Omicron Infection and Severity After Life Adversities: Evidence From a Trauma Injury Cohort Study in China

Life adversities may have long-lasting effects on mental and physical health, including respiratory infectious diseases. However, studies on different types of life adversities and their effects on COVID-19, especially omicron infection and severity, are scarce.

We established a cohort of 3567 patients admitted for physical injury to a trauma medical center in Southwest China between June 2020 and February 2024. Three types of life adversities-childhood maltreatment, adverse lifetime experiences, and index injury-were assessed through interviews. Omicron infection, severity, and symptoms were collected through a self-report questionnaire. Logistic regression was used to examine associations with subsequent omicron infection and severity, with further stratification by a polygenic risk score (PRS) of severe COVID-19. Mediation analyses were conducted to evaluate the contribution of post-injury psychiatric symptoms.

More severe index injury was associated with a higher risk of omicron infection (ORs = 1.64 to 1.67), partially mediated by posttrauma anxiety, depression, and stress-related symptoms (28.66 to 34.16%). Childhood physical abuse and severe index injury (ORs = 1.86 to 2.16) were associated with a higher risk of severe omicron infection requiring essential treatment or hospitalization. Childhood sexual abuse and individual adverse lifetime experiences (ORs = 1.48 to 2.89) were associated with a greater number of severe omicron infection symptoms ( N ≥3 vs no symptoms). Similar patterns were observed in individuals with a high PRS of severe COVID-19.

Our findings suggest that individuals with greater exposure to traumatic experiences are at increased risk of severe omicron infection, adding to the growing knowledge that recent and early life adversities may have both short and long-term negative influences on health outcomes.