Hill Elaine, Mehta Hemal, Sharma Suchetha, Mane Klint, 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
Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
medRxiv. 2022 Aug 17:2022.08.15.22278603. doi: 10.1101/2022.08.15.22278603.
More than one-third of individuals experience post-acute sequelae of SARS-CoV-2 infection (PASC, which includes long-COVID).
To identify risk factors associated with PASC/long-COVID.
Retrospective case-control study.
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.
Risk factors included demographics, comorbidities, and 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.
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.
This national study identified important risk factors for PASC 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.
超过三分之一的个体经历过新冠病毒2型感染的急性后遗症（PASC，包括长期新冠）。
确定与PASC/长期新冠相关的风险因素。
回顾性病例对照研究。
来自国家新冠队列协作组（N3C）的美国31个医疗系统。
8325例患有PASC的个体（由国际疾病分类第10版代码U09.9或长期新冠门诊就诊确定），与同一医疗系统内的41625例对照相匹配。
风险因素包括人口统计学特征、合并症以及与新冠相关的治疗和急性特征。使用多变量逻辑回归、随机森林和XGBoost来确定风险因素与PASC之间的关联。
在8325例患有PASC的个体中，大多数年龄超过50岁（56.6%），女性（62.8%），非西班牙裔白人（68.6%）。在逻辑回归中，中年类别（40至69岁；比值比范围为2.32至2.58）、女性（比值比1.4，95%置信区间1.33 - 1.48）、与新冠相关的住院治疗（比值比3.8，95%置信区间3.05 - 4.73）、长时间（8 - 30天，比值比1.69，95%置信区间1.31 - 2.17）或延长住院时间（30天以上，比值比3.38，95%置信区间2.45 - 4.67）、接受机械通气（比值比1.44，95%置信区间1.18 - 1.74）以及几种合并症，包括抑郁症（比值比1.50，95%置信区间1.40 - 1.60）、慢性肺病（比值比1.63，95%置信区间1.53 - 1.74）和肥胖症（比值比1.23，95%置信区间1.16 - 1.3）与在长期新冠门诊进行PASC诊断或治疗的可能性增加相关。与在长期新冠门诊进行PASC诊断或治疗可能性较低相关的特征包括年龄较小（18至29岁）、男性、非西班牙裔黑人种族以及药物滥用、心肌病、精神病和痴呆等合并症。居住县人均医生数量较多与在长期新冠门诊进行PASC诊断或治疗的可能性增加相关。我们的研究结果在使用多种分析技术和方法选择对照的敏感性分析中是一致的。
这项全国性研究确定了PASC的重要风险因素，如中年、重症新冠疾病和特定合并症。需要进一步的临床和流行病学研究，以更好地了解潜在机制以及疫苗和治疗方法在改变PASC病程中的潜在作用。
