Examining the impact of sex differences and the COVID-19 pandemic on health and health care: findings from a national cross-sectional study

Objective To examine the association of the coronavirus disease 2019 (COVID-19) pandemic, the association of sex, and the joint association of sex and the COVID-19 pandemic with health communication, physical activity, mental health, and behavioral health. Materials and Methods We drew data from the National Cancer Institute's 2020 Health Information National Trends Survey. We described and compared the characteristics of social determinants of health, physical activity, mental health, alcohol use, patterns of social networking service use, and health information data sharing. Analyses were weighted to provide nationally representative estimates. Multivariate models (multiple linear regression, multiple logistic regression, and multinomial logistic model) were used to assess the sole and joint association with sex and pandemic. In addition, we applied the Bonferroni correction to adjust P values to decrease the risks of type I errors when making multiple statistical tests. Results Females were more likely to use mobile health and health communication technologies than males, and the difference increased after the pandemic. The association between sex and mental health was significant after the COVID-19 pandemic. Females were more likely to experience depression or anxiety disorders. Both males and females had a slight decrease in terms of the quantity and intensity of physical activity and females were less likely to perform moderate exercise and strength training regularly. Males were likely to drink more alcohol than females. Conclusion The COVID-19 pandemic amplifies the differences between males and females in health communication, physical activity, mental health, and behavioral health. Intersectional analyses of sex are integral to addressing issues that arise and mitigating the exacerbation of inequities. Responses to the pandemic should consider diverse perspectives, including sex and gender. Lay Summary The coronavirus disease 2019 (COVID-19) pandemic has had unprecedented and potentially irreversible impacts on health and health care globally. Many complex issues and factors therefore need to be accounted for as we look at the long-term impact of COVID-19 on humanity and society and how this ongoing crisis continues to affect health outcomes for different populations. There are significant health disparities and sex inequalities associated with the COVID-19 pandemic. Sex-responsive interventions are imperative to address widening sex gaps resulting from the pandemic. Although many researchers have studied the impact of the COVID-19 pandemic on health disparities, there is a lack of research on the sole and joint association of the pandemic or sex differences and their specific impact on health and health care. The study examined the association of the COVID-19 pandemic, the association of sex, and the joint association of sex and the COVID-19 pandemic with health communication, physical activity, mental health, and behavioral health. We also highlighted the application of Bonferroni corrections when conducting multiple hypotheses testing simultaneously.