity in COVID-19 cases and mortalities over time and between states. These data suggest that the sex disparity, when present, is modest, and likely varies in relation to context-sensitive variables, which may include health behaviors, preexisting health status, occupation, race/ethnicity, and other markers of social experience.