Long-term post-acute sequelae of COVID-19 infection: a retrospective, multi-database cohort study in Hong Kong and the UK

Ivan Chun Hang Lam; Carlos King Ho Wong; Ran Zhang; Celine Sze Ling Chui; Francisco Tsz Tsun Lai; Xue Li; Esther Wai Yin Chan; Hao Luo; Qingpeng Zhang; Kenneth Keng Cheung Man; Bernard Man Yung Cheung; Sydney Chi Wai Tang; Chak Sing Lau; Eric Yuk Fai Wan; Ian Chi Kei Wong

doi:10.1016/j.eclinm.2023.102000

Long-term post-acute sequelae of COVID-19 infection: a retrospective, multi-database cohort study in Hong Kong and the UK

EClinicalMedicine. 2023 Jun:60:102000. doi: 10.1016/j.eclinm.2023.102000. Epub 2023 May 11.

Authors

Ivan Chun Hang Lam¹, Carlos King Ho Wong^{1

2

3}, Ran Zhang², Celine Sze Ling Chui^{3

4

5}, Francisco Tsz Tsun Lai^{1

3}, Xue Li^{1

3

6}, Esther Wai Yin Chan^{1

3

7

8}, Hao Luo^{9

10

11}, Qingpeng Zhang¹², Kenneth Keng Cheung Man^{1

3

13

14}, Bernard Man Yung Cheung^{6

15}, Sydney Chi Wai Tang¹⁶, Chak Sing Lau¹⁷, Eric Yuk Fai Wan^{1

2

3}, Ian Chi Kei Wong^{1

3

18}

Affiliations

¹ Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
² Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
³ Laboratory of Data Discovery for Health (D4H), Hong Kong Science and Technology Park, Sha Tin, Hong Kong SAR, China.
⁴ School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong SAR, Hong Kong, China.
⁵ School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
⁶ Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
⁷ Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
⁸ The University of Hong Kong Shenzhen Institute of Research and Innovation, Hong Kong SAR, China.
⁹ Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China.
¹⁰ The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong SAR, China.
¹¹ Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China.
¹² School of Data Science, City University of Hong Kong, Hong Kong SAR, China.
¹³ Research Department of Practice and Policy, School of Pharmacy, University College London, United Kingdom.
¹⁴ Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
¹⁵ Research Centre of Heart, Brain, Hormone and Healthy Aging, The University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong, China.
¹⁶ Division of Nephrology, Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
¹⁷ Division of Rheumatology and Clinical Immunology, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
¹⁸ Aston Pharmacy School, Aston University, Birmingham, United Kingdom.

Abstract

Background: Evidence on post-acute sequelae of SARS-CoV-2 (PASC) has shown inconsistent findings. This study aimed to generate coherent evidence on the post-acute sequelae of COVID-19 infection using electronic healthcare records across two regions.

Methods: In this retrospective, multi-database cohort study, patients with COVID-19 aged 18 or above between April 1st 2020 and May 31st 2022 from the Hong Kong Hospital Authority (HKHA) and March 16th 2020 and May 31st 2021 from the UK Biobank (UKB) databases and their matched controls were followed for up to 28 and 17 months, respectively. Covariates between patients with COVID-19 and non-COVID-19 controls were adjusted using propensity score-based inverse probability treatment weighting. Cox proportional regression was used to estimate the hazard ratio (HR) of clinical sequelae, cardiovascular, and all-cause mortality 21 days after COVID-19 infection.

Findings: A total of 535,186 and 16,400 patients were diagnosed with COVID-19 from HKHA and UKB, of whom 253,872 (47.4%) and 7613 (46.4%) were male, with a mean age (±SD) of 53.6 (17.8) years and 65.0 (8.5) years, respectively. Patients with COVID-19 incurred greater risk of heart failure (HR 1.82; 95% CI 1.65, 2.01), atrial fibrillation (1.31; 1.16, 1.48), coronary artery disease (1.32; 1.07, 1.63), deep vein thrombosis (1.74; 1.27, 2.37), chronic pulmonary disease (1.61; 1.40, 1.85), acute respiratory distress syndrome (1.89; 1.04, 3.43), interstitial lung disease (3.91; 2.36, 6.50), seizure (2.32; 1.12, 4.79), anxiety disorder (1.65; 1.29, 2.09), post-traumatic stress disorder (1.52; 1.23, 1.87), end-stage renal disease (1.76; 1.31, 2.38), acute kidney injury (2.14; 1.69, 2.71), pancreatitis (1.42; 1.10, 1.83), cardiovascular (2.86; 1.25, 6.51) and all-cause mortality (4.16; 2.11, 8.21) mortality during their post-acute phase of infection.

Interpretation: The consistent greater risk of PASC highlighted the need for sustained multi-disciplinary care for COVID-19 survivors.

Funding: Health Bureau, The Government of the Hong Kong Special Administrative Region, Collaborative Research Fund, The Government of the Hong Kong Special Administrative Region and AIR@InnoHK, administered by the Innovation and Technology Commission, The Government of the Hong Kong Special Administrative Region.

Keywords: COVID-19; PASC; Post-acute sequelae of SARS-CoV-2; SARS-CoV-2.