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Women with polycystic ovary syndrome (PCOS) face an almost 30% increased risk for COVID-19 compared with unaffected women, even after adjusting for cardiometabolic and other related factors, suggests an analysis of United Kingdom primary care data.
“Our research has highlighted that women with PCOS are an often overlooked and potentially high-risk population for contracting COVID-19,” said joint senior author Wiebke Arlt, MD, PhD, Director of the Institute of Metabolism and Systems Research at the University of Birmingham, UK, in a press release.
“Before the onset of the COVID-19 pandemic, women with PCOS consistently report fragmented care, delayed diagnosis and a perception of poor clinician understanding of their condition,” added co-author Michael W. O’Reilly, MD, PhD, University of Medicine and Health Sciences, Dublin, Ireland.
“Women suffering from this condition may fear, with some degree of justification, that an enhanced risk of COVID-19 infection will further compromise timely access to healthcare and serve to increase the sense of disenfranchisement currently experienced by many patients,” he added.
Consequently, “these findings need to be considered when designing public health policy and advice as our understanding of COVID-19 evolves,” noted first author Anuradhaa Subramanian, PhD Student, Institute of Applied Health Research, University of Birmingham.
The research was published by the European Journal of Endocrinology on March 9.
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Women With PCOS: A Distinct Subgroup?
PCOS, which is thought to affect up to 16% of women, is associated with a significantly increased risk for type 2 diabetes, non-alcoholic fatty liver disease, and cardiovascular disease, all which have been linked to more severe COVID-19.
The condition is more prevalent in Black and South Asian women, who also appear to have an increased risk for severe COVID-19 vs their White counterparts.
However, women and younger people in general have a lower overall risk for severe COVID-19 and mortality compared with older people and men.
Women with PCOS may therefore “represent a distinct subgroup of women at higher than average [on the basis of their sex and age] risk of adverse COVID-19-related outcomes,” the researchers note.
To investigate further, they collated data from The Health Improvement Network primary care database, which includes information from 365 active general practices in the UK for the period January 31, 2020, to July 22, 2020.
They identified women with PCOS or a coded diagnosis of polycystic ovaries (PCO), and then for each woman randomly selected four unaffected controls matched for age and general practice location.
They included 21,292 women with PCOS/PCO and 78,310 controls, who had a mean age at study entry of 39.3 years and 39.5 years, respectively. The mean age at diagnosis of PCOS was 27 years, and the mean duration of the condition was 12.4 years.
The crude incidence of COVID-19 was 18.1 per 1000 person-years among women with PCOS vs 11.9 per 1000 person-years in those without.
Cox regression analysis adjusted for age indicated that women with PCOS faced a significantly increased risk for COVID-19 than those without, at a hazard ratio of 1.51 (P < .001).
Further adjustment for body mass index (BMI) and age reduced the hazard ratio to 1.36 (P = .001).
In the fully adjusted model, which also took into account impaired glucose regulation, androgen excess, anovulation, hypertension, and other PCOS-related factors, the hazard ratio remained significant, at 1.28 (P = .015).
For Shielding, Balance Benefits With Impact on Mental Health
Joint senior author Krishnarajah Nirantharakumar, MD, PhD, also of the University of Birmingham, commented that, despite the increased risks, shielding strategies for COVID-19 need to take into account the impact of PCOS on women’s mental health.
“The risk of mental health problems, including low self-esteem, anxiety, and depression, is significantly higher in women with PCOS,” he said, “and advice on strict adherence to social distancing needs to be tempered by the associated risk of exacerbating these underlying problems.”
Arlt also pointed out that the study only looked at the incidence of COVID-19 infection, rather than outcomes.
“Our study does not provide information on the risk of a severe course of the COVID-19 infection or on the risk of COVID-19–related long-term complications [in women with PCOS] and further research is required,” she concluded.
The study was funded by Health Data Research UK and supported by the Wellcome Trust, the Health Research Board, and the National Institute for Health Research Birmingham Biomedical Research Centre based at the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust. The study authors have disclosed no relevant financial relationships.
Eur J Endocrinol. Published online March 9, 2021. Full text