The 2019-2020 SARS-related coronavirus-2 (SARS-CoV-2) pandemic has brought unprecedented challenges to healthcare sectors around the world. As of November 2020, there have been over 64 million confirmed cases and approaching 2 million deaths globally. Despite the large number of positive cases, there are very limited established standards of care and therapeutic options available. To date, there is still no Food and Drug Administration (FDA) approved vaccine for COVID-19, although there are several options in various clinical trial stages. Herein, we have performed a global review evaluating the roles of age and sex on COVID-19 hospitalizations, ICU admissions, deaths in hospitals, and deaths in nursing homes. We have identified a trend in which elderly and male patients are significantly affected by adverse outcomes. There is evidence suggesting that sex hormone levels can influence immune system function against SARS-CoV-2 infection, thus reducing the adverse effects of COVID-19. Since older adults have lower levels of these sex hormones, we therefore speculate, within rational scientific context, that sex steroids, such as estrogen and progesterone, needs further consideration for use as alternative therapeutic option for treating COVID-19 elderly patients. To our knowledge, this is the first comprehensive article evaluating the significance of sex hormones in COVID-19 outcomes in older adults.

Background Insufficient physical activity (PA) is a common health risk and more prevalent in rural populations. Few studies have assessed relationships between the built environment and PA in rural settings, and community policy guidance to promote PA through built environment interventions is primarily based on evidence from urban studies. Methods Participants in the Bogalusa Heart Study, a longitudinal study in rural Louisiana, with International Physical Activity Questionnaire data from 2012 to 2013 and a valid residential address (N = 1245) were included. PA was summarized as the number of weekly metabolic equivalent (MET)-minutes of total, transportation, and leisure time PA. The Rural Active Living Assessment street segment audit tool and Google Street View were used to assess features of the built environment overall and in six categories (path features, pedestrian safety features, aesthetics, physical security, destinations and land use) that influence PA. Scores for street segment built environment (overall and in categories) were calculated, for segments and buffers of 0.25, 0.50, 1.00 and 1.50 miles. Associations between built environment scores and PA were assessed with generalized estimating equations. Results Participants reported little weekly total, leisure time, and transportation PA (mean 470, 230 and 43 MET-minutes per week, respectively). A 1-point increase in the overall built environment score was associated with 10.30 additional weekly leisure time MET-minutes within a 1.50 mile buffer (p-value 0.05), with a similar magnitude observed for a 1.00-mile buffer. A 1-point increase in the aesthetic score was associated with significantly higher leisure time PA for all geographic units (from 22.21 to 38.75 MET-minutes weekly) when adjusted for individual covariates, but was attenuated and only significant for the segment of the residence after accounting for other neighborhood characteristics. Conclusions Significant associations between features of the environment (overall and aesthetic scores) with leisure time PA were observed among adults in this rural population. Built environment interventions in rural settings face additional barriers of lower population density and greater distances for infrastructure projects, and it is important to identify approaches that are both feasible for rural communities and can promote PA.

Obesity and food insecurity are known public health concerns for older adults, and both are independent predictors of glycated hemoglobin (HbA1c). I examined the impact of the co-existence of food insecurity and obesity on HbA1c using the National Health and Nutrition Examination Survey (NHANES), 2005-2014. Body mass index /waist circumference (WC) cut- off values were used to create six body types: normal weight with normal WC, overweight with normal WC, obese with normal WC, normal weight with high WC, overweight with high WC, and obese with high WC. HbA1c was defined as normal < 5.7% and abnormal >5.7%. Food security status (FSS) was defined following USDA protocols (food secure-FS, food insecure-FI). The sample population included 5,772 participants 50 years and older with mean (SD) age of 61.8 (0.2). A weighted multivariable logistic regression controlling for age, gender, race/ethnicity, education, and poverty-to-income ratio was run for this analysis. The proportion of older adults with both FI and obesity with high WC (51.1%, p<0.0001) was significantly higher than those FS (37.5%). Logistic regression model with body types and FSS had a maximum-rescaled R-square (MRRS) of 0.147 vs. 0.093 and 0.144 for FSS and body types alone. An increase in MRRS in the model with both body types and FSS compared to the models containing only body types or FSS demonstrates an improved model for fitting abnormal HbA1c levels. The knowledge of this effect may benefit health risk assessment and management in this population.

Older Americans are increasingly affected by overweight and obesity now as compared to previous decades. We examine the prevalence rates and association of Depressive Symptoms (DS) across body types created using the National Heart, Lung, Blood Institute recommended body mass index /waist circumference (WC) anthropometric cut off values among older Americans. 3,132 participants, 50 years and older from the National Health and Nutrition Examination Survey (NHANES) 2013-2016 was used for this analysis. Six body types were created using the anthropometric cut off values- normal weight with normal WC, overweight with normal WC, obese with normal WC, normal weight with high WC, overweight with high WC, and obese with high WC. The PHQ-9 score was used to create DS categories (1-4, 5-9, 10-14, 15-19, ≥20). The relationship of body types to DS categories was assessed using weighted multinomial logistic regression. The mean (SD) sample age was 63.4 (9.2). Approximately 12.9% of participants had a PHQ-9 score of at least 10. After adjusting for age, gender, race/ethnicity and poverty-income ratio, overweight with high WC (OR 7.61, 95% CI 2.37-24.48) had high odds of moderately severe DS. Obese with high WC had high odds of mild DS (OR 1.76, 95% CI 1.22-2.52), moderate DS (OR 2.14, 95% CI 1.09-4.20) and moderately severe DS (OR 5.59, 95% CI 2.75-11.39) compared to normal weight with normal WC. We demonstrate an association of body types with DS in an aging American population and these findings would not be identified if anthropometric measures were examined separately.

Obesity, a public health concern for older adults, contributes to abnormal glycated hemoglobin (HbA1c). We examine place of birth disparities in the prevalence rate of body types and their association to HbA1c using the National Health Nutrition and Examination Survey (NHANES) III. Body mass index /waist circumference (WC) cut off values were used to create six body types: normal weight with normal WC, overweight with normal WC, obese with normal WC, normal weight with high WC, overweight with high WC, and obese with high WC. Abnormal HbA1c was defined as HbA1c >5.7%. Weighted multivariable logistic regression adjusted for age, gender, education, and poverty-income-ratio was run. The sample population included 4,584 participants aged 50 years and older identifying as non-Hispanic whites (NHW), US-born Hispanics (USB-H), and foreign-born Hispanics (FB-H). The mean (SD) sample age was 63.9 (0.3). USB-H had the highest proportion of obese with high WC (35.6%,p<0.0001) compared to NHW (26.6%) and FB-H (22.2%). USB-H (aOR 1.97 95% CI 1.45,2.68) and FB-H (aOR 1.51 95% CI 1.10,2.06) had higher odds of abnormal HbA1c compared to NHW. Overweight with high WC (aOR 1.47 95% CI 1.11-1.93) and obese with high WC (aOR 2.11, 95% CI 1.60-2.79) had a high likelihood of abnormal HbA1c compared to normal weight with normal WC. Further adjustment for co-morbid conditions yielded a significantly improved fitting model (Maximum-rescaled R-square (MRRS) =0.1997,p<0.0001) compared to that further adjusted for health-related behaviors (MRRS=0.082,p<0.0001). The knowledge of these associations in an at-risk sub-population is insightful for clinical assessments and preventive interventions.