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Post COVID-19 Condition Diagnosis: A Population-Based Cohort Study of Occurrence, Associated Factors, and Healthcare Use by Severity of Acute Infection
26 Pages Posted: 22 Jun 2022
More...Abstract
Background: The occurrence and healthcare use trajectory of post COVID-19 is poorly understood. Accordingly, our aim was to investigate these aspects in SARS-CoV-2 positive individuals with and without a post COVID-19 condition diagnosis.
Methods: We conducted a population-based cohort study of adult residents in Stockholm Region with a positive SARS-CoV-2 test from 1 March 2020 to 31 July 2021, stratified by severity of the acute infection. The study outcome was post COVID-19 condition diagnosis registered any time 90 to 360 days after positive test. We performed Cox proportional hazard regression models to assess baseline characteristics associated with post COVID-19. Individuals with post COVID-19 were then propensity score matched to individuals without post COVID-19, followed by descriptive analyses and difference-in-difference models to analyse healthcare use beyond the acute infection.
Findings: Among 204 805 SARS-CoV-2-positive individuals, the proportion receiving a post COVID-19 diagnosis was 1% among non-hospitalized, 6% among hospitalized, and 32% among ICU-treated individuals. Female sex was associated with post COVID-19 among non-hospitalized and hospitalized individuals, with strong interactions between age and sex. Previous mental health disorders and asthma were associated with post COVID-19 among non-hospitalized [aHR 2·18 (95% CI 1·98-2·39), aHR 2·09 (95% CI 1·82-2·40)] and hospitalized [aHR 1·38 (95% CI 1·17-1·64), aHR 1·64 (95% CI 1·34-2·00)] individuals. Among individuals with post COVID-19, the monthly proportion with outpatient care visits after the infection compared to before the infection was substantially elevated up to one year after the acute infection, with substantial proportions of this care attributed to post COVID-19-related care.
Interpretation: The differential association of age, sex, comorbidities, and healthcare use with severity of the acute infection indicates different trajectories and phenotypes of post COVID-19 condition with incomplete resolution one year after infection.
Funding Information: The work was supported by grants from EuCARE, Region Stockholm, Swedish Research Council Dnr 2021-04809 and 2021-06540, Swedish Heart and Lung Foundation, Emil and Wera Cornell Foundation.
Declaration of Interests: None of the authors report competing interests. All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: no support from any organisation for the submitted work [or describe if any]; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years [or describe if any], no other relationships or activities that could appear to have influenced the submitted work [or describe if any].
Ethics Approval Statement: The need for consent was waived by the Swedish Ethical Review Authority (Dnr 2018/1030-31, COVID-19 research amendment Dnr 2020-01385) since analyses are based on retrospectively collected data from the administrative health registry.
Keywords: COVID-19, SARS-CoV-2, post COVID-19 condition
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