Symptoms and risk factors for long COVID in non-hospitalised adults

Anuradhaa Subramanian, Krishnarajah Nirantharakumar, Sarah Hughes, Puja R Myles, Tim Williams, Krishna Gokhale, Thomas Taverner, Joht Chandan, Kirsty Brown, Nikita Simms-Williams, Anoop Shah, Megha Singh, Farah Kidy, Kelvin Okoth, Richard Hotham, Nasir Bashir, Neil Cockburn, Siang Lee, Grace Turner, Georgios GkoutosOlalekan Lee Aiyegbusi, Christel McMullan, Alastair Denniston, Elizabeth Sapey, Janet Lord, David Wraith, Edward Leggett, Clare Iles, Tom Marshall, Malcolm Price, Steven Marwaha, Elin Haf Davies, Louise Jackson, Karen Matthews, Jenny Camaradou, Melanie Calvert, Shamil Haroon

Research output: Contribution to journalArticlepeer-review


Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is associated with a range of persistent symptoms impacting everyday functioning, known as post-COVID-19 condition or long COVID. We undertook a retrospective matched cohort study using a UK-based primary care database, Clinical Practice Research Datalink Aurum, to determine symptoms that are associated with confirmed SARS-CoV-2 infection beyond 12 weeks in non-hospitalized adults and the risk factors associated with developing persistent symptoms. We selected 486,149 adults with confirmed SARS-CoV-2 infection and 1,944,580 propensity score-matched adults with no recorded evidence of SARS-CoV-2 infection. Outcomes included 115 individual symptoms, as well as long COVID, defined as a composite outcome of 33 symptoms by the World Health Organization clinical case definition. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for the outcomes. A total of 62 symptoms were significantly associated with SARS-CoV-2 infection after 12 weeks. The largest aHRs were for anosmia (aHR 6.49, 95% CI 5.02–8.39), hair loss (3.99, 3.63–4.39), sneezing (2.77, 1.40–5.50), ejaculation difficulty (2.63, 1.61–4.28) and reduced libido (2.36, 1.61–3.47). Among the cohort of patients infected with SARS-CoV-2, risk factors for long COVID included female sex, belonging to an ethnic minority, socioeconomic deprivation, smoking, obesity and a wide range of comorbidities. The risk of developing long COVID was also found to be increased along a gradient of decreasing age. SARS-CoV-2 infection is associated with a plethora of symptoms that are associated with a range of sociodemographic and clinical risk factors.
Original languageEnglish
Pages (from-to)1-20
Number of pages20
JournalNature Medicine
Publication statusPublished - 25 Jul 2022


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