Quantifying the Adverse Effects of Long COVID on Individuals’ Health After Infection: A Propensity Score Matching Design Study

Objective To evaluate the prevalence and influencing factors of long COVID, and measure the difference in health status between long COVID and non-long COVID cases. Methods A cross-sectional survey was conducted from February 1 to 8, 2023, using a stratified random sampling method in four regions (eastern [Changzhou], central [Zhengzhou], western [Xining] and northeastern [Mudanjiang]) of China. The survey collected COVID-19 patients’ socio-demographic characteristics and lifestyles information. The scores of lifestyles and health status range from 5 to 21 and 0 to 100 points, respectively. The criteria of “persistent health problems after 4 weeks of COVID-19 infection” issued by the US Centers for Disease Control and Prevention was used to assess long COVID. Multiple linear regression was used to analyze the influencing factors of the health. The bootstrap method was used to analyze the lifestyles’ mediating effect. Propensity score matching (PSM) was used to evaluate the net difference in health scores between long COVID and non-long COVID cases. Results The study included 3165 COVID-19 patients, with 308 (9.73%) long COVID cases. The health score of the long COVID cases (74.79) was lower than that of the non-long COVID cases (81.06). After adjusting for potential confounding variables, we found that never focused on mental decompression was a common risk factor for the health of both groups. Lifestyles was the mediating factor on individuals’ health. After PSM, the non-long COVID cases’ health scores remained higher than that of long COVID cases. Conclusion The proportion of long COVID cases was low, but they were worse off in health. Given the positive moderating effect of healthy lifestyles on improving the health of long COVID cases, healthy lifestyles including mental decompression should be considered as the core strategy of primary prevention when the epidemic of COVID-19 is still at a low level.

[1]  Z. Gai,et al.  Interplay between LPL and GPIHBP1 in COVID-19 patients: a possible mechanism for post-recovery cardiomyopathy , 2023, Human Cell.

[2]  Wen Zhang,et al.  A one-year follow-up study of systematic impact of long COVID symptoms among patients post SARS-CoV-2 omicron variants infection in Shanghai, China , 2023, Emerging microbes & infections.

[3]  Guohui Fan,et al.  6-month consequences of COVID-19 in patients discharged from hospital: a cohort study , 2023, The Lancet.

[4]  J. Overhage,et al.  One-Year Adverse Outcomes Among US Adults With Post–COVID-19 Condition vs Those Without COVID-19 in a Large Commercial Insurance Database , 2023, JAMA health forum.

[5]  D. Tempesta,et al.  Poor sleep quality, insomnia, and short sleep duration before infection predict long-term symptoms after COVID-19 , 2023, Brain, Behavior, and Immunity.

[6]  J. Kang,et al.  Adherence to Healthy Lifestyle Prior to Infection and Risk of Post–COVID-19 Condition , 2023, JAMA internal medicine.

[7]  L. Zong,et al.  China ends its zero-COVID-19 policy: New challenges facing mental health services , 2023, Asian Journal of Psychiatry.

[8]  L. Yin,et al.  Undiagnosed Long COVID-19 in China Among Non-vaccinated Individuals: Identifying Persistent Symptoms and Impacts on Patients' Health-Related Quality of Life , 2022, Journal of Epidemiology and Global Health.

[9]  N. Alwan,et al.  Long COVID: long-term health outcomes and implications for policy and research , 2022, Nature reviews. Nephrology.

[10]  Jill P. Pell,et al.  Outcomes among confirmed cases and a matched comparison group in the Long-COVID in Scotland study , 2022, Nature Communications.

[11]  James N. Druckman,et al.  Prevalence and Correlates of Long COVID Symptoms Among US Adults , 2022, JAMA network open.

[12]  B. Penninx,et al.  How COVID-19 shaped mental health: from infection to pandemic effects , 2022, Nature Medicine.

[13]  Z. Gai,et al.  Hypertension is still a moving target in the context of COVID‐19 and post‐acute COVID‐19 syndrome , 2022, Journal of medical virology.

[14]  F. K. Chan,et al.  Epidemiology, Symptomatology, and Risk Factors for Long COVID Symptoms: Population-Based, Multicenter Study , 2022, JMIR public health and surveillance.

[15]  M. Abdalla,et al.  Cardiovascular complications in the post-acute COVID-19 syndrome: A novel perspective down the road , 2022, Travel Medicine and Infectious Disease.

[16]  E. Wan,et al.  Post-COVID-19 Condition. , 2022, Annual review of medicine.

[17]  J. Rosmalen,et al.  Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study , 2022, The Lancet.

[18]  G. Gkoutos,et al.  Symptoms and risk factors for long COVID in non-hospitalized adults , 2022, Nature Medicine.

[19]  K. Bhaskaran,et al.  Long COVID burden and risk factors in 10 UK longitudinal studies and electronic health records , 2022, Nature Communications.

[20]  C. Li,et al.  A systematic review and meta-analysis of long term physical and mental sequelae of COVID-19 pandemic: call for research priority and action , 2022, Molecular Psychiatry.

[21]  P. Weihe,et al.  Prevalence of long COVID in a national cohort: longitudinal measures from disease onset until 8 months’ follow-up , 2022, International Journal of Infectious Diseases.

[22]  T. Chun,et al.  A Longitudinal Study of COVID-19 Sequelae and Immunity: Baseline Findings , 2022, Annals of Internal Medicine.

[23]  S. Riley,et al.  Persistent COVID-19 symptoms in a community study of 606,434 people in England , 2022, Nature Communications.

[24]  B. Lapin,et al.  Health-Related Quality of Life Mildly Affected Following COVID-19: a Retrospective Pre-post Cohort Study with a Propensity Score–Matched Control Group , 2022, Journal of General Internal Medicine.

[25]  Janet Diaz,et al.  A clinical case definition of post-COVID-19 condition by a Delphi consensus , 2021, The Lancet Infectious Diseases.

[26]  Xinyi Jiang,et al.  What are the challenges faced by COVID-19 vaccines? , 2021, Expert review of vaccines.

[27]  Z. Al-Aly,et al.  Burdens of post-acute sequelae of COVID-19 by severity of acute infection, demographics and health status , 2021, Nature Communications.

[28]  S. Klochkov,et al.  Analysis of post COVID-19 condition and its overlap with myalgic encephalomyelitis/chronic fatigue syndrome , 2021, Journal of Advanced Research.

[29]  E. Khedr,et al.  Long term impact of Covid-19 infection on sleep and mental health: A cross-sectional study , 2021, Psychiatry Research.

[30]  M. Ghasemi,et al.  Long‐term side effects and lingering symptoms post COVID‐19 recovery , 2021, Reviews in medical virology.

[31]  David A. Drew,et al.  Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: a prospective, community-based, nested, case-control study , 2021, The Lancet Infectious Diseases.

[32]  Urvish K. Patel,et al.  Post‐acute COVID‐19 syndrome (PCS) and health‐related quality of life (HRQoL)—A systematic review and meta‐analysis , 2021, Journal of medical virology.

[33]  M. Abdalla,et al.  In the face of the future, what do we learn from COVID-19? , 2021, Human vaccines & immunotherapeutics.

[34]  E. Sapey,et al.  Symptoms, complications and management of long COVID: a review , 2021, Journal of the Royal Society of Medicine.

[35]  R. Guner,et al.  Post‐COVID syndrome: A single‐center questionnaire study on 1007 participants recovered from COVID‐19 , 2021, Journal of medical virology.

[36]  Y. Bao,et al.  Prevalence of posttraumatic stress disorder after infectious disease pandemics in the twenty-first century, including COVID-19: a meta-analysis and systematic review , 2021, Molecular Psychiatry.

[37]  M. Andrés,et al.  Post-acute COVID-19 syndrome. Incidence and risk factors: A Mediterranean cohort study , 2021, Journal of Infection.

[38]  B. Plaud,et al.  Three-month quality of life in survivors of ARDS due to COVID-19: A preliminary report from a French academic centre , 2020, Anaesthesia Critical Care & Pain Medicine.

[39]  F. Bruyère,et al.  Follow-up of adults with noncritical COVID-19 two months after symptom onset , 2020, Clinical Microbiology and Infection.

[40]  Eric A. Meyerowitz,et al.  Transmission of SARS-CoV-2: A Review of Viral, Host, and Environmental Factors , 2020, Annals of Internal Medicine.

[41]  N. Alwan.  Surveillance is underestimating the burden of the COVID-19 pandemic , 2020, The Lancet.

[42]  Ankur Khajuria,et al.  The effect of smoking on COVID‐19 severity: A systematic review and meta‐analysis , 2020, Journal of medical virology.

[43]  Jay S. Steingrub,et al.  Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020 , 2020, MMWR. Morbidity and mortality weekly report.

[44]  Manoj Sivan,et al.  Postdischarge symptoms and rehabilitation needs in survivors of COVID‐19 infection: A cross‐sectional evaluation , 2020, Journal of medical virology.

[45]  Angelo Carfì,et al.  Persistent Symptoms in Patients After Acute COVID-19. , 2020, JAMA.

[46]  Y. Bao,et al.  Prevalence of and Risk Factors Associated With Mental Health Symptoms Among the General Population in China During the Coronavirus Disease 2019 Pandemic , 2020, JAMA network open.

[47]  K. Hashimoto,et al.  Poor-sleep is associated with slow recovery from lymphopenia and an increased need for ICU care in hospitalized patients with COVID-19: A retrospective cohort study , 2020, Brain, Behavior, and Immunity.

[48]  H. Hendriks.  Alcohol and Human Health: What Is the Evidence? , 2020, Annual review of food science and technology.

[49]  M. Grønbaek,et al.  The positive and negative health effects of alcohol‐ and the public health implications , 2009, Journal of internal medicine.

[50]  U. John,et al.  Alcohol consumption and out-patient services utilization by abstainers and drinkers. , 2006, Addiction.