Symptoms and risk factors for long COVID in non-hospitalized 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 Gkoutos; Olalekan 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

doi:10.1038/s41591-022-01909-w

Symptoms and risk factors for long COVID in non-hospitalized 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

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

71 Downloads (Pure)

Abstract

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 language	English
Pages (from-to)	1706-1714
Number of pages	9
Journal	Nature Medicine
Volume	28
Issue number	8
Early online date	25 Jul 2022
DOIs	https://doi.org/10.1038/s41591-022-01909-w
Publication status	Published - Aug 2022

Bibliographical note

Funding Information:
M.C. is Director of the Birmingham Health Partners Center for Regulatory Science and Innovation and Director of the Center for Patient-Reported Outcomes Research and is an NIHR Senior Investigator. M.C. receives funding from the NIHR Birmingham Biomedical Research Center (BRC), NIHR Surgical Reconstruction and Microbiology Research Center (SRMRC), NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics and NIHR Applied Research Collaboration (ARC) West Midlands at the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Health Data Research UK, Innovate UK (part of UK Research and Innovation), Macmillan Cancer Support, SPINE UK, UKRI, UCB Pharma, Janssen, GSK and Gilead. M.C. has received personal fees from Astellas, Aparito, CIS Oncology, Takeda, Merck, Daiichi Sankyo, Glaukos, GSK and the Patient-Centered Outcomes Research Institute outside the submitted work. S.E.H. receives funding from NIHR ARC, West Midlands and the NIHR BTRU in Precision Transplant and Cellular Therapeutics at the University of Birmingham. S.E.H. declares personal fees from Cochlear and Aparito outside the submitted work. O.L.A. receives funding from the NIHR Birmingham BRC, NIHR ARC, West Midlands, NIHR BTRU in Precision Transplant and Cellular Therapeutics at the University of Birmingham and University Hospitals Birmingham NHS Foundation, Innovate UK, Gilead Sciences, Janssen Pharmaceuticals and Sarcoma UK. O.L.A. declares personal fees from Gilead Sciences, GSK and Merck outside the submitted work. C.M. receives funding from NIHR SRMRC, NIHR BTRU in Precision Transplant and Cellular Therapeutics and Innovate UK and has received personal fees from Aparito outside the submitted work. A.D.S. is supported by a postdoctoral fellowship from THIS Institute, NIHR University College London Hospitals BRC, grants from NIHR and British Heart Foundation Accelerator Award. E.S. has received grants from the Wellcome Trust, MRC, NIHR EME, NIHR HTA, HDR-UK, BLF, EPSRC and Alpha 1 Foundation in the last 36 months. She has been an honorarium for lectures about COVID-19 treatments, which are run by GSK, attended a virtual conference at the European Respiratory Society in 2020 that was funded by AstraZeneca and participated in an advisory board for COPD, which is run by Boehringer Ingelheim. S.M. has received funding from NIHR (RfPB, PGfAR, HTA and EME streams), UKRI, ESRC and the Midlands Engine. He has attended educational events funded by Psychiatric Genetic Testing, Janssen and Lundbeck in the last 5 years. P.M., T.W., C.I. and E.L. are employees of CPRD, the data custodians for CPRD Aurum. CPRD is jointly sponsored by the UK Government’s MHRA and NIHR. As a not-for-profit UK Government body, CPRD seeks to recoup the cost of delivering its research services to academic, industry and government researchers through research user license fees. J.C. receives funding from NIHR on PPI from a study at UCL (NIHR132914) and a study at University Hospitals Bristol (NIHR203304). J.C. is a lay member on the NICE COVID expert panel and a citizen partner on the COVID END Evidence Synthesis Global Horizon Scanning panel. J.C. declares personal fees from MEDABLE, GlaxoSmithKline and Roche Canada outside of submitted work. K.L.M. is a trustee and volunteer at long COVID SOS. K.L.M. is on the long COVID Advisory Board for Dysautonomia International and is employed by NIHR. T.M. receives funding from NIHR ARC, West Midlands. G.V.G. receives funding from the NIHR Birmingham ECMC, NIHR Birmingham SRMRC, Nanocommons H2020-EU (731032), MAESTRIA (grant agreement no. 965286) and the MRC Health Data Research UK (HDRUK/CFC/01). J.M.L. receives funding from the MRC, Versus Arthritis, NIHR, FOREUM, UKSPINE and the Scar Free Foundation and declares personal fees from Bayer. F.K. is supported by an NIHR Doctoral Fellowship award (grant no. 300688). M.J.P. is supported by NIHR BRC. All other co-authors declare no competing interests. The views expressed are those of the investigators, and the funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

We thank the funders of our TLC study (COV-LT-0013), NIHR and UKRI, all the patients on the TLC Lived Experience Advisory Group and N. Mangat for supporting LEAP member recruitment. We also thank A. Walker, K. Jones and Y. Lee for providing administrative support for the study.

Publisher Copyright:
© 2022, The Author(s).

ASJC Scopus subject areas

General Biochemistry,Genetics and Molecular Biology

Access to Document

10.1038/s41591-022-01909-wLicence: Creative Commons: Attribution (CC BY)

SubramanianA2022SymptomsFinal published version, 6.24 MBLicence: Creative Commons: Attribution (CC BY)

1 Preprint

Assessment of 115 symptoms for Long COVID (post-COVID-19 condition) and their risk factors in non-hospitalised individuals: a retrospective matched cohort study in UK primary care
Subramanian, A., Nirantharakumar, K., Hughes, S., Myles, P., Williams, T., Gokhale, K., Taverner, T., Chandan, J., Brown, K., Simms-Williams, N., Shah, A., Singh, M., Kidy, F., Okoth, K., Hotham, R., Bashir, N., Cockburn, N., Lee, S., Turner, G., Gkoutos, G., & 16 othersAiyegbusi, O. L., McMullan, C., Denniston, A., Sapey, E., Lord, J., Wraith, D., Leggett, E., Iles, C., Marshall, T., Price, M., Marwaha, S., Davies, E. H., Jackson, L., Camaradou, J., Calvert, M. & Haroon, S., 15 Feb 2022, Research Square.
Research output: Working paper/Preprint › Preprint

Cite this

Subramanian, A., Nirantharakumar, K., Hughes, S., Myles, P. R., Williams, T., Gokhale, K., Taverner, T., Chandan, J., Brown, K., Simms-Williams, N., Shah, A., Singh, M., Kidy, F., Okoth, K., Hotham, R., Bashir, N., Cockburn, N., Lee, S., Turner, G., ... Haroon, S. (2022). Symptoms and risk factors for long COVID in non-hospitalized adults. Nature Medicine, 28(8), 1706-1714. https://doi.org/10.1038/s41591-022-01909-w

@article{3050b911e97c4ef49870f945cb51654e,

title = "Symptoms and risk factors for long COVID in non-hospitalized adults",

abstract = "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.",

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

note = "Funding Information: M.C. is Director of the Birmingham Health Partners Center for Regulatory Science and Innovation and Director of the Center for Patient-Reported Outcomes Research and is an NIHR Senior Investigator. M.C. receives funding from the NIHR Birmingham Biomedical Research Center (BRC), NIHR Surgical Reconstruction and Microbiology Research Center (SRMRC), NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics and NIHR Applied Research Collaboration (ARC) West Midlands at the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Health Data Research UK, Innovate UK (part of UK Research and Innovation), Macmillan Cancer Support, SPINE UK, UKRI, UCB Pharma, Janssen, GSK and Gilead. M.C. has received personal fees from Astellas, Aparito, CIS Oncology, Takeda, Merck, Daiichi Sankyo, Glaukos, GSK and the Patient-Centered Outcomes Research Institute outside the submitted work. S.E.H. receives funding from NIHR ARC, West Midlands and the NIHR BTRU in Precision Transplant and Cellular Therapeutics at the University of Birmingham. S.E.H. declares personal fees from Cochlear and Aparito outside the submitted work. O.L.A. receives funding from the NIHR Birmingham BRC, NIHR ARC, West Midlands, NIHR BTRU in Precision Transplant and Cellular Therapeutics at the University of Birmingham and University Hospitals Birmingham NHS Foundation, Innovate UK, Gilead Sciences, Janssen Pharmaceuticals and Sarcoma UK. O.L.A. declares personal fees from Gilead Sciences, GSK and Merck outside the submitted work. C.M. receives funding from NIHR SRMRC, NIHR BTRU in Precision Transplant and Cellular Therapeutics and Innovate UK and has received personal fees from Aparito outside the submitted work. A.D.S. is supported by a postdoctoral fellowship from THIS Institute, NIHR University College London Hospitals BRC, grants from NIHR and British Heart Foundation Accelerator Award. E.S. has received grants from the Wellcome Trust, MRC, NIHR EME, NIHR HTA, HDR-UK, BLF, EPSRC and Alpha 1 Foundation in the last 36 months. She has been an honorarium for lectures about COVID-19 treatments, which are run by GSK, attended a virtual conference at the European Respiratory Society in 2020 that was funded by AstraZeneca and participated in an advisory board for COPD, which is run by Boehringer Ingelheim. S.M. has received funding from NIHR (RfPB, PGfAR, HTA and EME streams), UKRI, ESRC and the Midlands Engine. He has attended educational events funded by Psychiatric Genetic Testing, Janssen and Lundbeck in the last 5 years. P.M., T.W., C.I. and E.L. are employees of CPRD, the data custodians for CPRD Aurum. CPRD is jointly sponsored by the UK Government{\textquoteright}s MHRA and NIHR. As a not-for-profit UK Government body, CPRD seeks to recoup the cost of delivering its research services to academic, industry and government researchers through research user license fees. J.C. receives funding from NIHR on PPI from a study at UCL (NIHR132914) and a study at University Hospitals Bristol (NIHR203304). J.C. is a lay member on the NICE COVID expert panel and a citizen partner on the COVID END Evidence Synthesis Global Horizon Scanning panel. J.C. declares personal fees from MEDABLE, GlaxoSmithKline and Roche Canada outside of submitted work. K.L.M. is a trustee and volunteer at long COVID SOS. K.L.M. is on the long COVID Advisory Board for Dysautonomia International and is employed by NIHR. T.M. receives funding from NIHR ARC, West Midlands. G.V.G. receives funding from the NIHR Birmingham ECMC, NIHR Birmingham SRMRC, Nanocommons H2020-EU (731032), MAESTRIA (grant agreement no. 965286) and the MRC Health Data Research UK (HDRUK/CFC/01). J.M.L. receives funding from the MRC, Versus Arthritis, NIHR, FOREUM, UKSPINE and the Scar Free Foundation and declares personal fees from Bayer. F.K. is supported by an NIHR Doctoral Fellowship award (grant no. 300688). M.J.P. is supported by NIHR BRC. All other co-authors declare no competing interests. The views expressed are those of the investigators, and the funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. We thank the funders of our TLC study (COV-LT-0013), NIHR and UKRI, all the patients on the TLC Lived Experience Advisory Group and N. Mangat for supporting LEAP member recruitment. We also thank A. Walker, K. Jones and Y. Lee for providing administrative support for the study. Publisher Copyright: {\textcopyright} 2022, The Author(s). ",

year = "2022",

month = aug,

doi = "10.1038/s41591-022-01909-w",

language = "English",

volume = "28",

pages = "1706--1714",

journal = "Nature Medicine",

issn = "1078-8956",

publisher = "Nature Publishing Group",

number = "8",

}

Subramanian, A , Nirantharakumar, K , Hughes, S, Myles, PR, Williams, T, Gokhale, K, Taverner, T, Chandan, J , Brown, K , Simms-Williams, N, Shah, A, Singh, M, Kidy, F, Okoth, K, Hotham, R, Bashir, N, Cockburn, N , Lee, S , Turner, G , Gkoutos, G , Aiyegbusi, OL , McMullan, C , Denniston, A , Sapey, E , Lord, J , Wraith, D, Leggett, E, Iles, C, Marshall, T , Price, M , Marwaha, S, Davies, EH, Jackson, L, Matthews, K, Camaradou, J, Calvert, M & Haroon, S 2022, 'Symptoms and risk factors for long COVID in non-hospitalized adults', Nature Medicine, vol. 28, no. 8, pp. 1706-1714. https://doi.org/10.1038/s41591-022-01909-w

TY - JOUR

T1 - Symptoms and risk factors for long COVID in non-hospitalized adults

AU - Subramanian, Anuradhaa

AU - Nirantharakumar, Krishnarajah

AU - Hughes, Sarah

AU - Myles, Puja R

AU - Williams, Tim

AU - Gokhale, Krishna

AU - Taverner, Thomas

AU - Chandan, Joht

AU - Brown, Kirsty

AU - Simms-Williams, Nikita

AU - Shah, Anoop

AU - Singh, Megha

AU - Kidy, Farah

AU - Okoth, Kelvin

AU - Hotham, Richard

AU - Bashir, Nasir

AU - Cockburn, Neil

AU - Lee, Siang

AU - Turner, Grace

AU - Gkoutos, Georgios

AU - Aiyegbusi, Olalekan Lee

AU - McMullan, Christel

AU - Denniston, Alastair

AU - Sapey, Elizabeth

AU - Lord, Janet

AU - Wraith, David

AU - Leggett, Edward

AU - Iles, Clare

AU - Marshall, Tom

AU - Price, Malcolm

AU - Marwaha, Steven

AU - Davies, Elin Haf

AU - Jackson, Louise

AU - Matthews, Karen

AU - Camaradou, Jenny

AU - Calvert, Melanie

AU - Haroon, Shamil

N1 - Funding Information: M.C. is Director of the Birmingham Health Partners Center for Regulatory Science and Innovation and Director of the Center for Patient-Reported Outcomes Research and is an NIHR Senior Investigator. M.C. receives funding from the NIHR Birmingham Biomedical Research Center (BRC), NIHR Surgical Reconstruction and Microbiology Research Center (SRMRC), NIHR Birmingham-Oxford Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics and NIHR Applied Research Collaboration (ARC) West Midlands at the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Health Data Research UK, Innovate UK (part of UK Research and Innovation), Macmillan Cancer Support, SPINE UK, UKRI, UCB Pharma, Janssen, GSK and Gilead. M.C. has received personal fees from Astellas, Aparito, CIS Oncology, Takeda, Merck, Daiichi Sankyo, Glaukos, GSK and the Patient-Centered Outcomes Research Institute outside the submitted work. S.E.H. receives funding from NIHR ARC, West Midlands and the NIHR BTRU in Precision Transplant and Cellular Therapeutics at the University of Birmingham. S.E.H. declares personal fees from Cochlear and Aparito outside the submitted work. O.L.A. receives funding from the NIHR Birmingham BRC, NIHR ARC, West Midlands, NIHR BTRU in Precision Transplant and Cellular Therapeutics at the University of Birmingham and University Hospitals Birmingham NHS Foundation, Innovate UK, Gilead Sciences, Janssen Pharmaceuticals and Sarcoma UK. O.L.A. declares personal fees from Gilead Sciences, GSK and Merck outside the submitted work. C.M. receives funding from NIHR SRMRC, NIHR BTRU in Precision Transplant and Cellular Therapeutics and Innovate UK and has received personal fees from Aparito outside the submitted work. A.D.S. is supported by a postdoctoral fellowship from THIS Institute, NIHR University College London Hospitals BRC, grants from NIHR and British Heart Foundation Accelerator Award. E.S. has received grants from the Wellcome Trust, MRC, NIHR EME, NIHR HTA, HDR-UK, BLF, EPSRC and Alpha 1 Foundation in the last 36 months. She has been an honorarium for lectures about COVID-19 treatments, which are run by GSK, attended a virtual conference at the European Respiratory Society in 2020 that was funded by AstraZeneca and participated in an advisory board for COPD, which is run by Boehringer Ingelheim. S.M. has received funding from NIHR (RfPB, PGfAR, HTA and EME streams), UKRI, ESRC and the Midlands Engine. He has attended educational events funded by Psychiatric Genetic Testing, Janssen and Lundbeck in the last 5 years. P.M., T.W., C.I. and E.L. are employees of CPRD, the data custodians for CPRD Aurum. CPRD is jointly sponsored by the UK Government’s MHRA and NIHR. As a not-for-profit UK Government body, CPRD seeks to recoup the cost of delivering its research services to academic, industry and government researchers through research user license fees. J.C. receives funding from NIHR on PPI from a study at UCL (NIHR132914) and a study at University Hospitals Bristol (NIHR203304). J.C. is a lay member on the NICE COVID expert panel and a citizen partner on the COVID END Evidence Synthesis Global Horizon Scanning panel. J.C. declares personal fees from MEDABLE, GlaxoSmithKline and Roche Canada outside of submitted work. K.L.M. is a trustee and volunteer at long COVID SOS. K.L.M. is on the long COVID Advisory Board for Dysautonomia International and is employed by NIHR. T.M. receives funding from NIHR ARC, West Midlands. G.V.G. receives funding from the NIHR Birmingham ECMC, NIHR Birmingham SRMRC, Nanocommons H2020-EU (731032), MAESTRIA (grant agreement no. 965286) and the MRC Health Data Research UK (HDRUK/CFC/01). J.M.L. receives funding from the MRC, Versus Arthritis, NIHR, FOREUM, UKSPINE and the Scar Free Foundation and declares personal fees from Bayer. F.K. is supported by an NIHR Doctoral Fellowship award (grant no. 300688). M.J.P. is supported by NIHR BRC. All other co-authors declare no competing interests. The views expressed are those of the investigators, and the funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. We thank the funders of our TLC study (COV-LT-0013), NIHR and UKRI, all the patients on the TLC Lived Experience Advisory Group and N. Mangat for supporting LEAP member recruitment. We also thank A. Walker, K. Jones and Y. Lee for providing administrative support for the study. Publisher Copyright: © 2022, The Author(s).

PY - 2022/8

Y1 - 2022/8

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85136410804&partnerID=8YFLogxK

U2 - 10.1038/s41591-022-01909-w

DO - 10.1038/s41591-022-01909-w

M3 - Article

C2 - 35879616

SN - 1078-8956

VL - 28

SP - 1706

EP - 1714

JO - Nature Medicine

JF - Nature Medicine

IS - 8

ER -

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

Abstract

Bibliographical note

ASJC Scopus subject areas

Access to Document

Fingerprint

Research output

Assessment of 115 symptoms for Long COVID (post-COVID-19 condition) and their risk factors in non-hospitalised individuals: a retrospective matched cohort study in UK primary care

Cite this