Exploring adverse outcomes in post-COVID-19 condition patients

By Bhavana KunkalikarMar 7 2023Reviewed by Aimee Molineux

In a recent study published in the JAMA Health Forum, researchers assessed the adverse outcomes observed among post-coronavirus disease 2019 (COVID-19) condition (PCC) patients as compared to non-COVID-19 (NC) persons.

Variable recovery duration and a variety of problems have been among the many debatable elements of COVID-19 experienced by numerous individuals. Published estimates note that almost 10% to 25% of symptomatic COVID-19 patients have symptoms that linger beyond the acute phase of infection. Symptoms such as pain, fatigue, cough, loss of smell or taste, shortness of breath, thromboembolic disorders, neurocognitive issues, and depression are used to diagnose PCC. Those with milder instances frequently self-manage, making it difficult to conduct follow-ups. Moreover, early studies frequently involved field reports or research letters that were not submitted to peer review, eliciting the need for well-reviewed research.

About the study

In the present study, researchers compared the one-year outcomes of people suffering from PCC with those of an NC control group.

The team studied administrative claims as well as laboratory results obtained from the HealthCore Integrated Research Environment, which incorporates medical, laboratory, and pharmacy data from 14 health plans involving members residing in all 50 states of the United States along with the District of Columbia. The PCC group comprised 249,013 COVID-19-positive individuals aged 18 years and older diagnosed between 1 April 2020 and 31 July 2020. The index date was the initial diagnosis or COVID-19-positive test date. Participants were required to have been continuously enrolled for at least six months before the index date and to have survived for a minimum of 30 days after their diagnosis date. The index month was determined by adding 30 days to the date of the COVID-19 diagnosis.

The outcomes were chosen according to an internal health plan assessment conducted during the first year of the COVID-19 pandemic when a high number of cardiovascular-related uses were noted among COVID-19-positive plan members. Outcomes of interest were claims-based utilization associated with cardiovascular illnesses, chronic respiratory problems, and mortality. Using the Social Security Administration's Death Master File and Datavant Flatiron data files, mortality that may have been noted after health plan disenrollment was recorded.

Results

The study sample involved a total of 13,435 PCC patients and 26,870 non-COVID-19 persons. The average age of the PCC group was 50.1 years, while 58.7% of the cohort was female. The PCC group included persons residing in the South, West, Northeast, and Midwest regions of the United States. Prior to developing COVID-19, the PCC group had a rather high prevalence of chronic diseases, including hypertension, diabetes, depression, asthma, chronic obstructive pulmonary disease (COPD), and severe obesity.

In the PCC group, adverse outcomes were consistently higher than in the NC group. In the follow-up period, the PCC group displayed elevated healthcare utilization for cardiac arrhythmias, with a relative risk (RR) increase of 2.35; pulmonary embolism with an RR increase of 3.64; ischemic stroke with an RR increase of 2.17; coronary artery disease with an RR increase of 1.78; heart failure, with an RR increase of 1.97; COPD with an RR increase of 1.94; and asthma with an RR increase of 1.95. During the follow-up period, 2.8% of the PCC group and 1.2% of the NC group succumbed to the disease. This discrepancy corresponds to an excess mortality rate of 16.4 per 1000 persons.

In the first month, 27.5% of patients within the PCC group were hospitalized. The hospitalized subset from the PCC group displayed an average age of 57.4 years while 55.2% of its members were female. Before acquiring COVID-19, these hospitalized patients had greater levels of hypertension, asthma, COPD, type 2 diabetes, and severe obesity compared to the overall PCC cohort. The hospitalized subset, in contrast, showed lower depression levels. In the pre-index period, 61.9% of the sample exhibited two or more comorbidities, as measured by the mean Elixhauser Comorbidity Index score of 3.2.

In the follow-up period, the hospitalized PCC group revealed increased utilization of health care for cardiac arrhythmias, with an RR increase of 2.97; pulmonary embolism with an RR increase of 6.23; ischemic stroke with an RR increase of 3.07; coronary artery disease with an RR increase of 1.99; heart failure with an RR increase of 2.53; COPD with an RR increase of 2.24; and asthma with an RR increase of 2.15.

Conclusion

The study findings showed that after adjusting for pre-COVID-19 risk factors, people with PCC had higher incidences of adverse health events as well as mortality over the one-year follow-up period. The researchers believe that the present study will be vital to assess the ongoing needs of PCC patients, particularly in relation to the onset of additional chronic illnesses following the first sickness. These findings will increase understanding of the care required for patients with PCC and inform healthcare systems about allocating surveillance, case management, and follow-up resources to this population.