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Multicenter Study
. 2023 Mar 7:9:e42315.
doi: 10.2196/42315.

Epidemiology, Symptomatology, and Risk Factors for Long COVID Symptoms: Population-Based, Multicenter Study

Martin Chi-Sang Wong #  1   2   3   4 , Junjie Huang #  1   2 , Yuet-Yan Wong  1 , Grace Lai-Hung Wong  5   6   7 , Terry Cheuk-Fung Yip  5   6   7 , Rachel Ngan-Yin Chan  8 , Steven Wai-Ho Chau  8 , Siew-Chien Ng  5   7 , Yun-Kwok Wing  8 , Francis Ka-Leung Chan  5   7
Affiliations
Multicenter Study

Epidemiology, Symptomatology, and Risk Factors for Long COVID Symptoms: Population-Based, Multicenter Study

Martin Chi-Sang Wong et al. JMIR Public Health Surveill. .

Abstract

Background: Long COVID induces a substantial global burden of disease. The pathogenesis, complications, and epidemiological and clinical characteristics of patients with COVID-19 in the acute phase have been evaluated, while few studies have characterized the epidemiology, symptomatology, and risk factors of long COVID symptoms. Its characteristics among patients with COVID-19 in the general population remain unaddressed.

Objective: We examined the prevalence of long COVID symptoms, its symptom patterns, and its risk factors in 4 major Chinese cities in order to fill the knowledge gap.

Methods: We performed a population-based, multicenter survey using a representative sampling strategy via the Qualtrics platform in Beijing, Shanghai, Guangzhou, and Hong Kong in June 2022. We included 2712 community-dwelling patients with COVID-19 and measured the prevalence of long COVID symptoms defined by the World Health Organization (WHO), and their risk factors. The primary outcomes were the symptoms of long COVID, with various levels of impact. A descriptive analysis of the prevalence and distribution of long COVID symptoms according to disease severity was conducted. A sensitivity analysis of increasing the number of long COVID symptoms was also conducted. Univariate and multivariate regression analyses were performed to examine the risk factors of severe long COVID symptoms, including age, gender, marital status, current occupation, educational level, living status, smoking habits, monthly household income, self-perceived health status, the presence of chronic diseases, the use of chronic medication, COVID-19 vaccination status, and the severity of COVID-19.

Results: The response rate was 63.6% (n=2712). The prevalence of long COVID, moderate or severe long COVID, and severe long COVID was 90.4% (n=2452), 62.4% (n=1692), and 31.0% (n=841), respectively. Fatigue (n=914, 33.7%), cough (n=865, 31.9%), sore throat (n=841, 31.0%), difficulty in concentrating (n=828, 30.5%), feeling of anxiety (n=817, 30.2%), myalgia (n=811, 29.9%), and arthralgia (n=811, 29.9%) were the most common severe long COVID symptoms. From multivariate regression analysis, female gender (adjusted odds ratio [aOR]=1.49, 95% CI 1.13-1.95); engagement in transportation, logistics, or the discipline workforce (aOR=2.52, 95% CI 1.58-4.03); living with domestic workers (aOR=2.37, 95% CI 1.39-4.03); smoking (aOR=1.55, 95% CI 1.17-2.05); poor or very poor self-perceived health status (aOR=15.4, 95% CI 7.88-30.00); ≥3 chronic diseases (aOR=2.71, 95% CI 1.54-4.79); chronic medication use (aOR=4.38, 95% CI 1.66-11.53); and critical severity of COVID-19 (aOR=1.52, 95% CI 1.07-2.15) were associated with severe long COVID. Prior vaccination with ≥2 doses of COVID-19 vaccines was a protective factor (aOR=0.35-0.22, 95% CI 0.08-0.90).

Conclusions: We examined the prevalence of long COVID symptoms in 4 Chinese cities according to the severity of COVID-19. We also evaluated the pattern of long COVID symptoms and their risk factors. These findings may inform early identification of patients with COVID-19 at risk of long COVID and planning of rehabilitative services.

Keywords: COVID-19; epidemiology; general population; long COVID; multicenter survey; risk factor; symptom.

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Conflict of interest statement

Conflicts of Interest: S-CN and FK-LC are scientific cofounders of Geniebiome Ltd.

Figures

Figure 1
Figure 1
Distribution of long COVID symptoms. The highest proportion of respondents suffered from fatigue (n=914, 33.7%), cough (n=865, 31.9%), sore throat (n=841, 31.0%), difficulty in concentrating (n=828, 30.5%), feeling of anxiety (n=817, 30.2%), myalgia (n=811, 29.9%), arthralgia (n=811, 29.9%), sputum production (n=789, 29.4%), and difficulty in falling asleep (n=792, 29.2%).
Figure 2
Figure 2
The prevalence of having long COVID symptoms of any severity, moderate or high severity, and high severity was 90.4% (n=2452), 62.4% (n=1692), and 31.0% (n=841), respectively. The symptoms were qualified in terms of self-perceived severity, and sensitivity analysis of using more than 1 symptom showed a better estimate of long COVID syndrome/disorder.
Figure 3
Figure 3
Prevalence of long COVID with severity. These prevalence figures were the highest in Hong Kong (n=541, 97.7%, n=385, 69.5%, and n=194, 35.0%, respectively) and Shanghai (n=662, 92.2%, n=461, 64.2%, and n=287, 40.0%, respectively), followed by Guangzhou (n=630, 88.1%, n=451, 63.1%, and n=212, 29.7%, respectively) and Beijing (n=619, 85.4%, n=395, 54.5%, and n=148, 20.4%, respectively).
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