Background:
Infectious diseases are influenced by both sex and gender, with psychosocial stress potentially playing a critical role, particularly in upper respiratory tract infections (URTIs). Despite existing evidence, a comprehensive analysis of the interplay between sex, gender, stress, and RTIs is lacking.
Methods:
Our monocentric, prospective study included 273 healthy individuals (cohort H) and 194 patients with hematological cancer (cohort P) who had undergone stem cell transplantation, enrolled between 11/2013 and 05/2017. Eligible participants were aged 18 years or older. Data collection encompassed demographics, household composition, smoking behavior, cancer-related characteristics, RTI-symptoms, and perceived stress, measured using the 4-item perceived stress scale (PSS-4). Participants were categorized based on biological sex, without assessing gender identity. For analysis, we assumed that sex and gender were aligned.
Results:
In cohort H, 50% of the participants were female, with most individuals aged ≤ 30 years. Women experienced notably more moderate to severe URTI symptoms than men (57% vs. 36%, p < .001, φ = 0.210). Additionally, women across all age groups also exhibited higher PSS-4 levels than men [t(271) = 2.84, p < .001, d = -0.636] and the PSS-4 was significantly affected by sex [F(1, 261) = 22.22, p < 0.001, η2 0.078]. In cohort P, 40.5% of the patients were female, with the majority aged ≥ 30 years. The occurrence and severity of RTI symptoms were more pronounced in men than women. The PSS-4 was not affected by sex. Unlike in cohort H, a significant correlation between the PSS-4 and RTI symptoms was found for both sexes in cohort P. In both groups, the lowest stress levels were observed in individuals over 60 years old.
Conclusion
Perceived stress was higher in younger women, as was the occurrence and severity of URTIs. However, a significant correlation between stress and URTIs was found only in patients with cancer, suggesting a more complex interaction between sex, gender, stress and URTIs in individuals with compromised health as compared to healthy individuals, which deserves further study.
Trial registration:
Registry: the German Clinical Trials Register