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Epidemiologic Features of Recovery From SARS-CoV-2 Infection

医学 比例危险模型 2019年冠状病毒病(COVID-19) 严重急性呼吸综合征冠状病毒2型(SARS-CoV-2) 大流行 前瞻性队列研究 队列 队列研究 年轻人 流行病学 人口学 内科学 疾病 传染病(医学专业) 社会学
作者
Elizabeth C. Oelsner,Yifei Sun,Pallavi Balte,Norrina B Allen,Howard Andrews,April P. Carson,Shelley A. Cole,Josef Coresh,David J. Couper,Mary Cushman,Martha L. Daviglus,Ryan T. Demmer,Mitchell S.V. Elkind,Linda C. Gallo,José D. Gutiérrez,Virginia J. Howard,Carmen R. Isasi,Suzanne E. Judd,Alka M. Kanaya,Namratha R. Kandula,Robert C. Kaplan,Gregory L. Kinney,Anna Kucharska‐Newton,Daniel T. Lackland,Joyce Lee,Barry J. Make,Yuan‐I Min,Joanne M. Murabito,Arnita F. Norwood,Victor E. Ortega,Kelley Pettee Gabriel,Bruce M. Psaty,Elizabeth A. Regan,Daniela Sotres‐Alvarez,David A. Schwartz,James M. Shikany,Bharat Thyagarajan,Russell P. Tracy,Jason G. Umans,Ramachandran S. Vasan,Sally E. Wenzel,Prescott G. Woodruff,Vanessa Xanthakis,Ying Zhang,Wendy S. Post
出处
期刊:JAMA network open [American Medical Association]
卷期号:7 (6): e2417440-e2417440
标识
DOI:10.1001/jamanetworkopen.2024.17440
摘要

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.
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