Differences in Clinical Presentation With Long COVID After Community and Hospital Infection and Associations With...

Area of Science:

• Public Health
• Epidemiology
• Primary Care Medicine

Background:

• Long COVID (post-COVID-19 symptoms beyond 4 weeks) research often overlooks non-hospitalized individuals.
• Long COVID is suspected to be under-documented in UK primary care electronic health records.
• Understanding primary care presentations of long COVID is crucial for accurate diagnosis and management.

Purpose of the Study:

• To identify symptoms patients present with in primary care following COVID-19 infection.
• To compare long COVID symptom presentation between hospitalized and non-hospitalized individuals.
• To investigate post-long COVID mortality rates.

Main Methods:

• Utilized a large, nationally representative UK primary care cohort (N=7,396,702).
• Applied a predefined long COVID phenotype to cases from March 2020 to April 2021.
• Conducted a before-and-after analysis of prespecified long COVID symptoms and logistic regression to assess odds ratios.

Main Results:

• 1.83% of COVID-19 patients received a long COVID diagnosis or referral.
• Long COVID patients had significantly higher odds of presenting with symptoms post-infection (OR 2.66 for community, OR 2.42 for hospitalized).
• Nonspecific symptoms were more common after community infection, while mental health sequelae were more linked to hospital infections. Higher mortality in long COVID was associated with age, male sex, and multimorbidity, but reduced by vaccination.

Conclusions:

• The low recorded prevalence of long COVID may indicate underdiagnosis or underrecording.
• Distinct patient characteristics and comorbidities exist for long COVID following community versus hospital infections.
• Findings offer insights into primary care workload and the varied presentation of long COVID.