Long COVID-19 Risk Linked to Women, Older Age, Higher BMI

Vasiliki Tsampasian, MD, MSc

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Post-COVID-19 condition, or “long COVID-19,” is more commonly associated with female sex, older age and clinical characteristics including cigarette use and body mass index (BMI), according to new data.¹

In a new systematic review and meta-analysis from a team of UK-based investigators, demographic and clinical characteristics were associated with increased risk of developing the long-term condition after SARS-CoV-2 infection and recovery. The could help elucidate individual risk of post-COVID-19 conditions and better prioritize such patients to timely screening and treatment strategies.

Led by Vasiliki Tsampasian, MD, MSc, of the department of cardiology at Norfolk and Norwich University Hospital, investigators conducted an assessment to identify clinical and epidemiologic risk factors linked to the development of long COVID-19 via available literature. They stressed the impact of interpreting individual risk not only to optimize follow-up care strategies, but to provide more refined public health measures in the long-term management of the pandemic.

“The World Health Organization (WHO) defined post−COVID-19 condition as having symptoms usually 3 months from the onset of COVID-19 with a duration of at least 2 months,” investigators wrote. “Typical clinical symptoms include dyspnea, fatigue, autonomic dysfunction, headache, and persistent loss of smell and/or taste—although a wide range of symptoms has been described. Given that individuals with post-COVID-19 condition may need long-term clinical support, the economic consequences have been estimated to be substantial.”

Tsampasian and colleagues conducted their meta-analysis using all published trials that assessed risk factors and predictors of long COVID-19 among adult patients ≥18 years old. They synthesized data to generate odds ratios (ORs) for each determined risk factor from the trial data. Selected risk factors included patient age, sex, BMI, smoking status, previous hospitalization or intensive care unit (ICU) admission due to COVID-19, COVID-19 vaccination status, and comorbidities including the following:

• Anxiety and/or depression
• Asthma
• Chronic kidney disease (CKD)
• COPD
• Diabetes
• Immunosuppression
• Ischemic heart disease

Their final assessment included 41 published studies including 860,783 patients who met inclusion criteria.

Female sex was associated with a 56% increased risk of post-COVID-19 condition (OR, 1.56; 95% CI, 1.41 – 1.73). When comparing 3 age groups—18-40 years, 40-69 years and ≥70 years—investigators observed the 2 older groups had significantly greater risk of post-COVID-19 condition as well (OR, 1.21; 95% CI, 1.11 – 1.33).

Patients with high BMI (≥30) defining obesity were additionally at significant risk of long COVID-19 (OR, 1.15; 95% CI, 1.08 – 1.23), as was current smoking status (OR, 1.10; 95% CI, 1.07 – 1.13).

Patients who were previously hospitalized due to COVID-19 were associated with the greatest risk of long COVID-19 development relative to all observed factors (OR, 2.48; 95% CI, 1.97 – 3.13). A further meta-analysis showed patients who required ICU admission during acute infection were at a similar risk (OR, 2.37; 95% CI, 2.18 – 2.56).

All but 1 of the clinical comorbidities were linked to an increased risk of long COVID-19; the highest-risk comorbidities included immunosuppression, COPD, and ischemic heart disease. The odds ratios for each comorbidities were as follows:

• Anxiety and/or depression (OR, 1.19; 95% CI, 1.02 – 1.40)
• Asthma (OR, 1.24; 95% CI, 1.15 – 1.35)
• CKD (OR, 1.12; 95% CI, 0.98 – 1.28)
• COPD (OR, 1.38; 95% CI, 1.08 – 1.78)
• Diabetes (OR, 1.06; 95% CI, 1.03 – 1.09)
• Immunosuppression (OR, 1.50; 95% CI, 1.05 – 2.15)
• Ischemic heart disease (OR, 1.28; 95% CI, 1.19 – 1.38)

Patients who had received 2 doses of a COVID-19 vaccine had a 43% reduced risk of developing post-COVID-19 condition than those who had not (OR, 0.57; 95% CI, 0.43 – 0.76).

In reviewing the data, Tsampasian and colleagues noted the findings confirm post-COVID-19 condition to be a “complex clinical syndrome.”

“Individuals with PCC may experience long-lasting adverse effects requiring long-lasting support. It has been reported that 15% of individuals with post-COVID-19 condition were absent from work owing to illness,” investigators wrote. “Follow-up outpatient services may be needed to manage this condition and to better understand the possible association between symptoms and residual organ impairment.”

The team concluded a holistic approach supported by integrated care pathways may improve the support available for patients with long COVID-19, as well as enable physicians to better prepare to manage patients at higher risk of long COVID-19 development.

“Moreover, in addition to preventing and diminishing the acute phase of the infection, COVID-19 vaccination may protect against post-COVID-19 , giving vaccination additional evidence of benefit,” they wrote.

References

1. ^{Tsampasian V, Elghazaly H, Chattopadhyay R, et al. Risk Factors Associated With Post−COVID-19 Condition: A Systematic Review and Meta-analysis. JAMA Intern Med. Published online March 23, 2023. doi:10.1001/jamainternmed.2023.0750}