Long COVID Burden and Risk Factors in 10 UK Longitudinal Studies and Electronic Health Records

The frequency of, and risk factors for, long COVID are unclear among community-based individuals with a history of COVID-19. To elucidate the burden and possible causes of long COVID in the community, we coordinated analyses of survey data from 6907 individuals with self-reported COVID-19 from 10 UK longitudinal study (LS) samples and 1.1 million individuals with COVID-19 diagnostic codes in electronic healthcare records (EHR) collected by spring 2021. Proportions of presumed COVID-19 cases in LS reporting any symptoms for 12+ weeks ranged from 7.8% and 17% (with 1.2 to 4.8% reporting debilitating symptoms). Increasing age, female sex, white ethnicity, poor pre-pandemic general and mental health, overweight/obesity, and asthma were associated with prolonged symptoms in both LS and EHR data, but findings for other factors, such as cardio-metabolic parameters, were inconclusive.

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References

Peghin M, Palese A, Venturini M, De Martino M, Gerussi V, Graziano E . Post-COVID-19 symptoms 6 months after acute infection among hospitalized and non-hospitalized patients. Clin Microbiol Infect. 2021; 27(10):1507-1513. PMC: 8180450. DOI: 10.1016/j.cmi.2021.05.033. View

Smith B, Campbell A, Linksted P, Fitzpatrick B, Jackson C, Kerr S . Cohort Profile: Generation Scotland: Scottish Family Health Study (GS:SFHS). The study, its participants and their potential for genetic research on health and illness. Int J Epidemiol. 2012; 42(3):689-700. DOI: 10.1093/ije/dys084. View

Moreno-Perez O, Merino E, Leon-Ramirez J, Andres M, Ramos J, Arenas-Jimenez J . Post-acute COVID-19 syndrome. Incidence and risk factors: A Mediterranean cohort study. J Infect. 2021; 82(3):378-383. PMC: 7802523. DOI: 10.1016/j.jinf.2021.01.004. View

Ayoubkhani D, Khunti K, Nafilyan V, Maddox T, Humberstone B, Diamond I . Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study. BMJ. 2021; 372:n693. PMC: 8010267. DOI: 10.1136/bmj.n693. View

Griffith G, Morris T, Tudball M, Herbert A, Mancano G, Pike L . Collider bias undermines our understanding of COVID-19 disease risk and severity. Nat Commun. 2020; 11(1):5749. PMC: 7665028. DOI: 10.1038/s41467-020-19478-2. View

Amin-Chowdhury Z, Ladhani S . Causation or confounding: why controls are critical for characterizing long COVID. Nat Med. 2021; 27(7):1129-1130. DOI: 10.1038/s41591-021-01402-w. View

Elliott J, Shepherd P . Cohort profile: 1970 British Birth Cohort (BCS70). Int J Epidemiol. 2006; 35(4):836-43. DOI: 10.1093/ije/dyl174. View

Augustin M, Schommers P, Stecher M, Dewald F, Gieselmann L, Gruell H . Post-COVID syndrome in non-hospitalised patients with COVID-19: a longitudinal prospective cohort study. Lancet Reg Health Eur. 2021; 6:100122. PMC: 8129613. DOI: 10.1016/j.lanepe.2021.100122. View

Walker A, Mackenna B, Inglesby P, Tomlinson L, Rentsch C, Curtis H . Clinical coding of long COVID in English primary care: a federated analysis of 58 million patient records using OpenSAFELY. Br J Gen Pract. 2021; 71(712):e806-e814. PMC: 8340730. DOI: 10.3399/BJGP.2021.0301. View

10.

Cervia C, Zurbuchen Y, Taeschler P, Ballouz T, Menges D, Hasler S . Immunoglobulin signature predicts risk of post-acute COVID-19 syndrome. Nat Commun. 2022; 13(1):446. PMC: 8789854. DOI: 10.1038/s41467-021-27797-1. View

11.

Mahmud R, Rahman M, Rassel M, Monayem F, Been Sayeed S, Islam M . Post-COVID-19 syndrome among symptomatic COVID-19 patients: A prospective cohort study in a tertiary care center of Bangladesh. PLoS One. 2021; 16(4):e0249644. PMC: 8031743. DOI: 10.1371/journal.pone.0249644. View

12.

Verdi S, Abbasian G, Bowyer R, Lachance G, Yarand D, Christofidou P . TwinsUK: The UK Adult Twin Registry Update. Twin Res Hum Genet. 2019; 22(6):523-529. DOI: 10.1017/thg.2019.65. View

13.

Pickering S, Betancor G, Galao R, Merrick B, Signell A, Wilson H . Comparative assessment of multiple COVID-19 serological technologies supports continued evaluation of point-of-care lateral flow assays in hospital and community healthcare settings. PLoS Pathog. 2020; 16(9):e1008817. PMC: 7514033. DOI: 10.1371/journal.ppat.1008817. View

14.

Westerlind E, Palstam A, Sunnerhagen K, Persson H . Patterns and predictors of sick leave after Covid-19 and long Covid in a national Swedish cohort. BMC Public Health. 2021; 21(1):1023. PMC: 8164957. DOI: 10.1186/s12889-021-11013-2. View

15.

Sudre C, Murray B, Varsavsky T, Graham M, Penfold R, Bowyer R . Attributes and predictors of long COVID. Nat Med. 2021; 27(4):626-631. PMC: 7611399. DOI: 10.1038/s41591-021-01292-y. View

16.

Callard F, Perego E . How and why patients made Long Covid. Soc Sci Med. 2020; 268:113426. PMC: 7539940. DOI: 10.1016/j.socscimed.2020.113426. View

17.

Martimbianco A, Pacheco R, Maria Bagattini A, Riera R . Frequency, signs and symptoms, and criteria adopted for long COVID-19: A systematic review. Int J Clin Pract. 2021; 75(10):e14357. PMC: 8236920. DOI: 10.1111/ijcp.14357. View

18.

Hirschtick J, Titus A, Slocum E, Power L, Hirschtick R, Elliott M . Population-Based Estimates of Post-acute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection (PASC) Prevalence and Characteristics. Clin Infect Dis. 2021; 73(11):2055-2064. PMC: 8240848. DOI: 10.1093/cid/ciab408. View

19.

Wj Chioh F, Fong S, Young B, Wu K, Siau A, Krishnan S . Convalescent COVID-19 patients are susceptible to endothelial dysfunction due to persistent immune activation. Elife. 2021; 10. PMC: 7987341. DOI: 10.7554/eLife.64909. View

20.

Al-Aly Z, Xie Y, Bowe B . High-dimensional characterization of post-acute sequelae of COVID-19. Nature. 2021; 594(7862):259-264. DOI: 10.1038/s41586-021-03553-9. View