Long COVID: Potential risk factors identified through analysis of documented care


Factors associated with an increased risk of long-lasting COVID include older age, higher comorbidity burden, disease severity at diagnosis, and unvaccinated status at onset of infection. The results of these studies have been published in Open JAMA Network.

Using data from the Veterans Affairs Enterprise Data Warehouse and COVID-19 Shared Data Resource, researchers conducted a retrospective cohort study among patients who tested positive for the infection. to COVID-19 between February 2020 and April 2021. Excluded patients were those who died within 3 months of testing positive. Patients with a second positive result after 3 months or more were also excluded to avoid confusion with reinfection treatment. The primary outcome was documentation of care for long COVID for 3 months or more after the initial onset of infection. Multivariate logistic regression was used to assess potential associations between patient characteristics and long-term COVID care outcomes, with adjustments for age, sex, race/ethnicity, rural residence or urban, time of infection, and number of health care visits in the 2 years prior to onset of infection.

A total of 198,601 patients were included in the analysis, with a mean age of 60.4 ± 17.7 years, 89.1% were male, 67.4% Caucasian, and 69.6 % resided in urban areas.

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During an average follow-up period of 13.5 ± 3.6 months, long-term COVID care was documented in 13.5% of patients overall. Analysis between these patients and those without documented care showed several factors associated with an increased risk of long COVID. These factors included older age (18-49 versus 50-84; odds ratio adjusted [aOR], 1.38; 95% CI, 1.28-1.48), hospitalization (aOR, 2.60; 95% CI, 2.51-2.69), need for mechanical ventilation (aOR, 2.46; 95%, 2.26-2.69) and an increased number of symptoms in the acute phase of infection (aOR, 1.71; 95% CI, 1.65-1.78).

Compared to white patients, those who were black (aOR, 1.10; 95% CI, 1.09-1.21), Asian (aOR, 1.12; 95% CI, 0.98-1, 29) and American Indian/Alaska Native (aOR, 1.18; 95% CI, 1.03-1.35) were significantly more likely to receive documented care for long COVID. Documented care for long-term COVID is also more common among Hispanic vs. non-Hispanic patients (aOR, 1.15; 95% CI, 1.10-1.21) and among those who resided in urban areas or rural (aOR, 1.14; 95% CI, 1.10-1.19).

The researchers found a linear association between patients’ Charlson Comorbidity Index scores and documented care for long COVID, with documented care being significantly more likely among those with scores of 9 or greater (aOR, 2, 19; 95% CI, 1.98-2.41). Comorbid conditions significantly associated with documented long-term care for COVID included chronic obstructive pulmonary disease, asthma, congestive heart failure, history of myocardial infarction, cerebrovascular disease, chronic kidney disease, and diabetes .

Patients receiving opioids (aOR, 1.24; 95% CI, 1.17-1.30) or calcium channel blockers (aOR, 1.24; 95% CI, 1.20-1.27) were more likely to have documented care for long COVID.

No significant association was found between the number of primary care visits in the past 2 years and documented long-term COVID care. However, patients with a higher number of visits to a mental health facility (≥20 visits; ORa, 1.16; 95% CI, 1.11-1.21) or specialist care (≥19 visits; ORa, 1.90; 95% CI, 1.65-2.18) clinic over the past 2 years were significantly more likely to have received documented care for long COVID.

This study was limited by the lack of standardized diagnostic criteria for long COVID.

These findings “provide support and guidance to health care systems to develop systematic approaches for assessing and managing patients at risk of long-term COVID,” the researchers concluded.

Disclosure: One study author disclosed affiliations with biotechnology, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Ioannou GN, Baraff A, Fox A, et al. Rates and factors associated with documentation of diagnostic codes for long COVID in the National Veterans Health Care System. JAMA Netw Open. 2022;5(7):e2224359. doi:10.1001/jamanetworkopen.2022.24359

This article originally appeared on Infectious Disease Advisor

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