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. 2022 Aug 9:12:05029.
doi: 10.7189/jogh.12.05029.

Clinical, sociodemographic and environmental factors impact post-COVID-19 syndrome

Juliana Carvalho Ferreira  1   2 , Tiana C Lopes Moreira #  3 , Adriana Ladeira de Araújo #  4 , Marta Imamura  5 , Rodolfo F Damiano  6 , Michelle L Garcia  1 , Marcio Vy Sawamura  7 , Fabio R Pinna  8 , Bruno F Guedes  9 , Fabio A Rodrigues Gonçalves  10 , Marcio Mancini  11 , Emmanuel A Burdmann  12 , Demóstenes Ferreira da Silva Filho  13 , Jefferson Lordello Polizel  14 , Ricardo F Bento  8   15 , Vanderson Rocha  16 , Ricardo Nitrini  9 , Heraldo Possolo de Souza  17 , Anna S Levin  18 , Esper G Kallas  18 , Orestes V Forlenza  19 , Geraldo F Busatto  4   6 , Linamara R Batistella  5 , Carlos R Ribeiro de Carvalho  1 , Thais Mauad #  3 , Nelson Gouveia #  20 ; HCFMUSP COVID-19 Study Group
Collaborators, Affiliations

Clinical, sociodemographic and environmental factors impact post-COVID-19 syndrome

Juliana Carvalho Ferreira et al. J Glob Health. .

Abstract

Background: Sociodemographic and environmental factors are associated with incidence, severity, and mortality of COVID-19. However, little is known about the role of such factors in persisting symptoms among recovering patients. We designed a cohort study of hospitalized COVID-19 survivors to describe persistent symptoms and identify factors associated with post-COVID-19 syndrome.

Methods: We included patients hospitalized between March to August 2020 who were alive six months after hospitalization. We collected individual and clinical characteristics during hospitalization and at follow-up assessed ten symptoms with standardized scales, 19 yes/no symptoms, a functional status and a quality-of-life scale and performed four clinical tests. We examined individual exposure to greenspace and air pollution and considered neighbourhood´s population density and socioeconomic conditions as contextual factors in multilevel regression analysis.

Results: We included 749 patients with a median follow-up of 200 (IQR = 185-235) days, and 618 (83%) had at least one of the ten symptoms measured with scales. Pain (41%), fatigue (38%) and posttraumatic stress disorder (35%) were the most frequent. COVID-19 severity, comorbidities, BMI, female sex, younger age, and low socioeconomic position were associated with different symptoms. Exposure to ambient air pollution was associated with higher dyspnoea and fatigue scores and lower functional status.

Conclusions: We identified a high frequency of persistent symptoms among COVID-19 survivors that were associated with clinical, sociodemographic, and environmental variables. These findings indicate that most patients recovering from COVID-19 will need post-discharge care, and an additional burden to health care systems, especially in LMICs, should be expected.

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Conflict of interest statement

Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and declare the following activities and relationships: Dr Ferreira received speaker fees from Medtronic, outside of the submitted work. Dr Burdmann received speaker fees from AstraZeneca and Fresenius, outside of the submitted work. Dr Guedes holds stock in Fleury Ltd, a clinical analysis laboratory, which is not the provider of tests for this study.

Figures

Figure 1
Figure 1
Study participant flow. Legend: Flow of potentially eligible participants in the study, and final numbers included and analysed.
Figure 2
Figure 2
Patients place of residence, sociodemographic and environmental characteristics of the Sao Paulo Metropolitan Region. Legend: Maps of the Sao Paulo Metropolitan Region, comprising 39 municipalities and where approximately 23 million people live. a) green dots represent the origin (residency) of each participant. The red line represents the borders of the city of Sao Paulo; b) population density in each neighbourhood; c) the average per capita income of the neighbourhoods; d) the distribution of greenspace; e) air pollution levels.
See this image and copyright information in PMC

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