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Lieberwerth M, Niemeijer A. Lost and changed meaning in life of people with Long Covid: a qualitative study. Int J Qual Stud Health Well-being 2024; 19:2289668. [PMID: 38055787 DOI: 10.1080/17482631.2023.2289668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023] Open
Abstract
Long Covid (LC) has been called the greatest mass-disabling event in human history. For patients, LC not only has implications for quality of life but also for meaning in life: how one's life and the world are understood and what is seen as valuable in one's life. This qualitative empirical study used a Constructivist Grounded Theory approach to investigate the meaning in life of people struggling with LC through ten patient interviews. This study shows that patients lose their prior understanding of life and come to a changed meaning in life, in part due to the experienced (social) isolation and loss of (both physical and cognitive) abilities caused by LC. Moreover, patients struggled with acceptance, uncertainty, and the inherent incomprehensibility and uncontrollability that living with LC entails, though this simultaneously co-existed with hope, optimism and acceptance. Additionally, dimensions of meaning intersect; a patient having some understanding of their illness (dimension of meaning: comprehension) required an understanding Other (dimension of meaning: connection). Emerging from lockdown brought the challenge and isolation of adjusting to chronic illness in society as usual (albeit divided about COVID-19 measures). This study thus offers novel insights regarding changed, present, and sought meaning in life for LC patients.
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Affiliation(s)
| | - Alistair Niemeijer
- Department of Ethics of Care, University of Humanistic Studies, Utrecht, Netherlands
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2
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Rabiee Rad M, Abbasi M, Salimian E, Norouzi M, Emamjomeh A, Haghighatdoost F, Mahmoudi S, Najafian J, Masoudi S, Ghasempour Dabaghi G, Mohammadifard N, Sarrafzadegan N. Baseline socioeconomic status predicting post-COVID-19 symptoms: Results from Isfahan COVID Cohort (ICC) study. Prev Med Rep 2024; 45:102814. [DOI: 10.1016/j.pmedr.2024.102814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
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3
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Menkir TF, Citarella BW, Sigfrid L, Doshi Y, Reyes LF, Calvache JA, Kildal AB, Nygaard AB, Holter JC, Panda PK, Jassat W, Merson L, Donnelly CA, Santillana M, Buckee C, Verguet S, Hejazi NS. Modeling the relative influence of socio-demographic variables on post-acute COVID-19 quality of life. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.21.24303099. [PMID: 39040190 PMCID: PMC11261939 DOI: 10.1101/2024.02.21.24303099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Background Post-acute sequelae of SARS-CoV-2, referred to as "long COVID", are a globally pervasive threat. While their many clinical determinants are commonly considered, their plausible social correlates are often overlooked. Methods Here, we use data from a multinational prospective cohort study to compare social and clinical predictors of differences in quality of life with long COVID. We further measure the extent to which clinical intermediates may explain relationships between social variables and quality of life with long COVID. Findings Beyond age, neuropsychological and rheumatological comorbidities, educational attainment, employment status, and female sex were important predictors of long COVID-associated quality of life days (long COVID QALDs). Furthermore, most of their associations could not be attributed to key long COVID-predicting comorbidities. In Norway, 90% (95% CI: 77%, 100%) of the adjusted association between belonging to the top two quintiles of educational attainment and long COVID QALDs was not explained by these clinical intermediates. The same was true for 86% (73%, 100%) and 93% (80%,100%) of the adjusted association between full-time employment and long COVID QALDs in the United Kingdom (UK) and Russia. Additionally, 77% (46%,100%) and 73% (52%, 94%) of the adjusted associations between female sex and long COVID QALDs in Norway and the UK were unexplained by the clinical mediators. Interpretation Our findings highlight that socio-economic proxies and sex are key predictors of long COVID QALDs and that other (non-clinical) mechanisms drive their observed relationships. Importantly, we outline a multi-method, adaptable causal approach for evaluating the isolated contributions of social disparities to experiences with long COVID. Funding UK Foreign, Commonwealth and Development Office; Wellcome Trust; Bill & Melinda Gates Foundation; Oxford COVID-19 Research Response Funding; UK National Institute for Health and Care Research; UK Medical Research Council; Public Health England; Liverpool Experimental Cancer Medicine Centre; Research Council of Norway; Vivaldi Invest A/S; South Eastern Norway Health Authority.
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Donald J, Bilasy SE, Yang C, El-Shamy A. Exploring the Complexities of Long COVID. Viruses 2024; 16:1060. [PMID: 39066223 DOI: 10.3390/v16071060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Since the emergence of the SARS-CoV-2 virus in 2019, nearly 700 million COVID-19 cases and 7 million deaths have been reported globally. Despite most individuals recovering within four weeks, the Center for Disease Control (CDC) estimates that 7.5% to 41% develop post-acute infection syndrome (PAIS), known as 'Long COVID'. This review provides current statistics on Long COVID's prevalence, explores hypotheses concerning epidemiological factors, such as age, gender, comorbidities, initial COVID-19 severity, and vaccine interactions, and delves into potential mechanisms, including immune responses, viral persistence, and gut dysbiosis. Moreover, we conclude that women, advanced age, comorbidities, non-vaccination, and low socioeconomic status all appear to be risk factors. The reasons for these differences are still not fully understood and likely involve a complex relationship between social, genetic, hormonal, and other factors. Furthermore, individuals with Long COVID-19 seem more likely to endure economic hardship due to persistent symptoms. In summary, our findings further illustrate the multifaceted nature of Long COVID and underscore the importance of understanding the epidemiological factors and potential mechanisms needed to develop effective therapeutic strategies and interventions.
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Affiliation(s)
- Jackson Donald
- College of Graduate Studies, California Northstate University, 9700 West Taron Drive, Elk Grove, CA 95757, USA
| | - Shymaa E Bilasy
- College of Dental Medicine, California Northstate University, 9700 West Taron Drive, Elk Grove, CA 95757, USA
| | - Catherine Yang
- College of Graduate Studies, California Northstate University, 9700 West Taron Drive, Elk Grove, CA 95757, USA
| | - Ahmed El-Shamy
- College of Graduate Studies, California Northstate University, 9700 West Taron Drive, Elk Grove, CA 95757, USA
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Ramírez-Toscano Y, Torres-Ibarra L, Carnalla M, Basto-Abreu A, Vidaña-Perez D, Colchero MA, Bautista-Arredondo S, Saydah S, Barrientos-Gutiérrez T. Prevalence of Post-COVID conditions among Mexican COVID-19 survivors: a nationwide cross-sectional study. BMC Public Health 2024; 24:1729. [PMID: 38943168 PMCID: PMC11212168 DOI: 10.1186/s12889-024-19274-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 06/25/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND There are limited population-representative data that describe the potential burden of Post-COVID conditions (PCC) in Mexico. We estimated the prevalence of PCC overall and by sociodemographic characteristics among a representative sample of adults previously diagnosed with COVID-19 in Mexico. We additionally, characterized the PCC symptoms, and estimated the association between diagnosed type-2 diabetes and hypertension with PCC. METHODS We used data from the 2021 National Health and Nutrition Survey in Mexico, a nationally and regionally representative survey, from August 1st to October 31st, 2021. Using the WHO definition, we estimated the prevalence of PCC by sociodemographics and prevalence of PCC symptoms. We fit multivariable log-binomial regression models to estimate the associations. RESULTS The prevalence of PCC was 37.0%. The most common persistent symptoms were fatigue (56.8%), myalgia or arthralgia (47.5%), respiratory distress and dyspnea (42.7%), headache (34.0%), and cough (25.7%). The prevalence was higher in older people, women, and individuals with low socioeconomic status. There was no significant association between hypertension and PCC or diabetes and PCC prevalence. CONCLUSIONS About one-third of the adult Mexican population who had COVID-19 in 2021 had Post-COVID conditions. Our population-based estimates can help assess potential priorities for PCC-related health services, which is critical in light of our weak health system and limited funding.
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Affiliation(s)
- Yenisei Ramírez-Toscano
- Center for Population Health Research, National Institute of Public Health, Santa María Ahuacatitlán, Avenida Universidad 655, Cuernavaca, Morelos CP, 62100, Mexico
| | - Leticia Torres-Ibarra
- Center for Population Health Research, National Institute of Public Health, Santa María Ahuacatitlán, Avenida Universidad 655, Cuernavaca, Morelos CP, 62100, Mexico.
| | - Martha Carnalla
- Center for Population Health Research, National Institute of Public Health, Santa María Ahuacatitlán, Avenida Universidad 655, Cuernavaca, Morelos CP, 62100, Mexico
| | - Ana Basto-Abreu
- Center for Population Health Research, National Institute of Public Health, Santa María Ahuacatitlán, Avenida Universidad 655, Cuernavaca, Morelos CP, 62100, Mexico
| | - Dèsirée Vidaña-Perez
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - M Arantxa Colchero
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Sergio Bautista-Arredondo
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Sharon Saydah
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Coronaviruses and Other Respiratory Viruses Division, Atlanta, GA, USA
| | - Tonatiuh Barrientos-Gutiérrez
- Center for Population Health Research, National Institute of Public Health, Santa María Ahuacatitlán, Avenida Universidad 655, Cuernavaca, Morelos CP, 62100, Mexico
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Jones F, Domeny A, Fish J, Leggat F, Patel I, McRae J, Rowe C, Busse ME. Using co-design methods to develop new personalised support for people living with Long Covid: The 'LISTEN' intervention. Health Expect 2024; 27:e14093. [PMID: 38783782 PMCID: PMC11116943 DOI: 10.1111/hex.14093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/12/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Many Covid-19 survivors are living with unresolved, relapsing and remitting symptoms and no 'one size' of treatment is likely to be effective for everyone. Supported self-management for the varied symptoms of Long Covid (LC) is recommended by the National Institute for Health and Care Excellence in the United Kingdom. We aimed to develop a new personalised support intervention for people living with LC using a structured co-design framework to guide replication and evaluation. METHODS We used the improvement methodology, Experience-Based Co-Design, in an accelerated form to harness the collective experiences of people with LC. Incorporating evidence from 'Bridges Self-Management' (Bridges) an approach in which healthcare professionals (HCPs)are trained to support knowledge, confidence and skills of individuals living with long term conditions. Co-designed resources are also central to Bridges. Adults who self-identified as living with or recovered from LC, from England or Wales, aged 18 years and over were recruited, and HCPs, with experience of supporting people with LC. Participants took part in a series of small co-design group meetings and larger mixed meetings to agree priorities, core principles and generate resources and intervention content. RESULTS People with LC (n = 28), and HCPs (n = 9) supported co-design of a book (hard-copy and digital form) to be used in 1:1 support sessions with a trained HCP. Co-design stages prioritised stories about physical symptoms first, and psychological and social challenges which followed, nonlinear journeys and reconceptualising stability as progress, rich descriptions of strategies and links to reputable advice and support for navigating healthcare services. Co-design enabled formulation of eight core intervention principles which underpinned the training and language used by HCPs and fidelity assessments. CONCLUSION We have developed a new personalised support intervention, with core principles to be used in one-to-one sessions delivered by trained HCPs, with a new co-designed book as a prompt to build personalised strategies and plans using narratives, ideas, and solutions from other people with LC. Effectiveness and cost effectiveness of the 'LISTEN' intervention will be evaluated in a randomised controlled trial set within the context of the updated Framework for Developing and Evaluating Complex Interventions. PATIENT AND PUBLIC CONTRIBUTION The LISTEN Public and Patient Involvement (PPI) group comprised seven people living with LC. They all contributed to the design of this study and five members were part of a larger co-design community described in this paper. They have contributed to this paper by interpreting stages of intervention design and analysis of results. Three members of our PPI group are co-authors of this paper.
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Affiliation(s)
- Fiona Jones
- Population Health Research InstituteSt George's University of LondonLondonUK
- Bridges Self‐ManagementLondonUK
| | - Anne Domeny
- Bridges Self‐ManagementLondonUK
- LISTEN Lived Experience Advisory GroupLondonUK
| | - Jessica Fish
- Department of Clinical Neuropsychology and Clinical Health PsychologySt George's University Hospitals NHS Foundation TrustLondonUK
- Mental Health and Wellbeing, School of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Fiona Leggat
- Population Health Research InstituteSt George's University of LondonLondonUK
| | - Ian Patel
- LISTEN Lived Experience Advisory GroupLondonUK
| | - Jackie McRae
- Centre for Allied Health, Institute for Medical, Biomedical and Allied EducationSt George's University of LondonLondonUK
| | - Carol Rowe
- LISTEN Lived Experience Advisory GroupLondonUK
| | - Monica E. Busse
- Centre For Trials Research, School of MedicineCardiff UniversityCardiffWalesUK
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McCabe R, Danelian G, Panovska-Griffiths J, Donnelly CA. Inferring community transmission of SARS-CoV-2 in the United Kingdom using the ONS COVID-19 Infection Survey. Infect Dis Model 2024; 9:299-313. [PMID: 38371874 PMCID: PMC10867655 DOI: 10.1016/j.idm.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/20/2024] Open
Abstract
Key epidemiological parameters, including the effective reproduction number, R ( t ) , and the instantaneous growth rate, r ( t ) , generated from an ensemble of models, have been informing public health policy throughout the COVID-19 pandemic in the four nations of the United Kingdom of Great Britain and Northern Ireland (UK). However, estimation of these quantities became challenging with the scaling down of surveillance systems as part of the transition from the "emergency" to "endemic" phase of the pandemic. The Office for National Statistics (ONS) COVID-19 Infection Survey (CIS) provided an opportunity to continue estimating these parameters in the absence of other data streams. We used a penalised spline model fitted to the publicly-available ONS CIS test positivity estimates to produce a smoothed estimate of the prevalence of SARS-CoV-2 positivity over time. The resulting fitted curve was used to estimate the "ONS-based" R ( t ) and r ( t ) across the four nations of the UK. Estimates produced under this model are compared to government-published estimates with particular consideration given to the contribution that this single data stream can offer in the estimation of these parameters. Depending on the nation and parameter, we found that up to 77% of the variance in the government-published estimates can be explained by the ONS-based estimates, demonstrating the value of this singular data stream to track the epidemic in each of the four nations. We additionally find that the ONS-based estimates uncover epidemic trends earlier than the corresponding government-published estimates. Our work shows that the ONS CIS can be used to generate key COVID-19 epidemiological parameters across the four UK nations, further underlining the enormous value of such population-level studies of infection. This is not intended as an alternative to ensemble modelling, rather it is intended as a potential solution to the aforementioned challenge faced by public health officials in the UK in early 2022.
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Affiliation(s)
- Ruth McCabe
- Department of Statistics, University of Oxford, UK
- National Institute for Health and Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, UK
- United Kingdom Health Security Agency, UK
| | | | - Jasmina Panovska-Griffiths
- United Kingdom Health Security Agency, UK
- The Queen's College, University of Oxford, UK
- The Pandemic Sciences Institute, University of Oxford, UK
| | - Christl A. Donnelly
- Department of Statistics, University of Oxford, UK
- National Institute for Health and Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, UK
- The Pandemic Sciences Institute, University of Oxford, UK
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, UK
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Banerjee A. Disparities by Social Determinants of Health: Links Between Long COVID and Cardiovascular Disease. Can J Cardiol 2024; 40:1123-1134. [PMID: 38428523 DOI: 10.1016/j.cjca.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/03/2024] Open
Abstract
Long COVID has been defined by the World Health Organisation as "continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation." Cardiovascular disease is implicated as a risk factor, concomitant condition, and consequence of long COVID. As well as heterogeneity in definition, presentation, and likely underlying pathophysiology of long COVID, disparities by social determinants of health, extensively studied and described in cardiovascular disease, have been observed in 3 ways. First, underlying long-term conditions, such as cardiovascular disease and its risk factors, are associated with incidence and severity of long COVID, and previously described socioeconomic disparities in these factors are important in exacerbating disparities in long COVID. Second, socioeconomic disparities in management of COVID-19 may themselves lead to distal disparities in long COVID. Third, there are socioeconomic disparities in the way that long COVID is diagnosed, managed, and prevented. Together, factors such as age, sex, deprivation, and ethnicity have far-reaching implications in this new postviral syndrome across its management spectrum. There are similarities and differences compared with disparities for cardiovascular disease. Some of these disparities are in fact, inequalities, that is, rather than simply observed variations, they represent injustices with costs to individuals, communities, and economies. This review of current literature considers opportunities to prevent or at least attenuate these socioeconomic disparities in long COVID and cardiovascular disease, with special challenges for research, clinical practice, public health, and policy in a new disease which is evolving.
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Affiliation(s)
- Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom; Department of Cardiology, Barts Health NHS Trust, London, United Kingdom.
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Carlile O, Briggs A, Henderson AD, Butler-Cole BF, Tazare J, Tomlinson LA, Marks M, Jit M, Lin LY, Bates C, Parry J, Bacon SC, Dillingham I, Dennison WA, Costello RE, Walker AJ, Hulme W, Goldacre B, Mehrkar A, MacKenna B, Herrett E, Eggo RM. Impact of long COVID on health-related quality-of-life: an OpenSAFELY population cohort study using patient-reported outcome measures (OpenPROMPT). THE LANCET REGIONAL HEALTH. EUROPE 2024; 40:100908. [PMID: 38689605 PMCID: PMC11059448 DOI: 10.1016/j.lanepe.2024.100908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/22/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024]
Abstract
Background Long COVID is a major problem affecting patient health, the health service, and the workforce. To optimise the design of future interventions against COVID-19, and to better plan and allocate health resources, it is critical to quantify the health and economic burden of this novel condition. We aimed to evaluate and estimate the differences in health impacts of long COVID across sociodemographic categories and quantify this in Quality-Adjusted Life-Years (QALYs), widely used measures across health systems. Methods With the approval of NHS England, we utilised OpenPROMPT, a UK cohort study measuring the impact of long COVID on health-related quality-of-life (HRQoL). OpenPROMPT invited responses to Patient Reported Outcome Measures (PROMs) using a smartphone application and recruited between November 2022 and October 2023. We used the validated EuroQol EQ-5D questionnaire with the UK Value Set to develop disutility scores (1-utility) for respondents with and without Long COVID using linear mixed models, and we calculated subsequent Quality-Adjusted Life-Months (QALMs) for long COVID. Findings The total OpenPROMPT cohort consisted of 7575 individuals who consented to data collection, with which we used data from 6070 participants who completed a baseline research questionnaire where 24.6% self-reported long COVID. In multivariable regressions, long COVID had a consistent impact on HRQoL, showing a higher likelihood or odds of reporting loss in quality-of-life (Odds Ratio (OR): 4.7, 95% CI: 3.72-5.93) compared with people who did not report long COVID. Reporting a disability was the largest predictor of losses of HRQoL (OR: 17.7, 95% CI: 10.37-30.33) across survey responses. Self-reported long COVID was associated with an 0.37 QALM loss. Interpretation We found substantial impacts on quality-of-life due to long COVID, representing a major burden on patients and the health service. We highlight the need for continued support and research for long COVID, as HRQoL scores compared unfavourably to patients with conditions such as multiple sclerosis, heart failure, and renal disease. Funding This research was supported by the National Institute for Health and Care Research (NIHR) (OpenPROMPT: COV-LT2-0073).
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Affiliation(s)
- Oliver Carlile
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Andrew Briggs
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | - Ben F.C. Butler-Cole
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - John Tazare
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Laurie A. Tomlinson
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Michael Marks
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Hospital for Tropical Diseases, University College London Hospital, London, WC1E 6JD, UK
- Division of Infection and Immunity, University College London, London, WC1E 6BT, UK
| | - Mark Jit
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Liang-Yu Lin
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Chris Bates
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX, UK
| | - John Parry
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX, UK
| | - Sebastian C.J. Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Iain Dillingham
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | | | - Ruth E. Costello
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Alex J. Walker
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - William Hulme
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Emily Herrett
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Rosalind M. Eggo
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Clutterbuck D, Ramasawmy M, Pantelic M, Hayer J, Begum F, Faghy M, Nasir N, Causer B, Heightman M, Allsopp G, Wootton D, Khan MA, Hastie C, Jackson M, Rayner C, Brown D, Parrett E, Jones G, Clarke R, Mcfarland S, Gabbay M, Banerjee A, Alwan NA. Barriers to healthcare access and experiences of stigma: Findings from a coproduced Long Covid case-finding study. Health Expect 2024; 27:e14037. [PMID: 38634418 PMCID: PMC11024953 DOI: 10.1111/hex.14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND AND AIM Long Covid is often stigmatised, particularly in people who are disadvantaged within society. This may prevent them from seeking help and could lead to widening health inequalities. This coproduced study with a Community Advisory Board (CAB) of people with Long Covid aimed to understand healthcare and wider barriers and stigma experienced by people with probable Long Covid. METHODS An active case finding approach was employed to find adults with probable, but not yet clinically diagnosed, Long Covid in two localities in London (Camden and Merton) and Derbyshire, England. Interviews explored the barriers to care and the stigma faced by participants and were analysed thematically. This study forms part of the STIMULATE-ICP Collaboration. FINDINGS Twenty-three interviews were completed. Participants reported limited awareness of what Long Covid is and the available pathways to management. There was considerable self-doubt among participants, sometimes reinforced by interactions with healthcare professionals (HCPs). Participants questioned their deservedness in seeking healthcare support for their symptoms. Hesitancy to engage with healthcare services was motivated by fear of needing more investigation and concerns regarding judgement about the ability to carry out caregiving responsibilities. It was also motivated by the complexity of the clinical presentation and fear of all symptoms being attributed to poor mental health. Participants also reported trying to avoid overburdening the health system. These difficulties were compounded by experiences of stigma and discrimination. The emerging themes reaffirmed a framework of epistemic injustice in relation to Long Covid, where creating, interpreting and conveying knowledge has varied credibility based on the teller's identity characteristics and/or the level of their interpretive resources. CONCLUSION We have codeveloped recommendations based on the findings. These include early signposting to services, dedicating protected time to listening to people with Long Covid, providing a holistic approach in care pathways, and working to mitigate stigma. Regardless of the diagnosis, people experiencing new symptoms must be encouraged to seek timely medical help. Clear public health messaging is needed among communities already disadvantaged by epistemic injustice to raise awareness of Long Covid, and to share stories that encourage seeking care and to illustrate the adverse effects of stigma. PATIENT OR PUBLIC CONTRIBUTION This study was coproduced with a CAB made up of 23 members including HCPs, people with lived experience of Long Covid and other stakeholders.
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Affiliation(s)
- Donna Clutterbuck
- School of Primary CarePopulation Sciences and Medical EducationUniversity of SouthamptonSouthamptonUK
| | - Mel Ramasawmy
- Institute of Health InformaticsUniversity College LondonLondonUK
| | - Marija Pantelic
- Brighton and Sussex Medical SchoolUniversity of SussexFalmerUK
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
| | - Jasmine Hayer
- PPIE Co‐applicant for STIMULATE‐ICPLondonUK
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Fauzia Begum
- University Hospitals of Derby and Burton NHS Foundation TrustDerbyshireUK
| | - Mark Faghy
- Clinical Exercise and Rehabilitation Research CentreUniversity of DerbyDerbyUK
| | - Nayab Nasir
- Department of Health and Social CareOffice for Health Improvement and DisparitiesUK
| | | | | | | | - Dan Wootton
- Clinical Infection Microbiology and ImmunologyUniversity of LiverpoolLiverpoolUK
- Liverpool University Hospitals NHS Foundation TrustLiverpoolUK
| | - M. Asad Khan
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
- Manchester University Hospitals NHS Foundation TrustManchesterUK
| | - Claire Hastie
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
- Long Covid Support CharityLondonUK
| | - Monique Jackson
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Clare Rayner
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Darren Brown
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
- Chelsea and Westminster Hospital NHS Foundation TrustLondonUK
| | - Emily Parrett
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Geraint Jones
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Rowan Clarke
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Sammie Mcfarland
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
- Long Covid Kids CharitySalisburyUK
| | - Mark Gabbay
- NIHR Applied Research Collaboration North West CoastLiverpoolUK
- Department of Primary Care and Mental HealthUniversity of LiverpoolLiverpoolUK
| | - Amitava Banerjee
- Institute of Health InformaticsUniversity College LondonLondonUK
| | - Nisreen A. Alwan
- School of Primary CarePopulation Sciences and Medical EducationUniversity of SouthamptonSouthamptonUK
- University Hospital Southampton NHS Foundation TrustSouthamptonUK
- NIHR Applied Research Collaboration WessexSouthamptonUK
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11
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Dababseh MMO, Sabaka P, Duraníková O, Horváthová S, Valkovič P, Straka I, Nagyová A, Boža V, Kravec M, Jurenka J, Koščálová A, Mihalov P, Marešová E, Bendžala M, Kušnírová A, Stankovič I. Delayed Antibody Response in the Acute Phase of Infection Is Associated with a Lower Mental Component of Quality of Life in Survivors of Severe and Critical COVID-19. J Clin Med 2024; 13:1938. [PMID: 38610703 PMCID: PMC11012816 DOI: 10.3390/jcm13071938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The long-term sequelae of coronavirus disease 2019 (COVID-19) significantly affects quality of life (QoL) in disease survivors. Delayed development of the adaptive immune response is associated with more severe disease and a worse prognosis in COVID-19. The effects of delayed immune response on COVID-19 sequelae and QoL are unknown. Methods: We conducted a prospective study to assess the relationship between the delayed antibody response in the acute phase of infection in naïve unvaccinated patients suffering from severe or critical COVID-19 and their QoL 12 months after hospital discharge. The 12-item Short Form Survey (SF-12) questionnaire was used for assessment of QoL. The SF-12 evaluates both mental and physical components of QoL, incorporating a mental component score (MCS-12) and a physical component score (PCS-12). A delayed antibody response was defined as testing negative for anti-spike SARS-CoV-2 antibodies at the time of hospital admission. Results: The study included 274 patients (154 men and 120 women). Of the enrolled patients, 144 had a delayed immune response. These patients had a significantly lower MCS-12 (p = 0.002), but PCS-12 (p = 0.397) was not significantly different at the 12-month follow-up compared to patients with positive anti-spike SARS-CoV-2 antibodies. The MCS-12 at the time of follow-up was negatively associated with delayed antibody response irrespective of possible confounders (p = 0.006; B = 3.609; ηp2 = 0.035; 95% CI = 1.069-6.150). An MSC-12 below 50 points at the time of follow-up was positively associated with delayed antibody response (p = 0.001; B = 1.092; OR = 2.979; 95% CI = 1.554-5.711). Conclusions: This study confirmed that, in patients with severe and critical COVID-19, a negative result for anti-spike SARS-CoV-2 antibodies at the time of hospital admission is associated with a lower mental component of QoL in unvaccinated patients naïve to COVID-19 one year after hospital discharge.
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Affiliation(s)
- Mohammad Mahmud Otman Dababseh
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (M.M.O.D.); (A.N.); (J.J.); (P.M.); (E.M.); (M.B.)
| | - Peter Sabaka
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (M.M.O.D.); (A.N.); (J.J.); (P.M.); (E.M.); (M.B.)
| | - Oľga Duraníková
- 2nd Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (O.D.); (S.H.); (P.V.); (I.S.)
| | - Simona Horváthová
- 2nd Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (O.D.); (S.H.); (P.V.); (I.S.)
| | - Peter Valkovič
- 2nd Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (O.D.); (S.H.); (P.V.); (I.S.)
- Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, 814 38 Bratislava, Slovakia
| | - Igor Straka
- 2nd Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (O.D.); (S.H.); (P.V.); (I.S.)
| | - Anna Nagyová
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (M.M.O.D.); (A.N.); (J.J.); (P.M.); (E.M.); (M.B.)
| | - Vladimír Boža
- Department of Applied Informatics, Faculty of Mathematics, Physics and Informatics, Comenius University in Bratislava, 842 48 Bratislava, Slovakia (M.K.)
| | - Marián Kravec
- Department of Applied Informatics, Faculty of Mathematics, Physics and Informatics, Comenius University in Bratislava, 842 48 Bratislava, Slovakia (M.K.)
| | - Ján Jurenka
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (M.M.O.D.); (A.N.); (J.J.); (P.M.); (E.M.); (M.B.)
| | - Alena Koščálová
- Department of Infectology, Slovak Medical University, 833 05 Bratislava, Slovakia;
| | - Peter Mihalov
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (M.M.O.D.); (A.N.); (J.J.); (P.M.); (E.M.); (M.B.)
| | - Eliška Marešová
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (M.M.O.D.); (A.N.); (J.J.); (P.M.); (E.M.); (M.B.)
| | - Matej Bendžala
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (M.M.O.D.); (A.N.); (J.J.); (P.M.); (E.M.); (M.B.)
| | - Alice Kušnírová
- 2nd Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (O.D.); (S.H.); (P.V.); (I.S.)
| | - Igor Stankovič
- Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, 833 05 Bratislava, Slovakia; (M.M.O.D.); (A.N.); (J.J.); (P.M.); (E.M.); (M.B.)
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12
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MacCallum-Bridges CL, Hirschtick JL, Allgood KL, Ryu S, Orellana RC, Fleischer NL. Cross-sectional population-based estimates of a rural-urban disparity in prevalence of long COVID among Michigan adults with polymerase chain reaction-confirmed COVID-19, 2020-2022. J Rural Health 2024; 40:303-313. [PMID: 37974389 DOI: 10.1111/jrh.12807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/25/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To (1) assess whether residential rurality/urbanicity was associated with the prevalence of 30- or 90-day long COVID, and (2) evaluate whether differences in long COVID risk factors might explain this potential disparity. METHODS We used data from the Michigan COVID-19 Recovery Surveillance Study, a population-based probability sample of adults with COVID-19 (n = 4,937). We measured residential rurality/urbanicity using dichotomized Rural-Urban Commuting Area codes (metropolitan, nonmetropolitan). We considered outcomes of 30-day long COVID (illness duration ≥30 days) and 90-day long COVID (illness duration ≥90 days). Using Poisson regression, we estimated unadjusted prevalence ratios (PRs) to compare 30- and 90-day long COVID between metropolitan and nonmetropolitan respondents. Then, we adjusted our model to account for differences between groups in long COVID risk factors (age, sex, acute COVID-19 severity, vaccination status, race and ethnicity, socioeconomic status, health care access, SARS-CoV-2 variant, and pre-existing conditions). We estimated associations for the full study period (Jan 1, 2020-May 31, 2022), the pre-vaccine era (before April 5, 2021), and the vaccine era (after April 5, 2021). FINDINGS Compared to metropolitan adults, the prevalence of 30-day long COVID was 15% higher (PR = 1.15 [95% CI: 1.03, 1.29]), and the prevalence of 90-day long COVID was 27% higher (PR = 1.27 [95% CI: 1.09, 1.49]) among nonmetropolitan adults. Adjusting for long COVID risk factors did not reduce disparity estimates in the pre-vaccine era but halved estimates in the vaccine era. CONCLUSIONS Our findings provide evidence of a rural-urban disparity in long COVID and suggest that the factors contributing to this disparity changed over time as the sociopolitical context of the pandemic evolved and COVID-19 vaccines were introduced.
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Affiliation(s)
| | - Jana L Hirschtick
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kristi L Allgood
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Epidemiology and Biostatistics, Texas A&M University, College Station, Texas, USA
| | - Soomin Ryu
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert C Orellana
- CDC Foundation, Atlanta, Georgia, USA
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Nancy L Fleischer
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
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13
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Bello-Chavolla OY, Fermín-Martínez CA, Ramírez-García D, Vargas-Vázquez A, Fernández-Chirino L, Basile-Alvarez MR, Sánchez-Castro P, Núñez-Luna A, Antonio-Villa NE. Prevalence and determinants of post-acute sequelae after SARS-CoV-2 infection (Long COVID) among adults in Mexico during 2022: a retrospective analysis of nationally representative data. LANCET REGIONAL HEALTH. AMERICAS 2024; 30:100688. [PMID: 38327277 PMCID: PMC10847769 DOI: 10.1016/j.lana.2024.100688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/26/2023] [Accepted: 01/21/2024] [Indexed: 02/09/2024]
Abstract
Background Post-acute sequelae after SARS-CoV-2 infection (PASC) remains a concerning long-term complication of COVID-19. Here, we aimed to characterize the epidemiology of PASC in Mexico during 2022 and identify potential associations of covariates with PASC prevalence using nationally representative data. Methods We analyzed data from the 2022 Mexican National Health and Nutrition Survey (ENSANUT) from 24,434 participants, representing 85,521,661 adults ≥20 years. PASC was defined using both the National Institute for Health and Care Excellence (NICE) definition and a PASC score ≥12. Estimates of PASC prevalence were stratified by age, sex, rural vs. urban setting, social lag quartiles, number of reinfections, vaccination status and periods of predominance of SARS-CoV-2 circulating variants. Determinants of PASC were assessed using log-binomial regression models adjusted by survey weights. Findings Persistent symptoms after SARS-CoV-2 infection were reported by 12.44% (95% CI 11.89-12.99) of adults ≥20 years in Mexico in 2022. The most common persistent symptoms were fatigue, musculoskeletal pain, headache, cough, loss of smell or taste, fever, post-exertional malaise, brain fog, anxiety, and chest pain. PASC was present in 21.21% (95% CI 19.74-22.68) of subjects with previously diagnosed COVID-19. Over 28.6% of patients with PASC reported symptoms persistence ≥6 months and 14.05% reported incapacitating symptoms. Higher PASC prevalence was associated with SARS-CoV-2 reinfections, depressive symptoms and living in states with high social lag. PASC prevalence, particularly its more severe forms, decreased with COVID-19 vaccination and for infections during periods of Omicron variant predominance. Interpretation PASC remains a significant public health burden in Mexico as the COVID-19 pandemic transitions into endemic. Promoting SARS-CoV-2 reinfection prevention and booster vaccination may be useful in reducing PASC burden. Funding This research was supported by Instituto Nacional de Geriatría in Mexico.
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Affiliation(s)
| | - Carlos A. Fermín-Martínez
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Daniel Ramírez-García
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | | | - Martín Roberto Basile-Alvarez
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Paulina Sánchez-Castro
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Alejandra Núñez-Luna
- Research Division, Instituto Nacional de Geriatría, Mexico City, Mexico
- Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
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14
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Mkoma GF, Agyemang C, Benfield T, Rostila M, Cederström A, Petersen JH, Norredam M. Risk of long COVID and associated symptoms after acute SARS-COV-2 infection in ethnic minorities: A nationwide register-linked cohort study in Denmark. PLoS Med 2024; 21:e1004280. [PMID: 38377114 PMCID: PMC10914299 DOI: 10.1371/journal.pmed.1004280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/05/2024] [Accepted: 01/30/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Ethnic minorities living in high-income countries have been disproportionately affected by Coronavirus Disease 2019 (COVID-19) in terms of infection rates, hospitalisations, and deaths; however, less is known about long COVID in these populations. Our aim was to examine the risk of long COVID and associated symptoms among ethnic minorities. METHODS AND FINDINGS We used nationwide register-based cohort data on individuals diagnosed with COVID-19 aged ≥18 years (n = 2,287,175) between January 2020 and August 2022 in Denmark. We calculated the risk of long COVID diagnosis and long COVID symptoms among ethnic minorities compared with native Danes using multivariable Cox proportional hazard regression and logistic regression, respectively. Among individuals who were first time diagnosed with COVID-19 during the study period, 39,876 (1.7%) were hospitalised and 2,247,299 (98.3%) were nonhospitalised individuals. Of the diagnosed COVID-19 cases, 1,952,021 (85.3%) were native Danes and 335,154 (14.7%) were ethnic minorities. After adjustment for age, sex, civil status, education, family income, and Charlson comorbidity index, ethnic minorities from North Africa (adjusted hazard ratio [aHR] 1.41, 95% confidence interval [CI] [1.12,1.79], p = 0.003), Middle East (aHR 1.38, 95% CI [1.24,1.55], p < 0.001), Eastern Europe (aHR 1.35, 95% CI [1.22,1.49], p < 0.001), and Asia (aHR 1.23, 95% CI [1.09,1.40], p = 0.001) had significantly greater risk of long COVID diagnosis than native Danes. In the analysis by largest countries of origin, the greater risks of long COVID diagnosis were found in people of Iraqi origin (aHR 1.56, 95% CI [1.30,1.88], p < 0.001), people of Turkish origin (aHR 1.42, 95% CI [1.24,1.63], p < 0.001), and people of Somali origin (aHR 1.42, 95% CI [1.07,1.91], p = 0.016). A significant factor associated with an increased risk of long COVID diagnosis was COVID-19 hospitalisation. The risk of long COVID diagnosis among ethnic minorities was more pronounced between January 2020 and June 2021. Furthermore, the odds of reporting cardiopulmonary symptoms (including dyspnoea, cough, and chest pain) and any long COVID symptoms were higher among people of North African, Middle Eastern, Eastern European, and Asian origins than among native Danes in both unadjusted and adjusted models. Despite including the nationwide sample of individuals diagnosed with COVID-19, the precision of our estimates on long COVID was limited to the sample of patients with symptoms who had contacted the hospital. CONCLUSIONS Belonging to an ethnic minority group was significantly associated with an increased risk of long COVID, indicating the need to better understand long COVID drivers and address care and treatment strategies in these populations.
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Affiliation(s)
- George Frederick Mkoma
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Thomas Benfield
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikael Rostila
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Agneta Cederström
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Jørgen Holm Petersen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
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15
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O’Laughlin KN, Klabbers RE, Ebna Mannan I, Gentile NL, Geyer RE, Zheng Z, Yu H, Li SX, Chan KCG, Spatz ES, Wang RC, L’Hommedieu M, Weinstein RA, Plumb ID, Gottlieb M, Huebinger RM, Hagen M, Elmore JG, Hill MJ, Kelly M, McDonald S, Rising KL, Rodriguez RM, Venkatesh A, Idris AH, Santangelo M, Koo K, Saydah S, Nichol G, Stephens KA. Ethnic and racial differences in self-reported symptoms, health status, activity level, and missed work at 3 and 6 months following SARS-CoV-2 infection. Front Public Health 2024; 11:1324636. [PMID: 38352132 PMCID: PMC10861779 DOI: 10.3389/fpubh.2023.1324636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/12/2023] [Indexed: 02/16/2024] Open
Abstract
Introduction Data on ethnic and racial differences in symptoms and health-related impacts following SARS-CoV-2 infection are limited. We aimed to estimate the ethnic and racial differences in symptoms and health-related impacts 3 and 6 months after the first SARS-CoV-2 infection. Methods Participants included adults with SARS-CoV-2 infection enrolled in a prospective multicenter US study between 12/11/2020 and 7/4/2022 as the primary cohort of interest, as well as a SARS-CoV-2-negative cohort to account for non-SARS-CoV-2-infection impacts, who completed enrollment and 3-month surveys (N = 3,161; 2,402 SARS-CoV-2-positive, 759 SARS-CoV-2-negative). Marginal odds ratios were estimated using GEE logistic regression for individual symptoms, health status, activity level, and missed work 3 and 6 months after COVID-19 illness, comparing each ethnicity or race to the referent group (non-Hispanic or white), adjusting for demographic factors, social determinants of health, substance use, pre-existing health conditions, SARS-CoV-2 infection status, COVID-19 vaccination status, and survey time point, with interactions between ethnicity or race and time point, ethnicity or race and SARS-CoV-2 infection status, and SARS-CoV-2 infection status and time point. Results Following SARS-CoV-2 infection, the majority of symptoms were similar over time between ethnic and racial groups. At 3 months, Hispanic participants were more likely than non-Hispanic participants to report fair/poor health (OR: 1.94; 95%CI: 1.36-2.78) and reduced activity (somewhat less, OR: 1.47; 95%CI: 1.06-2.02; much less, OR: 2.23; 95%CI: 1.38-3.61). At 6 months, differences by ethnicity were not present. At 3 months, Other/Multiple race participants were more likely than white participants to report fair/poor health (OR: 1.90; 95% CI: 1.25-2.88), reduced activity (somewhat less, OR: 1.72; 95%CI: 1.21-2.46; much less, OR: 2.08; 95%CI: 1.18-3.65). At 6 months, Asian participants were more likely than white participants to report fair/poor health (OR: 1.88; 95%CI: 1.13-3.12); Black participants reported more missed work (OR, 2.83; 95%CI: 1.60-5.00); and Other/Multiple race participants reported more fair/poor health (OR: 1.83; 95%CI: 1.10-3.05), reduced activity (somewhat less, OR: 1.60; 95%CI: 1.02-2.51; much less, OR: 2.49; 95%CI: 1.40-4.44), and more missed work (OR: 2.25; 95%CI: 1.27-3.98). Discussion Awareness of ethnic and racial differences in outcomes following SARS-CoV-2 infection may inform clinical and public health efforts to advance health equity in long-term outcomes.
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Affiliation(s)
- Kelli N. O’Laughlin
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Robin E. Klabbers
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Imtiaz Ebna Mannan
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States
| | - Nicole L. Gentile
- Department of Family Medicine, University of Washington, Seattle, WA, United States
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
- Post-COVID Rehabilitation and Recovery Clinic, University of Washington, Seattle, WA, United States
| | - Rachel E. Geyer
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Zihan Zheng
- Department of Family Medicine, University of Washington, Seattle, WA, United States
| | - Huihui Yu
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Shu-Xia Li
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States
| | - Kwun C. G. Chan
- Department of Biostatistics, University of Washington, Seattle, WA, United States
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States
| | - Erica S. Spatz
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, United States
- Department of Epidemiology, Yale School of Public Health, New Haven, CT, United States
- Yale Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States
| | - Ralph C. Wang
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Michelle L’Hommedieu
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Robert A. Weinstein
- Divisions of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
- Department of Medicine, Cook County Hospital, Chicago, IL, United States
| | - Ian D. Plumb
- National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Ryan M. Huebinger
- UTHealth Houston McGovern Medical School Department of Emergency Medicine, Houston, TX, United States
| | - Melissa Hagen
- National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Joann G. Elmore
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Mandy J. Hill
- UTHealth Houston McGovern Medical School Department of Emergency Medicine, Houston, TX, United States
| | - Morgan Kelly
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Samuel McDonald
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Kristin L. Rising
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
- Center for Connected Care, Thomas Jefferson University, Philadelphia, PA, United States
| | - Robert M. Rodriguez
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Arjun Venkatesh
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT, United States
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Ahamed H. Idris
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Michelle Santangelo
- Divisions of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Katherine Koo
- Divisions of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Sharon Saydah
- National Center for Immunizations and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Graham Nichol
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States
| | - Kari A. Stephens
- Department of Family Medicine, University of Washington, Seattle, WA, United States
- Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, United States
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16
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Tian T, Yang C, Long X, Kong F, Fu Y, Liu F, Tuo L, Guo X, Li L, Zhao X, Wang Q, Yuan G, Wang H, Wang Y, Qiao J. The Long-Term Impacts of COVID-19 on Physical and Psychological Health - Beijing Municipality, China, December 2022-April 2023. China CDC Wkly 2023; 5:894-899. [PMID: 37886617 PMCID: PMC10598477 DOI: 10.46234/ccdcw2023.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
What is already known about this topic? Reports detailing the clinical presentation of coronavirus disease 2019 (COVID-19) are extensive in China. However, data remains limited regarding the long-term effects of the 2022 outbreak on the community and healthcare workers (HCWs). What is added by this report? In the follow-up study conducted with 1,069 community members and 3,309 HCWs infected with COVID-19, we observed that five months post-outbreak, 39.2% of community members and 28.7% of HCWs reported experiencing at least one symptom. The symptoms most frequently reported included fatigue or muscle weakness, insomnia, cognitive dysfunction, hair loss, joint or muscle pain, and persistent cough. HCWs tended to experience fewer long-term physical consequences and their symptoms had an expedited recovery time compared to the community members. Nevertheless, HCWs displayed a higher prevalence of moderate to severe depression and anxiety. What are the implications for public health practice? The establishment of a public healthcare system dedicated to continual monitoring, prevention, and clinical treatment of persistent COVID-19 symptoms is imperative.
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Affiliation(s)
- Tian Tian
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Chuan Yang
- Personnel Department, Peking University Third Hospital, Beijing, China
| | - Xiaoyu Long
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Fei Kong
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Yu Fu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Fang Liu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Ling Tuo
- Office of Hospital Management, Peking University Health Science Center, Beijing, China
| | - Xiujun Guo
- The Second Outpatient Department of Peking University Third Hospital, Beijing, China
| | - Lei Li
- The Second Outpatient Department of Peking University Third Hospital, Beijing, China
| | - Xingxing Zhao
- The Second Outpatient Department of Peking University Third Hospital, Beijing, China
| | - Qun Wang
- Capital Airport sub-district DongPingLi Community Health Center, Beijing, China
| | - Guangti Yuan
- Zizhuyuan Community Service Station in Haidian District, Beijing, China
| | - Huiqing Wang
- Personnel Department, Peking University Third Hospital, Beijing, China
| | - Yuanyuan Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- State Key Laboratory of Female Fertility Promotion, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
- Beijing Advanced Innovation Center for Genomics, Beijing, China
- Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
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Abbasi K. Health, wellbeing, and equity: the tenets of health professionalism. J R Soc Med 2023; 116:259. [PMID: 37635679 PMCID: PMC10469971 DOI: 10.1177/01410768231196466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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