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BACKGROUND: Stroke is a leading cause of long-term disability among survivors. Past literature already investigated the biological sex differences in stroke outcome, still limited work on gender differences is published. Therefore, the study aimed at investigating whether biological sex and sociocultural gender of survivors play a role as determinants of disability and quality of life among stroke survivors across Europe and Canada. METHODS: Data were gathered from the European Health Information Survey (EHIS, n=316,333) and Canadian Community Health Survey (CCHS, n=127,462) datasets. Main outcomes of interest were disability, assessed through evaluating the impairment of Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (iADL), and inpatient care needs, such as hospitalization or institutionalization. Multivariate logistic regression models were utilized to identify factors independently associated with outcomes. Federated analysis was conducted for cross-country comparisons. Data were adjusted for the country-specific Gender Inequality Index (GII), with higher score corresponding to more gender inequality towards femalesResults: Female survivors showed greater impairments in iADL (OR=1.73, 95% CI 1.53 - 1.96) and ADL (OR=1.25, 95% CI 1.09-1.44), without a corresponding increase in inpatient care needs. Socioeconomic factors such as marital status and income level were significant predictors of disability, with low income and being single/divorced associated with higher risks. The impact of sex was more pronounced in countries with higher GII, indicating the influence of gender inequality on stroke outcomes. INTERPRETATION: The findings highlight the significant impact of biological sex and gender-related social determinants on post-stroke disability, with female sex and unfavorable socioeconomic conditions being associated with worse outcomes.
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Homophily, the tendency of humans to attract each other when sharing similar features, traits, or opinions, has been identified as one of the main driving forces behind the formation of structured societies. Here we ask to what extent homophily can explain the formation of social groups, particularly their size distribution. We propose a spin-glass-inspired framework of self-assembly, where opinions are represented as multidimensional spins that dynamically self-assemble into groups; individuals within a group tend to share similar opinions (intragroup homophily), and opinions between individuals belonging to different groups tend to be different (intergroup heterophily). We compute the associated nontrivial phase diagram by solving a self-consistency equation for "magnetization" (combined average opinion). Below a critical temperature, there exist two stable phases: one ordered with nonzero magnetization and large clusters, the other disordered with zero magnetization and no clusters. The system exhibits a first-order transition to the disordered phase. We analytically derive the group-size distribution that successfully matches empirical group-size distributions from online communities.
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IMPORTANCE: A male predominance is reported in hospitalised patients with COVID-19 alongside a higher mortality rate in men compared to women. OBJECTIVE: To assess if the reported sex bias in the COVID-19 pandemic is validated by analysis of a subset of patients with severe disease. DESIGN: A nationwide retrospective cohort study was performed using the Austrian National COVID Database. We performed a sex-specific Lasso regression to select the covariates best explaining the outcomes of mechanical ventilation and death using variables known before ICU admission. We use logistic regression to construct a sex-specific "risk score" for the outcomes using these variables. SETTING: We studied the characteristics and outcomes of patients admitted to intensive care units (ICUs) in Austria. PARTICIPANTS: 5118 patients admitted to the ICU in Austria with a COVID-19 diagnosis in 03/2020-03/2021. EXPOSURES: Demographic and clinical characteristics, vital signs and laboratory tests, comorbidities, and management of patients admitted to ICUs were analysed for possible sex differences. MAIN OUTCOMES AND MEASURES: The aim was to define risk scores for mechanical ventilation and mortality for each sex to provide better sex-sensitive management and outcomes in the future. RESULTS: We found balanced accuracies between 55% and 65% to predict the outcomes. Regarding outcome death, we found that the risk score for pre-ICU variables increases with age, renal insufficiency (f: OR 1.7(2), m: 1.9(2)) and decreases with observance as admission cause (f: OR 0.33(5), m: 0.36(5)). Additionally, the risk score for females also includes respiratory insufficiency (OR 2.4(4)) while heart failure for males only (OR 1.5(1)). CONCLUSIONS AND RELEVANCE: Better knowledge of how sex influences COVID-19 outcomes at ICUs will have important implications for the ongoing pandemic's clinical care and management strategies. Identifying sex-specific features in individuals with COVID-19 and fatal consequences might inform preventive strategies and public health services.
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The drivers behind regional differences of SARS-CoV-2 spread on finer spatio-temporal scales are yet to be fully understood. Here we develop a data-driven modelling approach based on an age-structured compartmental model that compares 116 Austrian regions to a suitably chosen control set of regions to explain variations in local transmission rates through a combination of meteorological factors, non-pharmaceutical interventions and mobility. We find that more than 60% of the observed regional variations can be explained by these factors. Decreasing temperature and humidity, increasing cloudiness, precipitation and the absence of mitigation measures for public events are the strongest drivers for increased virus transmission, leading in combination to a doubling of the transmission rates compared to regions with more favourable weather. We conjecture that regions with little mitigation measures for large events that experience shifts toward unfavourable weather conditions are particularly predisposed as nucleation points for the next seasonal SARS-CoV-2 waves.