Division of Communicable Disease Control, California Department of Public Health, Richmond, USA.
Department of Pathology, Microbiology, and Immunology, University of California, Davis, USA.
Sci Rep. 2024 Sep 30;14(1):22663. doi: 10.1038/s41598-024-73160-x.
Individuals infected with SARS-CoV-2 may develop post-acute sequelae of COVID-19 ("long COVID") even after asymptomatic or mild acute illness. Including time varying COVID symptom severity can provide more informative burden estimates for public health response. Using a compartmental model driven by confirmed cases, this study estimated long COVID burden by age group (0-4, 5-17, 18-49, 50-64, 65+) in California as measured by the cumulative and severity-specific proportion of quality-adjusted life years (QALYs) lost. Long COVID symptoms were grouped into severe, moderate, and mild categories based on estimates from the Global Burden of Disease study, and symptoms were assumed to decrease in severity in the model before full recovery. All 10,945,079 confirmed COVID-19 cases reported to the California Department of Public Health between March 1, 2020, and December 31, 2022, were included in the analysis. Most estimated long COVID-specific QALYs [59,514 (range: 10,372-180,257)] lost in California were concentrated in adults 18-49 (31,592; 53.1%). Relative to other age groups, older adults (65+) lost proportionally more QALYs from severe long COVID (1,366/6,984; 20%). Due to changing case ascertainment over time, this analysis might underestimate the actual total burden. In global sensitivity analysis, estimates of QALYs lost were most sensitive to the proportion of individuals that developed long COVID and proportion of cases with each initial level of long COVID symptom severity (mild/moderate/severe). Models like this analysis can help translate observable metrics such as cases and hospitalizations into quantitative estimates of long COVID burden that are currently difficult to directly measure. Unlike the observed relationship between age and incident severe outcomes for COVID-19, this study points to the potential cumulative impact of mild long COVID symptoms in younger individuals.
个体感染 SARS-CoV-2 后，即使无症状或轻度急性感染，也可能发展为 COVID-19 的急性后期后遗症（“长新冠”）。包括时间变化的 COVID 症状严重程度可以为公共卫生应对提供更具信息量的负担估计。本研究使用由确诊病例驱动的房室模型，根据加利福尼亚州因质量调整生命年（QALY）损失而导致的累积和严重程度特异性比例，按年龄组（0-4 岁、5-17 岁、18-49 岁、50-64 岁、65+）估计长新冠负担。根据全球疾病负担研究的估计，长新冠症状分为严重、中度和轻度，并且在模型中假设症状在完全恢复之前严重程度会降低。在 2020 年 3 月 1 日至 2022 年 12 月 31 日期间，向加利福尼亚州公共卫生部报告的所有 10,945,079 例 COVID-19 确诊病例均包含在分析中。在加利福尼亚州，估计有 59,514 个（范围：10,372-180,257）长新冠特定 QALY 丢失[59,514（范围：10,372-180,257）]，主要集中在 18-49 岁的成年人（31,592；53.1%）。与其他年龄组相比，年龄较大的成年人（65+）因严重长新冠而损失的 QALYs 比例更高（1,366/6,984；20%）。由于随时间推移病例确定发生变化，本分析可能低估了实际的总负担。在全球敏感性分析中，估计的 QALY 丢失对发展为长新冠的个体比例以及每种初始长新冠症状严重程度（轻度/中度/重度）病例比例最敏感。像这样的分析模型可以帮助将可观察到的指标（如病例和住院）转化为目前难以直接测量的长新冠负担的定量估计。与 COVID-19 年龄与发病严重程度之间的观察到的关系不同，本研究指出了轻度长新冠症状在年轻人中潜在的累积影响。
