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. 2024 Jun 4;24(1):557.
doi: 10.1186/s12879-024-09450-6.

COVID-19 and long-term impact on symptoms and Health-Related Quality of Life in Costa Rica: the RESPIRA cohort study

Cristina Barboza-Solis  1 , Romain Fantin  2 , Allan Hildesheim  2 , Ruth Pfeiffer  3 , Carolina Porras  2 , Julia Butt  4 , Tim Waterboer  4 , Henriette Raventós  5   6 , Arturo Abdelnour  7 , Amada Aparicio  7 , Viviana Loria  2 , D Rebecca Prevots  8 , Mitchell H Gail  3   9 , Rolando Herrero  2 ; RESPIRA Study Group
Collaborators, Affiliations

COVID-19 and long-term impact on symptoms and Health-Related Quality of Life in Costa Rica: the RESPIRA cohort study

Cristina Barboza-Solis et al. BMC Infect Dis. .

Abstract

Background: Evidence continues to accumulate regarding the potential long-term health consequences of COVID-19 in the population. To distinguish between COVID-19-related symptoms and health limitations from those caused by other conditions, it is essential to compare cases with community controls using prospective data ensuring case-control status. The RESPIRA study addresses this need by investigating the lasting impact of COVID-19 on Health-related Quality of Life (HRQoL) and symptomatology in a population-based cohort in Costa Rica, thereby providing a robust framework for controlling HRQoL and symptoms.

Methods: The study comprised 641 PCR-confirmed, unvaccinated cases of COVID-19 and 947 matched population-based controls. Infection was confirmed using antibody tests on enrollment serum samples and symptoms were monitored monthly for 6 months post-enrolment. Administered at the 6-month visit (occurring between 6- and 2-months post-diagnosis for cases and 6 months after enrollment for controls), HRQoL and Self-Perceived Health Change were assessed using the SF-36, while brain fog, using three items from the Mental Health Inventory (MHI). Regression models were utilized to analyze SF-36, MHI scores, and Self-Perceived Health Change, adjusted for case/control status, severity (mild case, moderate case, hospitalized) and additional independent variables. Sensitivity analyses confirmed the robustness of the findings.

Results: Cases showed significantly higher prevalences of joint pain, chest tightness, and skin manifestations, that stabilized at higher frequencies from the fourth month post-diagnosis onwards (2.0%, 1.2%, and 0.8% respectively) compared to controls (0.9%, 0.4%, 0.2% respectively). Cases also exhibited significantly lower HRQoL than controls across all dimensions in the fully adjusted model, with a 12.4 percentage-point difference [95%CI: 9.4-14.6], in self-reported health compared to one year prior. Cases reported 8.0% [95%CI: 4.2, 11.5] more physical limitations, 7.3% [95%CI: 3.5, 10.5] increased lack of vitality, and 6.0% [95%CI: 2.4, 9.0] more brain fog compared to controls with similar characteristics. Undiagnosed cases detected with antibody tests among controls had HRQoL comparable to antibody negative controls. Differences were more pronounced in individuals with moderate or severe disease and among women.

Conclusions: PCR-confirmed unvaccinated cases experienced prolonged HRQoL reductions 6 months to 2 years after diagnosis, this was particularly the case in severe cases and among women. Mildly symptomatic cases showed no significant long-term sequelae.

Keywords: Cohort study; Costa Rica; HRQoL; Health-Related Quality of Life; Middle-Income Country; PASC; PCC; Post-Acute Sequelae of SARS-CoV-2; Post-COVID Conditions; symptoms.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study schematic
Fig. 2
Fig. 2
Flow-chart of the study (N=1583)
Fig. 3
Fig. 3
Percentage of cases and controls who declared symptoms since their last visit, according to time since diagnosis (in cases) and on average (in controls). Interpretation: On average, at two months after diagnosis, cases reported symptoms since their last visit in 20.1% of the visits. In contrast, controls reported symptoms in 11.3% of all visits during the study period
See this image and copyright information in PMC

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