Post-acute COVID-19 sequelae in cases managed in the community or hospital in the UK: a population based study

  1. Hannah R Whittaker
  2. Claudia Gulea
  3. Ardita Koteci
  4. Constantinos Kallis
  5. Ann D Morgan
  6. Chukwuma Iwundu
  7. Mark Weeks
  8. Rikisha Gupta
  9. Jennifer K Quint

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Abstract

Objective

To compare post-COVID-19 sequelae between hospitalised and non-hospitalised individuals

Design

Population-based cohort study

Setting

1,383 general practices in England contributing to Clinical Practice Research Database Aurum

Participants

46,687 COVID-19 cases diagnosed between 1 st August to 17 th October 2020 (45.4% male; mean age 40), either hospitalised within two weeks of diagnosis or non-hospitalised, and followed-up for a maximum of three months.

Main outcome measures

Event rates of new symptoms, diseases, prescriptions and healthcare utilisation in hospitalised and non-hospitalised individuals, with between-group comparison using Cox regression. Outcomes compared at 6 and 12 months prior to index date, equating to first UK wave and pre-pandemic. Non-hospitalised group outcomes stratified by age and sex.

Results

45,272 of 46,687 people were non-hospitalised; 1,415 hospitalised. Hospitalised patients had higher rates of 13/26 symptoms and 11/19 diseases post-COVID-19 than the community group, received more prescriptions and utilised more healthcare. The largest differences were noted for rates per 100,000 person-weeks [95%CI] of breathlessness: 536 [432 to 663] v. 85 [77 to 93]; joint pain: 295 [221 to 392] v. 168 [158 to 179]; diabetes: 303 [225 to 416] v. 36 [32 to 42], hypertension: 244 [178 to 344] v. 47 [41 to 53]. Although low, rates of chest tightness, tinnitus and lung fibrosis were higher in the community group. 4.2% (1882/45,272) of the community group had a post-acute burden, most frequently reporting anxiety, breathlessness, chest pain and fatigue. In those non-hospitalised, age and sex differences existed in outcome rates. Healthcare utilisation in the community group increased 28.5% post-COVID-19 relative to pre-pandemic.

Conclusions

Post-COVID-19 sequelae differ between hospitalised and non-hospitalised individuals, with age and sex-specific differences in those non-hospitalised. Most COVID-19 cases managed in the community do not report ongoing issues to healthcare professionals. Post-COVID-19 follow-up and management strategies need to be tailored to specific groups.

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  1. ScreenIT

    SciScore for 10.1101/2021.04.09.21255199: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your code.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: Our study purposefully only included COVID-19 patients from wave two, when testing capacity was much higher, thereby limiting potential selection biases. That our proportion of hospitalised patients is in keeping with UK national estimates increases our confidence that our study population is broadly representative. Whilst we cannot ascertain whether symptoms recorded on primary care records were directly due to COVID-19 or other conditions, we did investigate event rates among the same cohorts 6 and 12 months prior to contextualize our findings. In addition, we did include a window of no symptoms to ensure diseases, symptoms and prescriptions captured were new and not pre-existing to the COVID-19 diagnosis. Risk of misclassification of diseases and symptoms, an inherent weakness of studies of this nature, was minimised by using previously validated codelists wherever possible and creating codelists tailored to the objectives of this study. We were unable to capture the effect of socioeconomic status as these data are not available in primary care records and accept that this is a limitation. Nor have we been able to consider the severity of our investigated outcomes. Given the relatively short follow-up period, we may be missing some symptoms and diseases which occur later in the trajectory of long-Covid. For this reason, we plan to repeat this analysis in the future. It is also likely that we will have missed some cases of new onset symptoms or di...

    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.

    About SciScore

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  2. Version published to 10.1101/2021.04.09.21255199 on medRxiv