NDLI: Risk factors associated with post-acute sequelae of SARS-CoV-2: an N3C and NIH RECOVER study

Content Provider	Springer Nature : BioMed Central
Author	Hill, Elaine L. Mehta, Hemalkumar B. Sharma, Suchetha Mane, Klint Singh, Sharad Kumar Xie, Catherine Cathey, Emily Loomba, Johanna Russell, Seth Spratt, Heidi DeWitt, Peter E. Ammar, Nariman Madlock-Brown, Charisse Brown, Donald McMurry, Julie A. Chute, Christopher G. Haendel, Melissa A. Moffitt, Richard Pfaff, Emily R. Bennett, Tellen D.
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.
Related Links	https://bmcpublichealth.biomedcentral.com/counter/pdf/10.1186/s12889-023-16916-w.pdf
Ending Page	13
Page Count	13
Starting Page	1
File Format	HTM / HTML
ISSN	14712458
DOI	10.1186/s12889-023-16916-w
Journal	BMC Public Health
Issue Number	1
Volume Number	23
Language	English
Publisher	BioMed Central
Publisher Date	2023-10-25
Access Restriction	Open
Subject Keyword	Public Health Medicine Epidemiology Biostatistics Vaccine Environmental Health Post-acute sequelae of SARS-CoV-2 PASC Long-COVID COVID-19 Risk factors Medicine/Public Health
Content Type	Text
Resource Type	Article
Subject	Public Health, Environmental and Occupational Health
Journal Impact Factor	3.5/2023
5-Year Journal Impact Factor	3.9/2023

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