Prevalence and risk factors for persistent symptoms after COVID-19: a systematic review and meta-analysis

Abstract

Background: Long-term physical and mental persistent symptoms after COVID-19 represent a growing global public health concern. However, there remains a substantial knowledge gap regarding their prevalence and risk factors.

Objectives: To estimate the prevalence and risk factors for persistent symptoms after COVID-19.

Methods of data synthesis: We used a random-effects model to pool persistent symptom prevalence and risk ratios comparing COVID-19 patients with non-COVID-19 individuals.

Data sources: Electronic databases were searched for studies published from December 2019 to January 2023.

Study eligibility criteria: Eligible studies that reported the prevalence and risk factors for persistent symptoms after COVID-19 were included.

Participants: Patients who recovered from COVID-19.

Assessment of risk of bias: The Joanna Briggs Institute critical appraisal tool was used to assess the risk of bias in prevalence studies, whereas the risk of bias in cohort studies was evaluated with the Newcastle-Ottawa Scale.

Results: After screening 4359 studies, a total of 211 eligible studies were included, covering a population of 13 368 074 individuals. Fatigue, dyspnoea, post-traumatic stress disorder, anxiety, and depression were the most frequently reported persistent symptoms after COVID-19. Subgroup analyses revealed that individuals with more severe illness in the acute phase or from Europe exhibited a higher prevalence of certain symptoms, whereas children demonstrated a lower prevalence. Furthermore, COVID-19 patients had a significantly higher prevalence of most persistent symptoms compared with non-COVID-19 individuals. Factors frequently associated with a higher prevalence of persistent symptoms included female gender, advanced age, severe illness during the acute phase of COVID-19, multiple comorbidities, an extended duration of hospital stay, and a high body mass index.

Conclusion: This meta-analysis provides a thorough review of the prevalence and risk factors for persistent symptoms following COVID-19. The findings underscore the importance of long-term monitoring and support for individuals recovering from COVID-19.

Keywords: COVID-19; Long COVID; Post-COVID-19 sequelae; Post-COVID-19 symptoms; Prevalence; Risk factors; Systematic review.