Cross-sectional study of 261 post-hospitalization (PNP) and 2,068 non-hospitalized (NNP) Neuro-PASC patients at a single US center (May 2020–August 2025), comparing neurologic symptom burden, quality of life (PROMIS), and cognitive function (NIH Toolbox) between biological females and males at a mean of ~16 months after symptom onset.
Females outnumbered males in both groups (PNP 56.3% vs. 43.7%; NNP 66.3% vs. 33.7%). Females in both groups more often reported ≥4 neurologic symptoms (PNP: 79.6% vs. 64.9%, p=0.007; NNP: 76.1% vs. 64.6%, p<0.0001), worse fatigue on PROMIS (both groups, p≤0.004), and NNP females scored worse on NIH Toolbox attention (p=0.0002). No neurologic or non-neurologic PASC symptom was reported more frequently in males of either group.
- Single-center design with potential referral bias, though patients came from 39 US states. - ~30% of patients had a limited neurologic exam via televisit. - No adjustment for SARS-CoV-2 variant, and vaccination effects on sex differences were not analyzed in this study.
Female patients with Long COVID carry a heavier neurologic and somatic symptom burden than males and warrant closer attention for fatigue and cognitive deficits, particularly attentional dysfunction. Clinicians should be alert to gender bias that may delay or minimize diagnosis in this population.
