Health behaviours the month prior to COVID-19 infection and the development of self-reported long COVID and specific long COVID symptoms: a longitudinal analysis of 1581 UK adults

  1. Elise Paul
  2. Daisy Fancourt

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Abstract

Background

Demographic and infection-related characteristics have been identified as risk factors for long COVID, but research on the influence of health behaviours (e.g., exercise, smoking) immediately preceding the index infection is lacking. The aim of this study was to examine whether specific health behaviours in the month preceding infection with COVID-19 act as upstream risk factors for long COVID as well as well as three specific long COVID symptoms.

Methods

One thousand five hundred eighty-one UK adults from the UCL COVID-19 Social Study and who had previously been infected with COVID-19 were analysed. Health behaviours in the month before infection were weekly exercise frequency, days of fresh air per week, sleep quality, smoking, consuming more than the number of recommended alcoholic drinks per week (> 14), and the number of mental health care behaviours (e.g., online mental health programme). Logistic regressions controlling for covariates (e.g., COVID-19 infection severity, socio-demographics, and pre-existing health conditions) examined the impact of health behaviours on long COVID and three long COVID symptoms (difficulty with mobility, cognition, and self-care).

Results

In the month before infection with COVID-19, poor quality sleep increased the odds of long COVID (odds ratio [OR]: 3.53; (95% confidence interval [CI]: 2.01 to 6.21), as did average quality sleep (OR: 2.44; 95% CI: 1.44 to 4.12). Having smoked (OR: 8.39; 95% CI: 1.86 to 37.91) increased and meeting recommended weekly physical activity guidelines (3h hours) (OR: 0.05; 95% CI: 0.01 to 0.39) reduced the likelihood of difficulty with self-care (e.g., washing all over or dressing) amongst those with long COVID.

Conclusions

Results point to the importance of sleep quality for long COVID, potentially helping to explain previously demonstrated links between stress and long COVID. Results also suggest that exercise and smoking may be modifiable risk factors for preventing the development of difficulty with self-care.

Article activity feed

  1. Version published to 10.1186/s12889-022-14123-7
  2. ScreenIT

    SciScore for 10.1101/2022.04.12.22273792: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: The study was approved by the UCL Research Ethics Committee [12467/005] and all participants gave informed consent.
    Consent: The study was approved by the UCL Research Ethics Committee [12467/005] and all participants gave informed consent.
    Sex as a biological variablenot detected.
    RandomizationThe study is not random and therefore is not representative of the UK population.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study has several strengths as well as limitations. A major strength is its longitudinal design, particularly the measurement of health behaviours prior to infection with COVID-19, the latter of which is random and cannot be predicted. However, due to data limitations, we were not able to include important health behaviours such as diet and nutrition, which are key behavioural risks for morbidity.16 We also assessed a limited number of long COVID symptoms, and did not assess fatigue, which is often the most commonly reported.5 Although well-stratified across major demographic groups, the study sample is also not representative of the general UK population, and results therefore cannot be generalised. Our findings add to the dearth of research on health behaviours prior to infection with COVID-19 and the development of long COVID and suggest the importance of regular physical activity and smoking cessation, as early intervention (especially in relation to smoking) may reduce the likelihood of long COVID amongst those who become infected. Poor quality sleep prior to infection with COVID-19 is also associated with the development of long COVID but may be a result of stress due to experience of or concerns about adversities. More research on risk factors for long COVID is important, given that it is not the health behaviours per se that cause long COVID. At the time of writing, the percentage of people in the UK testing positive for COVID-19 is at an all-time high and still ...

    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.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2022.04.12.22273792v1 on medRxiv
  4. ScreenIT

    SciScore for 10.1101/2022.04.06.22273444: (What is this?)

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

    Table 1: Rigor

    EthicsIRB: The study was approved by the UCL Research Ethics Committee [12467/005] and all participants gave informed consent.
    Consent: The study was approved by the UCL Research Ethics Committee [12467/005] and all participants gave informed consent.
    Sex as a biological variablenot detected.
    RandomizationThe study is not random and therefore is not representative of the UK population.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    However, the current study also has several limitations. First, systematic reviews have reported that there are a large number of different symptoms associated with long COVID,2,11 but we assessed a limited number of long COVID symptoms, and did not ask about fatigue, which is the most commonly reported long COVID symptoms.9,10,12 However, it is possible that participants interpreted our question on difficulties with mobility (e.g., walking or climbing steps) to mean difficulty carrying out these activities due to fatigue. Second, due to insufficient numbers, we were not able to include vaccination status at the time of infection as a covariate, which may decrease the likelihood of developing long COVID.62,63 A third limitation is the self-reported nature of our long COVID variable; participants were left to decide for themselves whether they believed themselves to have or have had long COVID. Although having been formally diagnosed with long COVID was a response option to this question, only around 1 in 5 (19%) had been diagnosed. The sample was also insufficiently powered to use symptom duration as our main outcome variable, as fewer than half who self-reported long COVID said their symptoms had lasted at least four weeks. To address how this may have influenced results, we conducted analyses comparing people whose symptoms had lasted fewer than four weeks with those whose symptoms lasted longer. Using this criterion, worries about adversity experiences predicted the outcom...

    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.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  5. Version published to 10.1101/2022.04.06.22273444v1 on medRxiv