Risk factors associated with post-acute sequelae of SARS-CoV-2: an N3C and NIH RECOVER study
Abstract Background More than one-third of individuals experience post-acute sequelae of SARS-CoV-2 infection (PASC, which includes long-COVID). The objective is to identify risk factors associated with PASC/long-COVID diagnosis. Methods This was a retrospective case–control study including 31 healt...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | BMC Public Health |
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| Online Access: | https://doi.org/10.1186/s12889-023-16916-w |
| _version_ | 1797451176247033856 |
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| author | Elaine L. Hill Hemalkumar B. Mehta Suchetha Sharma Klint Mane Sharad Kumar Singh Catherine Xie Emily Cathey Johanna Loomba Seth Russell Heidi Spratt Peter E. DeWitt Nariman Ammar Charisse Madlock-Brown Donald Brown Julie A. McMurry Christopher G. Chute Melissa A. Haendel Richard Moffitt Emily R. Pfaff Tellen D. Bennett on behalf of the N3C Consortium and the RECOVER Consortium |
| author_facet | Elaine L. Hill Hemalkumar B. Mehta Suchetha Sharma Klint Mane Sharad Kumar Singh Catherine Xie Emily Cathey Johanna Loomba Seth Russell Heidi Spratt Peter E. DeWitt Nariman Ammar Charisse Madlock-Brown Donald Brown Julie A. McMurry Christopher G. Chute Melissa A. Haendel Richard Moffitt Emily R. Pfaff Tellen D. Bennett on behalf of the N3C Consortium and the RECOVER Consortium |
| author_sort | Elaine L. Hill |
| collection | DOAJ |
| description | Abstract Background More than one-third of individuals experience post-acute sequelae of SARS-CoV-2 infection (PASC, which includes long-COVID). The objective is to identify risk factors associated with PASC/long-COVID diagnosis. Methods This was a retrospective case–control study including 31 health systems in the United States from the National COVID Cohort Collaborative (N3C). 8,325 individuals with PASC (defined by the presence of the International Classification of Diseases, version 10 code U09.9 or a long-COVID clinic visit) matched to 41,625 controls within the same health system and COVID index date within ± 45 days of the corresponding case's earliest COVID index date. Measurements of risk factors included demographics, comorbidities, treatment and acute characteristics related to COVID-19. Multivariable logistic regression, random forest, and XGBoost were used to determine the associations between risk factors and PASC. Results Among 8,325 individuals with PASC, the majority were > 50 years of age (56.6%), female (62.8%), and non-Hispanic White (68.6%). In logistic regression, middle-age categories (40 to 69 years; OR ranging from 2.32 to 2.58), female sex (OR 1.4, 95% CI 1.33–1.48), hospitalization associated with COVID-19 (OR 3.8, 95% CI 3.05–4.73), long (8–30 days, OR 1.69, 95% CI 1.31–2.17) or extended hospital stay (30 + days, OR 3.38, 95% CI 2.45–4.67), receipt of mechanical ventilation (OR 1.44, 95% CI 1.18–1.74), and several comorbidities including depression (OR 1.50, 95% CI 1.40–1.60), chronic lung disease (OR 1.63, 95% CI 1.53–1.74), and obesity (OR 1.23, 95% CI 1.16–1.3) were associated with increased likelihood of PASC diagnosis or care at a long-COVID clinic. Characteristics associated with a lower likelihood of PASC diagnosis or care at a long-COVID clinic included younger age (18 to 29 years), male sex, non-Hispanic Black race, and comorbidities such as substance abuse, cardiomyopathy, psychosis, and dementia. More doctors per capita in the county of residence was associated with an increased likelihood of PASC diagnosis or care at a long-COVID clinic. Our findings were consistent in sensitivity analyses using a variety of analytic techniques and approaches to select controls. Conclusions This national study identified important risk factors for PASC diagnosis such as middle age, severe COVID-19 disease, and specific comorbidities. Further clinical and epidemiological research is needed to better understand underlying mechanisms and the potential role of vaccines and therapeutics in altering PASC course. |
| first_indexed | 2024-03-09T14:51:02Z |
| format | Article |
| id | doaj.art-20f3858d4ad34dccb3741a181a3c00df |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-03-09T14:51:02Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-20f3858d4ad34dccb3741a181a3c00df2023-11-26T14:26:25ZengBMCBMC Public Health1471-24582023-10-0123111310.1186/s12889-023-16916-wRisk factors associated with post-acute sequelae of SARS-CoV-2: an N3C and NIH RECOVER studyElaine L. Hill0Hemalkumar B. Mehta1Suchetha Sharma2Klint Mane3Sharad Kumar Singh4Catherine Xie5Emily Cathey6Johanna Loomba7Seth Russell8Heidi Spratt9Peter E. DeWitt10Nariman Ammar11Charisse Madlock-Brown12Donald Brown13Julie A. McMurry14Christopher G. Chute15Melissa A. Haendel16Richard Moffitt17Emily R. Pfaff18Tellen D. Bennett19on behalf of the N3C Consortiumand the RECOVER ConsortiumDepartment of Public Health Sciences, University of Rochester Medical CenterDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public HealthSchool of Data Science, University of VirginiaDepartment of Economics, University of RochesterGoergen Institute for Data Science, University of RochesterCMC BOX 275184, University of RochesterIvy Foundations Building, Integrated Translational Health Research Institute of Virginia (iTHRIV), University of VirginiaIvy Foundations Building, Integrated Translational Health Research Institute of Virginia (iTHRIV), University of VirginiaDepartment of Pediatrics, University of Colorado School of MedicineDepartment of Biostatistics and Data Science, Medical Branch, University of TexasDepartment of Pediatrics, University of Colorado School of MedicineDepartment of Diagnostic and Health Sciences, University of Tennessee Health Science CenterDepartment of Diagnostic and Health Sciences, University of Tennessee Health Science CenterIntegrated Translational Health Research Institute of Virginia (iTHRIV), University of VirginiaCenter for Health AI, University of Colorado School of MedicineSchools of Medicine, Public Health, and Nursing, Johns Hopkins UniversityCenter for Health AI, University of Colorado School of MedicineDepartment of Biomedical Informatics, Stony Brook University, and Stony Brook Cancer CenterDepartment of Medicine, North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel HillDepartment of Biomedical Informatics, University of Colorado School of MedicineAbstract Background More than one-third of individuals experience post-acute sequelae of SARS-CoV-2 infection (PASC, which includes long-COVID). The objective is to identify risk factors associated with PASC/long-COVID diagnosis. Methods This was a retrospective case–control study including 31 health systems in the United States from the National COVID Cohort Collaborative (N3C). 8,325 individuals with PASC (defined by the presence of the International Classification of Diseases, version 10 code U09.9 or a long-COVID clinic visit) matched to 41,625 controls within the same health system and COVID index date within ± 45 days of the corresponding case's earliest COVID index date. Measurements of risk factors included demographics, comorbidities, treatment and acute characteristics related to COVID-19. Multivariable logistic regression, random forest, and XGBoost were used to determine the associations between risk factors and PASC. Results Among 8,325 individuals with PASC, the majority were > 50 years of age (56.6%), female (62.8%), and non-Hispanic White (68.6%). In logistic regression, middle-age categories (40 to 69 years; OR ranging from 2.32 to 2.58), female sex (OR 1.4, 95% CI 1.33–1.48), hospitalization associated with COVID-19 (OR 3.8, 95% CI 3.05–4.73), long (8–30 days, OR 1.69, 95% CI 1.31–2.17) or extended hospital stay (30 + days, OR 3.38, 95% CI 2.45–4.67), receipt of mechanical ventilation (OR 1.44, 95% CI 1.18–1.74), and several comorbidities including depression (OR 1.50, 95% CI 1.40–1.60), chronic lung disease (OR 1.63, 95% CI 1.53–1.74), and obesity (OR 1.23, 95% CI 1.16–1.3) were associated with increased likelihood of PASC diagnosis or care at a long-COVID clinic. Characteristics associated with a lower likelihood of PASC diagnosis or care at a long-COVID clinic included younger age (18 to 29 years), male sex, non-Hispanic Black race, and comorbidities such as substance abuse, cardiomyopathy, psychosis, and dementia. More doctors per capita in the county of residence was associated with an increased likelihood of PASC diagnosis or care at a long-COVID clinic. Our findings were consistent in sensitivity analyses using a variety of analytic techniques and approaches to select controls. Conclusions This national study identified important risk factors for PASC diagnosis such as middle age, severe COVID-19 disease, and specific comorbidities. Further clinical and epidemiological research is needed to better understand underlying mechanisms and the potential role of vaccines and therapeutics in altering PASC course.https://doi.org/10.1186/s12889-023-16916-wPost-acute sequelae of SARS-CoV-2PASCLong-COVIDCOVID-19Risk factors |
| spellingShingle | Elaine L. Hill Hemalkumar B. Mehta Suchetha Sharma Klint Mane Sharad Kumar Singh Catherine Xie Emily Cathey Johanna Loomba Seth Russell Heidi Spratt Peter E. DeWitt Nariman Ammar Charisse Madlock-Brown Donald Brown Julie A. McMurry Christopher G. Chute Melissa A. Haendel Richard Moffitt Emily R. Pfaff Tellen D. Bennett on behalf of the N3C Consortium and the RECOVER Consortium Risk factors associated with post-acute sequelae of SARS-CoV-2: an N3C and NIH RECOVER study BMC Public Health Post-acute sequelae of SARS-CoV-2 PASC Long-COVID COVID-19 Risk factors |
| title | Risk factors associated with post-acute sequelae of SARS-CoV-2: an N3C and NIH RECOVER study |
| title_full | Risk factors associated with post-acute sequelae of SARS-CoV-2: an N3C and NIH RECOVER study |
| title_fullStr | Risk factors associated with post-acute sequelae of SARS-CoV-2: an N3C and NIH RECOVER study |
| title_full_unstemmed | Risk factors associated with post-acute sequelae of SARS-CoV-2: an N3C and NIH RECOVER study |
| title_short | Risk factors associated with post-acute sequelae of SARS-CoV-2: an N3C and NIH RECOVER study |
| title_sort | risk factors associated with post acute sequelae of sars cov 2 an n3c and nih recover study |
| topic | Post-acute sequelae of SARS-CoV-2 PASC Long-COVID COVID-19 Risk factors |
| url | https://doi.org/10.1186/s12889-023-16916-w |
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