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. 2023 Mar 3;4(3):e230010.
doi: 10.1001/jamahealthforum.2023.0010.

One-Year Adverse Outcomes Among US Adults With Post-COVID-19 Condition vs Those Without COVID-19 in a Large Commercial Insurance Database

Andrea DeVries  1 , Sonali Shambhu  1 , Sue Sloop  1 , J Marc Overhage  1
Affiliations

One-Year Adverse Outcomes Among US Adults With Post-COVID-19 Condition vs Those Without COVID-19 in a Large Commercial Insurance Database

Andrea DeVries et al. JAMA Health Forum. .

Erratum in

  • Error in Study Type.
    [No authors listed] [No authors listed] JAMA Health Forum. 2023 Jul 7;4(7):e232428. doi: 10.1001/jamahealthforum.2023.2428. JAMA Health Forum. 2023. PMID: 37505492 Free PMC article. No abstract available.

Abstract

Importance: Many individuals experience ongoing symptoms following the onset of COVID-19, characterized as postacute sequelae of SARS-CoV-2 or post-COVID-19 condition (PCC). Less is known about the long-term outcomes for these individuals.

Objective: To quantify 1-year outcomes among individuals meeting a PCC definition compared with a control group of individuals without COVID-19.

Design, setting, and participants: This case-control study with a propensity score-matched control group included members of commercial health plans and used national insurance claims data enhanced with laboratory results and mortality data from the Social Security Administration's Death Master File and Datavant Flatiron data. The study sample consisted of adults meeting a claims-based definition for PCC with a 2:1 matched control cohort of individuals with no evidence of COVID-19 during the time period of April 1, 2020, to July 31, 2021.

Exposures: Individuals experiencing postacute sequelae of SARS-CoV-2 using a Centers for Disease Control and Prevention-based definition.

Main outcomes and measures: Adverse outcomes, including cardiovascular and respiratory outcomes and mortality, for individuals with PCC and controls assessed over a 12-month period.

Results: The study population included 13 435 individuals with PCC and 26 870 individuals with no evidence of COVID-19 (mean [SD] age, 51 [15.1] years; 58.4% female). During follow-up, the PCC cohort experienced increased health care utilization for a wide range of adverse outcomes: cardiac arrhythmias (relative risk [RR], 2.35; 95% CI, 2.26-2.45), pulmonary embolism (RR, 3.64; 95% CI, 3.23-3.92), ischemic stroke (RR, 2.17; 95% CI, 1.98-2.52), coronary artery disease (RR, 1.78; 95% CI, 1.70-1.88), heart failure (RR, 1.97; 95% CI, 1.84-2.10), chronic obstructive pulmonary disease (RR, 1.94; 95% CI, 1.88-2.00), and asthma (RR, 1.95; 95% CI, 1.86-2.03). The PCC cohort also experienced increased mortality, as 2.8% of individuals with PCC vs 1.2% of controls died, implying an excess death rate of 16.4 per 1000 individuals.

Conclusions and relevance: This case-control study leveraged a large commercial insurance database and found increased rates of adverse outcomes over a 1-year period for a PCC cohort surviving the acute phase of illness. The results indicate a need for continued monitoring for at-risk individuals, particularly in the area of cardiovascular and pulmonary management.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Sample Construction
The sample construction diagram shows inclusion and exclusion criteria for assembly of the sample of individuals with post–COVID-19 condition (PCC) and matched controls without COVID-19. BMI indicates body mass index (calculated as weight in kilograms divided by height in meters squared); ER, emergency room.
Figure 2.
Figure 2.. Twelve-Month Mortality Among Individuals With Post–COVID-19 Condition vs Those Without COVID-19
The 12-month mortality for individuals with post–COVID-19 condition was substantially higher than in matched controls without COVID-19.
See this image and copyright information in PMC

Comment in

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