Symptoms and risk factors for long COVID in non-hospitalized adults

Anuradhaa Subramanian(University of Birmingham), Krishnarajah Nirantharakumar(Health Data Research UK), Sarah Hughes(National Institute for Health and Care Research), Puja Myles(Clinical Practice Research Datalink), Tim Williams(Clinical Practice Research Datalink), Krishna Gokhale(University of Birmingham), Tom Taverner(University of Birmingham), Joht Singh Chandan(University of Birmingham), Kirsty Brown(University of Birmingham), Nikita Simms-Williams(University of Birmingham), Anoop D Shah(University College London), Megha Singh(University of Birmingham), Farah Kidy(University of Warwick), Kelvin Okoth(University of Birmingham), Richard Hotham(University of Birmingham), Nasir Zeeshan Bashir(University Of Bristol Dental Hospital), Neil Cockburn(University of Birmingham), Siang Ing Lee(University of Birmingham), Grace Turner(NIHR Surgical Reconstruction and Microbiology Research Centre), Georgios V. Gkoutos(University Hospitals Birmingham NHS Foundation Trust), Olalekan Lee Aiyegbusi(National Institute for Health and Care Research), Christel McMullan(NIHR Surgical Reconstruction and Microbiology Research Centre), Alastair K. Denniston(University Hospitals Birmingham NHS Foundation Trust), Elizabeth Sapey(University Hospitals Birmingham NHS Foundation Trust), Janet M. Lord(Arthritis UK), David C. Wraith(NIHR Birmingham Biomedical Research Centre), Edward Leggett(Clinical Practice Research Datalink), Clare Iles(Clinical Practice Research Datalink), Tom Marshall(University of Birmingham), Malcolm J Price(NIHR Birmingham Biomedical Research Centre), Steven Marwaha(Birmingham and Solihull Mental Health NHS Foundation Trust), Elin Haf Davies, Louise Jackson(University of Birmingham), Karen Matthews, Jennifer Camaradou, Melanie Calvert(National Institute for Health and Care Research), Shamil Haroon(University of Birmingham)
Nature Medicine
July 25, 2022
10.1038/s41591-022-01909-w
Cited by 1,121Open Access
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Abstract

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is associated with a range of persistent symptoms impacting everyday functioning, known as post-COVID-19 condition or long COVID. We undertook a retrospective matched cohort study using a UK-based primary care database, Clinical Practice Research Datalink Aurum, to determine symptoms that are associated with confirmed SARS-CoV-2 infection beyond 12 weeks in non-hospitalized adults and the risk factors associated with developing persistent symptoms. We selected 486,149 adults with confirmed SARS-CoV-2 infection and 1,944,580 propensity score-matched adults with no recorded evidence of SARS-CoV-2 infection. Outcomes included 115 individual symptoms, as well as long COVID, defined as a composite outcome of 33 symptoms by the World Health Organization clinical case definition. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for the outcomes. A total of 62 symptoms were significantly associated with SARS-CoV-2 infection after 12 weeks. The largest aHRs were for anosmia (aHR 6.49, 95% CI 5.02-8.39), hair loss (3.99, 3.63-4.39), sneezing (2.77, 1.40-5.50), ejaculation difficulty (2.63, 1.61-4.28) and reduced libido (2.36, 1.61-3.47). Among the cohort of patients infected with SARS-CoV-2, risk factors for long COVID included female sex, belonging to an ethnic minority, socioeconomic deprivation, smoking, obesity and a wide range of comorbidities. The risk of developing long COVID was also found to be increased along a gradient of decreasing age. SARS-CoV-2 infection is associated with a plethora of symptoms that are associated with a range of sociodemographic and clinical risk factors.

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