Abstract
Importance: Persistent symptoms and disability following SARS-CoV-2 infection, known as post-COVID-19 condition or "long COVID," are frequently reported and pose a substantial personal and societal burden. Objective: To determine time to recovery following SARS-CoV-2 infection and identify factors associated with recovery by 90 days. Design, Setting, and Participants: For this prospective cohort study, standardized ascertainment of SARS-CoV-2 infection was conducted starting in April 1, 2020, across 14 ongoing National Institutes of Health-funded cohorts that have enrolled and followed participants since 1971. This report includes data collected through February 28, 2023, on adults aged 18 years or older with self-reported SARS-CoV-2 infection. Exposure: Preinfection health conditions and lifestyle factors assessed before and during the pandemic via prepandemic examinations and pandemic-era questionnaires. Main Outcomes and Measures: Probability of nonrecovery by 90 days and restricted mean recovery times were estimated using Kaplan-Meier curves, and Cox proportional hazards regression was performed to assess multivariable-adjusted associations with recovery by 90 days. Results: Of 4708 participants with self-reported SARS-CoV-2 infection (mean [SD] age, 61.3 [13.8] years; 2952 women [62.7%]), an estimated 22.5% (95% CI, 21.2%-23.7%) did not recover by 90 days post infection. Median (IQR) time to recovery was 20 (8-75) days. By 90 days post infection, there were significant differences in restricted mean recovery time according to sociodemographic, clinical, and lifestyle characteristics, particularly by acute infection severity (outpatient vs critical hospitalization, 32.9 days [95% CI, 31.9-33.9 days] vs 57.6 days [95% CI, 51.9-63.3 days]; log-rank P <.001). Recovery by 90 days post infection was associated with vaccination prior to infection (hazard ratio [HR], 1.30; 95% CI, 1.11-1.51) and infection during the sixth (Omicron variant) vs first wave (HR, 1.25; 95% CI, 1.06-1.49). These associations were mediated by reduced severity of acute infection (33.4% and 17.6%, respectively). Recovery was unfavorably associated with female sex (HR, 0.85; 95% CI, 0.79-0.92) and prepandemic clinical cardiovascular disease (HR, 0.84; 95% CI, 0.71-0.99). No significant multivariable-adjusted associations were observed for age, educational attainment, smoking history, obesity, diabetes, chronic kidney disease, asthma, chronic obstructive pulmonary disease, or elevated depressive symptoms. Results were similar for reinfections. Conclusions and Relevance: In this cohort study, more than 1 in 5 adults did not recover within 3 months of SARS-CoV-2 infection. Recovery within 3 months was less likely in women and those with preexisting cardiovascular disease and more likely in those with COVID-19 vaccination or infection during the Omicron variant wave.
| Original language | English (US) |
|---|---|
| Pages (from-to) | e2417440 |
| Journal | JAMA network open |
| Volume | 7 |
| Issue number | 6 |
| DOIs | |
| State | Published - Jun 17 2024 |
Funding
Conflict of Interest Disclosures: Dr Oelsner reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study and outside the submitted work. Dr Sun reported receiving grants from NIH during the conduct of the study. Dr Balte reported receiving grants from the National Heart, Lung, and Blood Institute (NHLBI) during the conduct of the study. Dr Allen reported receiving grants from NHLBI during the conduct of the study. Dr Carson reported receiving grants from NIH during the conduct of the study and from Amgen outside the submitted work. Prof Coresh reported receiving grants from NIH during the conduct of the study. Dr Couper reported receiving grants from NHLBI during the conduct of the study. Dr Cushman reported receiving grants from NIH during the conduct of the study. Dr Daviglus reported receiving grants from NIH during the conduct of the study. Dr Elkind reported receiving nonfinancial support from the Bristol Myers Squibb-Pfizer Alliance outside the submitted work. Dr Howard reported receiving grants from the National Institute of Neurological Disorders and Stroke, NHLBI, and the National Institute on Aging during the conduct of the study. Dr Kandula reported receiving grants from NHLBI during the conduct of the study and a stipend from the American Diabetes Association for service as an associate editor for Diabetes Care. Dr Lee reported receiving grants from NIH and Pliant Therapeutics; and personal fees from Boehringer Ingelheim, United Therapeutics, Blade Therapeutics, AstraZeneca, Eleven P15, and Elima; and medical advisor fees from the Pulmonary Fibrosis Foundation outside the submitted work. Dr Min reported receiving grants from NIH outside the submitted work. Dr Murabito reported receiving grants from NHLBI during the conduct of the study. Dr Ortega reported data monitoring committee membership with Regeneron and Sanofi outside the submitted work. Dr Pettee Gabriel reported receiving grants from NIH outside the submitted work. Prof Psaty reported steering committee membership of the Yale Open Data Access Project funded by Johnson & Johnson. Dr Regan reported receiving grants from NHLBI during the conduct of the study. Dr Schwartz reported receiving grants from the University of Colorado during the conduct of the study. Dr Shikany reported receiving contract fees from the University of Alabama at Birmingham Coronary Artery Risk Development in Young Adults (CARDIA) Study Coordinating Center during the conduct of the study. Dr Thyagarajan reported receiving grants from NIH during the conduct of the study. Dr Tracy reported receiving grants from NIH during the conduct of the study. Dr Umans reported receiving grants from NIH during the conduct of the study. Dr Vasan reported receiving grants from NIH during the conduct of the study. Dr Wenzel reported receiving grants from NIH during the conduct of the study. Dr Woodruff reported receiving consulting fees from Roche, AstraZeneca, Sanofi, and Regeneron outside the submitted work. Dr Zhang reported receiving grants from NIH during the conduct of the study. Dr Post reported receiving grants from NIH during the conduct of the study. No other disclosures were reported.
ASJC Scopus subject areas
- General Medicine
