Who is most at risk for long-term COVID-19? New study sheds light on vulnerable demographics

In a recent study uploaded to medRxiv preprint server*, researchers in the United States used a combined cohort of 124,313 Behavioral Risk Factor Surveillance System 2022 (BRFSS) and 10,131 National Health Interview Survey (NHIS) participants to uncover demographic factors that modify long-term COVID risk both descriptively and and using multiple logistic regression. The results showed that 21.5% of the BRFSS cohort and 17.1% of the NHIS cohort have the condition. The highest risk was in those who developed severe COVID-19 infections, with age (mean age), gender (female), ethnicity (Hispanic), education level (pre-college), and region of residence significantly increasing the risk associated with the disease COVID-19.

Study: Risk factors for developing long-lasting COVID symptoms: Insights from two nationally representative surveys. Image credit: Donkeyworx / Shutterstock

*Important note: medRxiv publishes preliminary scientific reports that have not been peer-reviewed and therefore should not be considered definitive, guide clinical practice/health-related behavior or be treated as established information.

Are some people more vulnerable to long-term COVID than others?

The term “long-lasting COVID-19”, also called “long-lasting COVID”, “post-COVID” and clinically “post-acute sequelae of COVID-19 (PASC)” is a general term for a group of health symptoms that persist for months or even years after the initial recovery of the infection. Symptoms such as post-exercise malaise, fatigue, muscle and chest pain, and cognitive dysfunction characterize it.

Although there is not yet a universal definition for the disease, the World Health Organization (WHO) has defined the condition as pre-existing or new symptoms that persist for at least three months after discharge from the hospital related to COVID-19. Alarmingly, between 5% and 60% of the nearly 700 million survivors of coronavirus disease 2019 (COVID-19) are estimated to have the condition.

While reports on disease prevalence are numerous, research on medical and demographic variables that influence long-term risk for COVID disease is still lacking.

About the study

In the present study, researchers used a combined cohort derived from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) and the National Health Interview Survey (NHIS), two nationally representative United States (US) medical databases. Inclusion criteria for the study included age (over 18 years) and clinically confirmed COVID-19 infections.

Since there is so far no clinically accepted diagnostic test for long-term COVID-19, participants were asked to self-report the prevalence of any medical symptoms that persisted or occurred after recovery from COVID-19 infection. Data collection included medical records of severity of COVID-19 infection (exclusive to the NHIS cohort) and demographic variables.

Statistical analyzes included within- and between-group estimates of long-term COVID prevalence and risk associations as revealed by chi-square and multivariate logistic regression models, respectively. Risk factors were identified and categorized hierarchically using calculated odds ratios (ORs).

Study findings

The BRFSS and NHIS presented 124,313 and 10,131 subjects who met the study inclusion criteria and were therefore included in the downstream analysis. Of these, 26,783 (21.5%) and 1,979 (17.1%) from each cohort were found to have long-term COVID-19.

Medical data revealed that severe COVID-19 infections presented the highest ORs of subsequent long-term COVID-19 conditions. Demographic analysis of variables showed that middle-aged, female, Hispanic, and college-educated individuals were at higher risk than the rest of the population. Although not as strong, further associations were revealed between residential development and long-term risk of COVID.

Asian ethnicity was found to have the lowest OR among all controlled variables.

conclusions

The present study uses data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) and the National Health Interview Survey (NHIS) databases to uncover risk factors associated with developing long-term COVID-19 symptoms for the first time. The results show that between 17.1% and 21.5% of the US population have long-term COVID-19, with severity of acute infection having the highest OR and Asian ethnicity the lowest among control variables.

Age (24-35), gender (female), Hispanic ethnicity, lack of a college degree, and living in an underdeveloped residential location were all variables identified as increasing risk for long-term COVID-19. While these findings are only generalizable to the US context, they are a first step in identifying and combating the risks associated with long-term COVID-19, thereby significantly improving the quality of life of patients suffering from COVID-19.

*Important note: medRxiv publishes preliminary scientific reports that have not been peer-reviewed and therefore should not be considered definitive, guide clinical practice/health-related behavior or be treated as established information.