Factors Associated With Long COVID Symptoms in an Online Cohort Study

Matthew S Durstenfeld; Michael J Peluso; Noah D Peyser; Feng Lin; Sara J Knight; Audrey Djibo; Rasha Khatib; Heather Kitzman; Emily O'Brien; Natasha Williams; Carmen Isasi; John Kornak; Thomas W Carton; Jeffrey E Olgin; Mark J Pletcher; Gregory M Marcus; Alexis L Beatty

doi:10.1093/ofid/ofad047

Factors Associated With Long COVID Symptoms in an Online Cohort Study

Open Forum Infect Dis. 2023 Feb 1;10(2):ofad047. doi: 10.1093/ofid/ofad047. eCollection 2023 Feb.

Authors

Matthew S Durstenfeld¹, Michael J Peluso², Noah D Peyser³, Feng Lin⁴, Sara J Knight⁵, Audrey Djibo⁶, Rasha Khatib⁷, Heather Kitzman⁸, Emily O'Brien⁹, Natasha Williams¹⁰, Carmen Isasi¹¹, John Kornak⁴, Thomas W Carton¹², Jeffrey E Olgin³, Mark J Pletcher⁴, Gregory M Marcus³, Alexis L Beatty^{3

4}

Affiliations

¹ Division of Cardiology at ZSFG, and Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
² Division of HIV, Infectious Disease, Global Medicine, University of California, San Francisco, San Francisco, California, USA.
³ Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
⁴ Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.
⁵ Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA.
⁶ CVS Health Clinical Trial Services, Blue Bell, Pennsylvania, USA.
⁷ Advocate Aurora Research Institute, Milwaukee, Wisconsin, USA.
⁸ Baylor Scott and White Health and Wellness Center, Dallas, Texas, USA.
⁹ Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
¹⁰ Institute for Excellence in Health Equity, Center for Healthful Behavior Change, NYU Grossman School of Medicine, New York, New York, USA.
¹¹ Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
¹² Louisiana Public Health Institute, New Orleans, Louisiana, USA.

Abstract

Background: Few prospective studies of Long COVID risk factors have been conducted. The purpose of this study was to determine whether sociodemographic factors, lifestyle, or medical history preceding COVID-19 or characteristics of acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are associated with Long COVID.

Methods: In March 26, 2020, the COVID-19 Citizen Science study, an online cohort study, began enrolling participants with longitudinal assessment of symptoms before, during, and after SARS-CoV-2 infection. Adult participants who reported a positive SARS-CoV-2 test result before April 4, 2022 were surveyed for Long COVID symptoms. The primary outcome was at least 1 prevalent Long COVID symptom greater than 1 month after acute infection. Exposures of interest included age, sex, race/ethnicity, education, employment, socioeconomic status/financial insecurity, self-reported medical history, vaccination status, variant wave, number of acute symptoms, pre-COVID depression, anxiety, alcohol and drug use, sleep, and exercise.

Results: Of 13 305 participants who reported a SARS-CoV-2 positive test, 1480 (11.1%) responded. Respondents' mean age was 53 and 1017 (69%) were female. Four hundred seventy-six (32.2%) participants reported Long COVID symptoms at a median 360 days after infection. In multivariable models, number of acute symptoms (odds ratio [OR], 1.30 per symptom; 95% confidence interval [CI], 1.20-1.40), lower socioeconomic status/financial insecurity (OR, 1.62; 95% CI, 1.02-2.63), preinfection depression (OR, 1.08; 95% CI, 1.01-1.16), and earlier variants (OR = 0.37 for Omicron compared with ancestral strain; 95% CI, 0.15-0.90) were associated with Long COVID symptoms.

Conclusions: Variant wave, severity of acute infection, lower socioeconomic status, and pre-existing depression are associated with Long COVID symptoms.

Keywords: COVID-19; Post-Acute Sequelae of SARS-CoV-2 (PASC); SARS-CoV-2; long COVID; patient-reported outcomes.

Abstract

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