Development of New Mental and Physical Health Sequelae among US Veterans after COVID-19

Abstract

Background:COVID-19 sequelae among veterans need evaluation. Design: Propensity-score-matched retrospective cohort study. Participants: A total 778,738 veterans, who were tested for COVID-19 at VA facilities between 20 February 2020−27 March 2021. Main Outcomes: Development of new physical and mental health conditions (incidence) during the follow-up period of 7 days to 3 months after the diagnosis of COVID-19. Results: Out of 778,738 veterans, 149,205 (19.2%) were inpatients and 629,533 (80.8%) were outpatients. 123,757 (15.9%) diagnosed with COVID-19. Mean age was 61 ± 15.4, mostly men (89%) who were White (68%) and non-Hispanic (88%). In hospitalized patients, COVID-19 is associated with significantly higher incidences of physical conditions (venous thromboembolism (5.8% vs. 2.9%, p < 0.001), pulmonary circulation disorder (5.1% vs. 2.9%, p < 0.001), chronic lung disease (8.4% vs. 4.3%, p < 0.001), acute kidney injury (16.4% vs. 9.3%, p < 0.001), chronic kidney disease (6.5% vs. 4.8%, p < 0.001), cardiac arrhythmia (15.2% vs. 10.9%, p < 0.001), complicated hypertension (12% vs. 8.5%, p < 0.001), coagulopathy (6.1% vs. 2.6%, p < 0.001), fluid/electrolyte disorders (24.4% vs. 12.6%, p < 0.001) and neurological disorders (7.1% vs. 3.8%, p < 0.001)) and mental health conditions (depressive episode (6.6% vs. 4.3%, p < 0.001), adjustment disorder (2.5% vs. 1.7%, p < 0.001), insomnia (4.9% vs. 3.2%, p < 0.001) and dementia (3.0% vs. 1.9%, p < 0.001)) compared to propensity-matched hospitalized COVID-19 negative patients. In outpatient settings, COVID-19 diagnosis is associated with smaller increase in the incidences of the physical sequelae. Conclusions: In this propensity-score-matched analysis of US veterans, COVID-19 survivors, especially those who were hospitalized, developed new physical and mental health sequelae at a significantly higher rate than those without COVID-19.

Keywords: COVID-19; mental sequelae; physical sequelae; veterans.

Figure 1

Flowchart.

Figure 2

Likelihood of development of new physical and mental health conditions in COVID-19-positive patients compared to COVID-19-negative patients. The figure (a) represents the odds ratio for the development of new physical and mental health conditions among propensity-score-matched hospitalized COVID-19 positive patients versus hospitalized COVID-19-negative patients during the follow-up period of 7 days to 3 months of diagnosis. For example—COVID-19-positive patients are 1.4 times (OR: 1.4, 95% CI 1.2–1.6) more likely to develop chronic kidney disease than COVID-19-negative patients during the follow-up period of 7 days to 3 months of diagnosis. The figure (b) represents the odds ratio for the development of new physical and mental health conditions among matched outpatient COVID-19-positive patients versus outpatient COVID-19-negative patients.