Kehl-Floberg Kristen, Freisberg Emma, Pop-Vicas Aurora, Gangnon Ron, Edwards Dorothy Farrar
Institute for Clinical and Translational Research, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A.
Geriatric Research, Education, and Clinical Center (GRECC), William S. Middleton Veteran's Memorial Hospital, 2500 Overlook Terrace, Madison, Wisconsin, 53705, U.S.A.
medRxiv. 2025 Aug 12:2025.08.07.25333259. doi: 10.1101/2025.08.07.25333259.
Over seven million U.S. adults experience "long COVID", or persistent health issues after COVID-19. Multiple guidelines recommend the inclusion of functional status in long COVID diagnostic criteria, but more evidence is needed to guide this recommendation. This study explores the adjusted odds of developing long COVID by pre-infection symptoms and functional status, and the feasibility of estimating functional status using health records data. DESIGN: Retrospective cohort study in a multicenter national longitudinal cohort of U.S. adults with history of COVID-19, using health records and survey responses through July 2022 ( CDR 7.0).
Pre-infection (-5 years) incidences of (a) at least one symptom common in long COVID, and (b) functional status, indicated by Us baseline survey responses and diagnostic/procedure/billing codes. Disease and demographic data covariates were included in the adjusted models.
= 65,464 met inclusion criteria (=40,655 had post-infection occurrences of at least one symptom (long COVID group), while 24,809 had none). Adjusted odds ratios within 99% confidence intervals [99% CI] of developing long COVID increased with lower pre-infection self-reported mental health ("Good" compared to "Excellent" AOR=1.14 [1.04,1.25], >0.000), and more pre-infection symptoms (compared to the median of four, people with zero had much lower odds (AOR=0.15 [0.04,0.61], =0.008). Adjusted odds were not significantly affected by any single pre-infection symptom, self-rated physical ability, or clinical documentation of functional impairment.
Greater pre-illness symptom burden and lower self-rated mental health increased the odds of long COVID symptoms, after adjusting for demographics, variant, functional status, and individual symptoms. Long COVID represents a change from baseline functioning and health, even in people with pre-infection incident symptoms and functional impairments. This estimation of pre-infection functional status using harmonized electronic health records data demonstrated the feasibility of these data in developing the diagnostic utility of functional status changes in long COVID.
超过700万美国成年人经历了“长新冠”，即感染新冠病毒后出现的持续健康问题。多项指南建议在长新冠诊断标准中纳入功能状态，但需要更多证据来指导这一建议。本研究探讨了感染前症状和功能状态与患长新冠的校正比值比，以及使用健康记录数据评估功能状态的可行性。设计：对美国有新冠病毒感染史的成年人进行多中心全国纵向队列的回顾性队列研究，使用截至2022年7月的健康记录和调查回复（CDR 7.0）。
感染前（-5年）（a）至少一种长新冠常见症状的发生率，以及（b）功能状态，由美国基线调查回复和诊断/程序/计费代码表示。疾病和人口统计学数据协变量纳入校正模型。
65464人符合纳入标准（40655人感染后出现至少一种症状（长新冠组），而24809人没有）。在99%置信区间[99%CI]内，感染前自我报告心理健康状况较差（“良好”与“优秀”相比，校正比值比=1.14[1.04,1.25]，P>0.000）以及感染前症状较多（与中位数4个相比，0个症状的人患长新冠的几率低得多（校正比值比=0.15[0.04,0.61]，P=0.008））时，患长新冠的校正比值比增加。校正比值不受任何单一感染前症状、自我评定身体能力或功能障碍临床记录的显著影响。
在调整人口统计学、病毒变种、功能状态和个体症状后，患病前症状负担较重和自我评定心理健康状况较差会增加出现长新冠症状的几率。即使在感染前有症状和功能障碍的人群中，长新冠也代表着基线功能和健康状况的改变。使用统一电子健康记录数据对感染前功能状态进行的这种评估证明了这些数据在开发长新冠功能状态变化诊断效用方面的可行性。
