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. 2023 Feb 1;10(2):ofad047.
doi: 10.1093/ofid/ofad047. eCollection 2023 Feb.

Factors Associated With Long COVID Symptoms in an Online Cohort Study

Matthew S Durstenfeld  1 , Michael J Peluso  2 , Noah D Peyser  3 , Feng Lin  4 , Sara J Knight  5 , Audrey Djibo  6 , Rasha Khatib  7 , Heather Kitzman  8 , Emily O'Brien  9 , Natasha Williams  10 , Carmen Isasi  11 , John Kornak  4 , Thomas W Carton  12 , Jeffrey E Olgin  3 , Mark J Pletcher  4 , Gregory M Marcus  3 , Alexis L Beatty  3   4
Affiliations

Factors Associated With Long COVID Symptoms in an Online Cohort Study

Matthew S Durstenfeld et al. Open Forum Infect Dis. .

Abstract

Background: Few prospective studies of Long COVID risk factors have been conducted. The purpose of this study was to determine whether sociodemographic factors, lifestyle, or medical history preceding COVID-19 or characteristics of acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are associated with Long COVID.

Methods: In March 26, 2020, the COVID-19 Citizen Science study, an online cohort study, began enrolling participants with longitudinal assessment of symptoms before, during, and after SARS-CoV-2 infection. Adult participants who reported a positive SARS-CoV-2 test result before April 4, 2022 were surveyed for Long COVID symptoms. The primary outcome was at least 1 prevalent Long COVID symptom greater than 1 month after acute infection. Exposures of interest included age, sex, race/ethnicity, education, employment, socioeconomic status/financial insecurity, self-reported medical history, vaccination status, variant wave, number of acute symptoms, pre-COVID depression, anxiety, alcohol and drug use, sleep, and exercise.

Results: Of 13 305 participants who reported a SARS-CoV-2 positive test, 1480 (11.1%) responded. Respondents' mean age was 53 and 1017 (69%) were female. Four hundred seventy-six (32.2%) participants reported Long COVID symptoms at a median 360 days after infection. In multivariable models, number of acute symptoms (odds ratio [OR], 1.30 per symptom; 95% confidence interval [CI], 1.20-1.40), lower socioeconomic status/financial insecurity (OR, 1.62; 95% CI, 1.02-2.63), preinfection depression (OR, 1.08; 95% CI, 1.01-1.16), and earlier variants (OR = 0.37 for Omicron compared with ancestral strain; 95% CI, 0.15-0.90) were associated with Long COVID symptoms.

Conclusions: Variant wave, severity of acute infection, lower socioeconomic status, and pre-existing depression are associated with Long COVID symptoms.

Keywords: COVID-19; Post-Acute Sequelae of SARS-CoV-2 (PASC); SARS-CoV-2; long COVID; patient-reported outcomes.

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Conflict of interest statement

Potential conflicts of interest. MJPe has received consulting fees from Gilead Sciences and AstraZeneca and serves on a data safety monitoring board for American Gene Technologies. AD is employed by CVS Health. EO has received research funding to their institution from Pfizer. HK is a consultant for Novo Nordisk. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Patient-reported symptoms of Long COVID among people reporting symptoms at least 1 month after COVID-19 (N = 476). Numbers to the right of bars represent number of participants reporting that symptom. Participants could report more than 1 symptom. Number and proportion with each symptom.
Figure 2.
Figure 2.
Average number of symptoms and proportion with symptoms on the weekly/daily surveys during each time period. We found higher proportions with symptoms and a higher number of symptoms reported among those with Long COVID. Of note, symptoms queried on the daily/weekly surveys included whether participants had 1 or more of the following: a scratchy throat, a painful sore throat, a cough, a runny nose, symptoms of fever or chills, a temperature >100.4°F or 38.0°C, muscle aches, nausea, vomiting, or diarrhea, shortness of breath, unable to taste or smell, and red or painful eyes. These symptoms are more typical during acute infection so some individuals with Long COVID did not have any of these symptoms but still reported Long COVID symptoms.
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Update of

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