From the Department of Neurology (A.H., Y.X.), Yale University, New Haven, CT; Department of Neurology (B.C.C., C.E.H.), University of Michigan, Ann Arbor; TriNetX (M.C.), Cambridge, MA; Boston University (J.N.), MA; Emory University (G.J.E.), Atlanta, GA.
Neurology. 2024 Apr 23;102(8):e209248. doi: 10.1212/WNL.0000000000209248. Epub 2024 Mar 20.
Following the outbreak of viral infections from the severe acute respiratory syndrome coronavirus 2 virus in 2019 (coronavirus disease 2019 [COVID-19]), reports emerged of long-term neurologic sequelae in survivors. To better understand the burden of neurologic health care and incident neurologic diagnoses in the year after COVID-19 vs influenza, we performed an analysis of patient-level data from a large collection of electronic health records (EMR).
We acquired deidentified data from TriNetX, a global health research network providing access to EMR data. We included individuals aged 18 years or older during index event, defined as hospital-based care for COVID-19 (from April 1, 2020, until November 15, 2021) or influenza (from 2016 to 2019). The study outcomes were subsequent health care encounters over the following year for 6 neurologic diagnoses including migraine, epilepsy, stroke, neuropathy, movement disorders, and dementia. We also created a composite of the 6 diagnoses as an incident event, which we call "incident neurologic diagnoses." We performed a 1:1 complete case nearest-neighbor propensity score match on age, sex, race/ethnicity, marital status, US census region patient residence, preindex years of available data, and Elixhauser comorbidity score. We fit time-to-event models and reported hazard ratios for COVID-19 vs influenza infection.
After propensity score matching, we had a balanced cohort of 77,272 individuals with COVID-19 and 77,272 individuals with influenza. The mean age was 51.0 ± 19.7 years, 57.7% were female, and 41.5% were White. Compared with patients with influenza, patients with COVID-19 had a lower risk of subsequent care for migraine (HR 0.645, 95% CI 0.604-0.687), epilepsy (HR 0.783, 95% CI 0.727-0.843), neuropathies (HR 0.567, 95% CI 0.532-0.604), movement disorders (HR 0.644, 95% CI 0.598-0.693), stroke (HR 0.904, 95% CI 0.845-0.967), or dementia (HR 0.931, 95% CI 0.870-0.996). Postinfection incident neurologic diagnoses were observed in 2.79% of the COVID-19 cohort vs 4.91% of the influenza cohort (HR 0.618, 95% CI 0.582-0.657).
Compared with a matched cohort of adults with a hospitalization or emergency department visit for influenza infection, those with COVID-19 had significantly fewer health care encounters for 6 major neurologic diagnoses over a year of follow-up. Furthermore, we found that COVID-19 infection was associated with a lower risk of an incident neurologic diagnosis in the year after infection.
2019 年严重急性呼吸综合征冠状病毒 2 型病毒（新冠病毒）引发病毒性感染疫情爆发后，有报道称幸存者存在长期神经系统后遗症。为了更好地了解新冠病毒感染后一年和流感后期间神经保健负担和新发神经系统诊断情况，我们对来自大型电子病历（EMR）数据库的患者水平数据进行了分析。
我们从 TriNetX 获得了匿名数据，TriNetX 是一个提供 EMR 数据访问的全球健康研究网络。我们纳入了索引事件期间年龄在 18 岁及以上的个体，索引事件定义为因新冠病毒（2020 年 4 月 1 日至 2021 年 11 月 15 日）或流感（2016 年至 2019 年）住院治疗。研究结果为在接下来的一年中出现的 6 种神经系统疾病的后续医疗就诊情况，包括偏头痛、癫痫、中风、神经病、运动障碍和痴呆。我们还创建了一个包含这 6 种疾病的复合事件，称为“新发神经系统诊断”。我们对年龄、性别、种族/民族、婚姻状况、患者居住的美国人口普查区、索引前可用数据年限和 Elixhauser 合并症评分进行了 1：1 完全病例最近邻倾向评分匹配。我们拟合了生存时间模型，并报告了新冠病毒与流感感染之间的风险比。
在倾向评分匹配后，我们得到了一个均衡的队列，其中包括 77272 例新冠病毒感染患者和 77272 例流感感染患者。患者平均年龄为 51.0±19.7 岁，57.7%为女性，41.5%为白人。与流感患者相比，新冠病毒感染患者随后出现偏头痛（HR 0.645，95%CI 0.604-0.687）、癫痫（HR 0.783，95%CI 0.727-0.843）、神经病变（HR 0.567，95%CI 0.532-0.604）、运动障碍（HR 0.644，95%CI 0.598-0.693）、中风（HR 0.904，95%CI 0.845-0.967）或痴呆（HR 0.931，95%CI 0.870-0.996）的保健就诊风险较低。在感染后，有 2.79%的新冠病毒感染患者和 4.91%的流感感染患者出现新发神经系统诊断（HR 0.618，95%CI 0.582-0.657）。
与因流感住院或急诊就诊的成人匹配队列相比，新冠病毒感染患者在一年的随访中出现 6 种主要神经系统疾病的医疗就诊情况明显减少。此外，我们发现新冠病毒感染与感染后一年新发神经系统诊断的风险降低相关。
