Chronic Lung Disease as a Risk Factor for Long COVID in Patients Diagnosed With Coronavirus Disease 2019: A Retrospective Cohort Study

Abstract

Background: Patients with coronavirus disease 2019 (COVID-19) often experience persistent symptoms, known as postacute sequelae of COVID-19 or long COVID, after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Chronic lung disease (CLD) has been identified in small-scale studies as a potential risk factor for long COVID.

Methods: This large-scale retrospective cohort study using the National COVID Cohort Collaborative data evaluated the link between CLD and long COVID over 6 months after acute SARS-CoV-2 infection. We included adults (aged ≥18 years) who tested positive for SARS-CoV-2 during any of 3 SARS-CoV-2 variant periods and used logistic regression to determine the association, considering a comprehensive list of potential confounding factors, including demographics, comorbidities, socioeconomic conditions, geographical influences, and medication.

Results: Of 1 206 021 patients, 1.2% were diagnosed with long COVID. A significant association was found between preexisting CLD and long COVID (adjusted odds ratio [aOR], 1.36). Preexisting obesity and depression were also associated with increased long COVID risk (aOR, 1.32 for obesity and 1.29 for depression) as well as demographic factors including female sex (aOR, 1.09) and older age (aOR, 1.79 for age group 40-65 [vs 18-39] years and 1.56 for >65 [vs 18-39] years).

Conclusions: CLD is associated with higher odds of developing long COVID within 6 months after acute SARS-CoV-2 infection. These data have implications for identifying high-risk patients and developing interventions for long COVID in patients with CLD.

Keywords: SARS-CoV-2 infection; chronic lung disease; long COVID; long COVID risk factor; postacute sequelae of COVID.

Figure 1.

Flowchart detailing the inclusion and exclusion criteria applied in the construction of the analytical cohort from the National COVID Cohort Collaborative (N3C) observational electronic health record data. Abbreviation: COVID-19, coronavirus disease 2019.

Figure 2.

Bar plot depicting baseline characteristics distributions for the entire cohort (blue/left), individuals with chronic lung disease (CLD; orange/middle), and non-CLD participants (green/right). Characteristics include demographic data, socioeconomic factors, and geographical details (A) and existing comorbidities (B). Abbreviations: CLD, chronic lung disease; COVID-19, coronavirus disease 2019; ECMO, extracorporeal membrane oxygenation; ED, emergency department; HIV, human immunodeficiency virus; IMV, intermittent mandatory ventilation.

Figure 3.

Forest plot depicting risk factors associated with long COVID with multiple logistic regression. Risk factors presented include demographic data, socioeconomic factors, and geographical details. *P < .05; **P < .005; ***P < .001. Abbreviations; COVID-19, coronavirus disease 2019; ECMO, extracorporeal membrane oxygenation; ED, emergency department; IMV, intermittent mandatory ventilation; OR, odds ratio.