Long-Term Health-Related Quality of Life in Non-Hospitalized Coronavirus Disease 2019 (COVID-19) Cases With Confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in England: Longitudinal Analysis and Cross-Sectional Comparison With Controls
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Abstract
Background
We aimed to quantify the unknown losses in health-related quality of life of coronavirus disease 2019 (COVID-19) cases using quality-adjusted lifedays (QALDs) and the recommended EQ-5D instrument in England.
Methods
Prospective cohort study of nonhospitalized, polymerase chain reaction (PCR)-confirmed severe acute respiratory syndrome coronavirus 2–positive (SARS-CoV-2–positive) cases aged 12–85 years and followed up for 6 months from 1 December 2020, with cross-sectional comparison to SARS-CoV-2–negative controls. Main outcomes were QALD losses; physical symptoms; and COVID-19-related private expenditures. We analyzed results using multivariable regressions with post hoc weighting by age and sex, and conditional logistic regressions for the association of each symptom and EQ-5D limitation on cases and controls.
Results
Of 548 cases (mean age 41.1 years; 61.5% female), 16.8% reported physical symptoms at month 6 (most frequently extreme tiredness, headache, loss of taste and/or smell, and shortness of breath). Cases reported more limitations with doing usual activities than controls. Almost half of cases spent a mean of £18.1 on nonprescription drugs (median: £10.0), and 52.7% missed work or school for a mean of 12 days (median: 10). On average, all cases lost 13.7 (95% confidence interval [CI]: 9.7, 17.7) QALDs, whereas those reporting symptoms at month 6 lost 32.9 (95% CI: 24.5, 37.6) QALDs. Losses also increased with older age. Cumulatively, the health loss from morbidity contributes at least 18% of the total COVID-19-related disease burden in the England.
Conclusions
One in 6 cases report ongoing symptoms at 6 months, and 10% report prolonged loss of function compared to pre-COVID-19 baselines. A marked health burden was observed among older COVID-19 cases and those with persistent physical symptoms.
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SciScore for 10.1101/2021.10.22.21264701: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization Participants aged 12 to 85 years inclusive were randomly selected from the Second Generation Surveillance System (SGSS; the routine laboratory reporting system in England [7]) to be proportionately representative by geographical region in England (East Midlands, East of England, London, North East, North West, South East, South West, West Midlands, Yorkshire and The Humber) from all those who requested a test through community testing with a specimen date of 26-27 November 2020. Blinding not detected. Power Analysis During the study design phase in spring/summer 2020, we estimated the sample size required with 300-350 cases to … SciScore for 10.1101/2021.10.22.21264701: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics not detected. Sex as a biological variable not detected. Randomization Participants aged 12 to 85 years inclusive were randomly selected from the Second Generation Surveillance System (SGSS; the routine laboratory reporting system in England [7]) to be proportionately representative by geographical region in England (East Midlands, East of England, London, North East, North West, South East, South West, West Midlands, Yorkshire and The Humber) from all those who requested a test through community testing with a specimen date of 26-27 November 2020. Blinding not detected. Power Analysis During the study design phase in spring/summer 2020, we estimated the sample size required with 300-350 cases to detect a difference with 80% power at a significance level of 5% and assuming a difference of half a quality-adjusted life-day (QALD) lost by laboratory-confirmed cases. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Strengths and Limitations: This study is one of the first to provide long-term QALY estimates associated with non-hospitalised COVID-19 in the UK, which will be of use in evaluation studies of vaccines, drugs, and non-pharmaceutical interventions. We also recruited a control group for the cross-sectional analysis, which is not often available in other studies. As cases were recruited after testing positive for SARS-CoV-2, they completed versions of the EQ-5D three times in the initial survey, including retrospectively about their pre-COVID-19 baseline health. Such a design is common, and while this may introduce recall bias most cases in our sample reported symptom onset within 2 weeks of having been tested and thus completed the initial survey within 4 weeks. For controls, the survey was sent by email to reduce the administrative burden and costs, which we tried to compensate for by inviting a larger sample. For the cases, we found some indication that the retainment of participants with worse health may be higher in those who return surveys by post (which we accounted for in the models). Although all respondents were randomly sampled and we applied post-hoc weighting by age group and sex for more representative results, we also cannot rule out self-selection bias into this study by more health-conscious individuals. We also provided results for both utility value sets in England of the EQ-5D-3L and EQ-5D-5L given that mapping from the responses on the EQ-5D-5L to the EQ-5D-...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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