Three-year outcomes of post-acute sequelae of COVID-19, 2024, Cai, Xie, Topol, Al-Aly

Three-year outcomes of post-acute sequelae of COVID-19
Cai, Miao; Xie, Yan; Topol, Eric J.; Al-Aly, Ziyad

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes post-acute sequelae of coronavirus disease 2019 (COVID-19) (PASC) in many organ systems. Risks of these sequelae have been characterized up to 2 years after infection, but longer-term follow-up is limited. Here we built a cohort of 135,161 people with SARS-CoV-2 infection and 5,206,835 controls from the US Department of Veterans Affairs who were followed for 3 years to estimate risks of death and PASC.

Among non-hospitalized individuals, the increased risk of death was no longer present after the first year of infection, and risk of incident PASC declined over the 3 years but still contributed 9.6 (95% confidence interval (CI): 0.4–18.7) disability-adjusted life years (DALYs) per 1,000 persons in the third year. Among hospitalized individuals, risk of death declined but remained significantly elevated in the third year after infection (incidence rate ratio: 1.29 (95% CI: 1.19–1.40)). Risk of incident PASC declined over the 3 years, but substantial residual risk remained in the third year, leading to 90.0 (95% CI: 55.2–124.8) DALYs per 1,000 persons.

Altogether, our findings show reduction of risks over time, but the burden of mortality and health loss remains in the third year among hospitalized individuals.

Link | PDF (Nature Medicine) [Open Access]

 

The data is surely going to be messy, with many people in the control group having Covid-19, and many people in both groups having multiple infections.

Compared to the control group without infection, people with COVID-19 who were not hospitalized during the acute phase of the disease were at an increased risk of death (incidence rate ratio (IRR): 1.58, 95% confidence interval (CI): 1.53–1.62; excess burden per 1,000 persons: 16.20, 95% CI: 14.90–17.51; Fig. 1a) during the first year after SARS-CoV-2 infection but not in the second year (IRR: 0.97, 95% CI: 0.94–1.00; excess burden per 1,000 persons: −0.91, 95% CI: −2.20 to 0.38) and third year (IRR: 1.01, 95% CI: 0.97–1.04; excess burden per 1,000 persons: 0.22, 95% CI: −1.14 to 1.58) after the infection.

Excess mortality relative to controls in the three years (years on x axis). Red is the hospitalised group, blue is the unhospitalised group.



Incidence of a range of symptom types relative to controls - for non-hospitalised group



Fig 2 has a very detailed break down of symptoms that is worth look, with incidence rate ratios.

Some of the "symptoms", such as 'Nicotine use disorder" which I assume is largely smoking, might actually be a contributor to the person ending up hospitalised with Covid-19. So they are more like a risk factor that is present at a higher rate than in the controls. So, far, while the symptoms are called 'post-acute sequelae' I haven't seen any analysis of symptoms that only arose after the infection.

Years are the three columns - 1,2,3
The top row is non-hospitalised
Bottom row is hospitalised

 

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