The risks of autoimmune- and inflammatory post-acute COVID-19 conditions: a network cohort study in six European countries, the US, and Korea, 2024,

[EndME]

The risks of autoimmune- and inflammatory post-acute COVID-19 conditions: a network cohort study in six European countries, the US, and Korea

Objectives We aimed to assess the risk of autoimmune- and inflammatory post-acute COVID-19 conditions.

Design Descriptive network cohort study.

Setting Electronic health records from UK and Dutch primary care, Norwegian linked health registry, hospital records of specialist centres in Spain, France, and Korea, and healthcare claims from Estonia and the US.

Participants We followed individuals between September 2020 and the latest available data from the day they fulfilled at least 365 days of prior observation (general population), additionally from day 91 after a SARS-Cov-2 negative test (comparator) or a COVID-19 record (exposed patients).

Main outcome measures We assessed postural orthostatic tachycardia syndrome (POTS) diagnoses/symptoms, myalgic encephalomyelitis / chronic fatigues syndrome (ME/CFS) diagnoses/symptoms, multi-inflammatory syndrome (MIS), and several autoimmune diseases. For contextualisation, we assessed any diabetes mellitus (DM).

Meta-analysed crude incidence rate ratios (IRR) of outcomes measures after COVID-19 versus negative testing yield the ratios of absolute risks. Furthermore, incidence rates (IR) of the outcomes in the general population describe the total disease burden.

Results We included 34’549’575 individuals of whom 2’521’812 had COVID-19, and 4’233’145 a first negative test. After COVID-19 compared to test negative patients, we observed IRRs of 1.24 (1.23-1.25), 1.22 (1.21-1.23), and 1.12 (1.04-1.21) for POTS symptoms, ME/CFS symptoms and diagnoses, respectively. In contrast, autoimmune diseases and DM did not yield higher rates after COVID-19. In individual general database populations, IRs of POTS and ME/CFS diagnoses were 17-1’477/100’000 person-years (pys) and 2-473/100’000 pys, respectively. IRs of MIS were lowest with IRs 0.4-16/100’000 pys, those of DM as a benchmark 8-86/100’000 pys. IRs largely depended on the care setting.

Conclusion In our unmatched comparison, we observed that, following COVID-19, POTS and ME/CFS yielded higher rates than after negative testing. In absolute terms, we observed POTS and ME/CFS diagnoses to have a similar disease burden as DM.

https://www.medrxiv.org/content/10.1101/2024.05.15.24307344v1

 

[ME/CFS Skeptic]

Looks like the first big study that measured ME/CFS following COVID-19.

It is based on a massive amount of health records from 8 countries (the UK, US, Korea, The Netherlands, Norway, Estonia, Spain, and France). They had data on 35 million people. 3 million of those got COVID-19 and 4 million had a negative test results for COVID-19. Both groups could be compared to see if COVID increased the risk of certain conditions such as ME/CFS.

The authors did not match the comparison groups and did not adjust for confounders leaving the results crude. This is a big caveat. Another issue is that conditions such as ME/CFS and POTS might have been severely under-diagnosed.

The found that ME/CFS was 12% more common after COVID-19. Although the incidence ME/CFS was highest in women and in the age group of 40-60, the incidence rate ratio was more pronounced in men and children. This could indicate that ME/CFS was more often picked up and diagnosed in these groups following COVID-19.



The authors could also give an estimate of the incidence of ME/CFS but this varied enormously (0.002-0.473%) depending on the database used, probably indicated the lack of quality of some of the data. They speak of 'disease burden' but it seems that they simply mean incidence rate by this. The incidence rate of ME/CFS was in the same ballpark as that of diabetes.

They also looked at POTS diagnosis but that was a null result. The authors argue that this might be due to under-diagnosis because POTS symptoms were increased by 24% following COVID-19.

Oddly enough, for autoimmune diseases and Diabetes, the rates after COVID-were 0.1-0.2 times lower than after negative testing. The authors suggest that this may be due to non-specific symptoms of these illnesses being attributed to the aftermaths of COVID-19 and delayed diagnoses. But this is just a guess I suppose.

This quote may be useful for advocacy:

"our work contributing absolute risks of ME/CFS and POTS among the general population is important to inform the healthcare system about the existing disease burden and to allocate the needed resources for these long-term conditions. Moreover, to put our estimated rates into perspective, we estimated the incidence of DM and observed similar incidence with POTS and ME/CFS, especially among children and elderly for POTS and for working age for ME/CFS. Our results suggest a significant strain for individuals, society, and the healthcare systems."​

 

[rvallee]

They also looked at POTS diagnosis but that was a null result. The authors argue that this might be due to under-diagnosis because POTS symptoms were increased by 24% following COVID-19.

Most comments from and about MDs I see out there reflect that they do see it, but blame the tiktoks and the social medias and other newfangled brain-altering technologies. I guess they moved on from blaming Dungeons & Dragons and bicycles.

Even though POTS is the easiest to diagnose of the bunch. It even has objective numbers that can be put into a simple diagnostic process. But they'd rather believe that the tiktoks are spreading social contagion, or whatever. Ugh. This all makes it so obvious why medical progress is so slow. So many lives ruined over clownish pseudoscience.