Schaefer Caroline M, Krause Trudy Millard, Delclos George L, Greenberg Raymond S
Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas United States of America.
Southwest Center for Occupational and Environmental Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas United States of America.
PLoS One. 2025 Apr 29;20(4):e0322020. doi: 10.1371/journal.pone.0322020. eCollection 2025.
A retrospective cohort study was undertaken to assess the relationship between initial disease severity of COVID-19 and the risk of post-acute symptoms. The COVID-19 cohort was compared against influenza and pneumonia cohorts to assess whether risk of post-acute symptoms differed.
Administrative health claims data were obtained for commercially insured and Medicare Advantage covered adults (≥ 18 years) with symptomatic laboratory-confirmed COVID-19 diagnosed in 2020 (n=121,205), and similar cohorts of influenza (n=20,844) and pneumonia (n=29,052) patients diagnosed prior to the pandemic. Post-acute symptoms were assessed at four weeks, three and six months following initial diagnosis.
Among the patients with COVID-19, the likelihood of any post-acute symptom increased with initial disease severity, and was also influenced by the presence of comorbidities, especially rheumatoid arthritis, ischemic heart disease and asthma. The specific post-acute symptoms varied by age, with increased risks of anxiety and headache among the young, whereas the elderly experienced increased brain fog and fatigue. When compared against the influenza and pneumonia cohorts, all three groups experienced post-acute symptoms, with a strong relationship to disease severity, and only partial resolution over the six-month observation period. Those with influenza were less likely than those with COVID-19 to experience post-acute symptoms while those with pneumonia were more likely to have post-acute illness than those with COVID-19.
Using a large national dataset, we found that COVID-19 symptomology could not be described by previously seen influenza or pneumonia symptomology and differences exist in the prevalence of symptoms as well as time to resolution, better characterizing "long COVID" and identifying that these differences are unique to COVID-19.
开展了一项回顾性队列研究，以评估新型冠状病毒肺炎（COVID-19）的初始疾病严重程度与急性后症状风险之间的关系。将COVID-19队列与流感和肺炎队列进行比较，以评估急性后症状风险是否存在差异。
获取了2020年诊断为有症状且实验室确诊的COVID-19的商业保险和医疗保险优势计划覆盖的成年人（≥18岁）的行政健康理赔数据（n=121,205），以及大流行前诊断的类似流感队列（n=20,844）和肺炎队列（n=29,052）患者的数据。在初次诊断后的四周、三个月和六个月评估急性后症状。
在COVID-19患者中，任何急性后症状的可能性随初始疾病严重程度增加而增加，并且还受合并症的影响，尤其是类风湿性关节炎、缺血性心脏病和哮喘。特定的急性后症状因年龄而异，年轻人焦虑和头痛的风险增加，而老年人脑雾和疲劳的风险增加。与流感和肺炎队列相比，所有三组都出现了急性后症状，与疾病严重程度密切相关，并且在六个月的观察期内仅部分缓解。流感患者出现急性后症状的可能性低于COVID-19患者，而肺炎患者比COVID-19患者更易患急性后疾病。
使用一个大型国家数据集，我们发现COVID-19的症状不能用先前观察到的流感或肺炎症状来描述，症状的患病率和缓解时间存在差异，更好地描述了“长新冠”，并确定这些差异是COVID-19所特有的。
