Long COVID burden and risk factors in 10 UK longitudinal studies and electronic health records

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Abstract

The frequency of, and risk factors for, long COVID are unclear among community-based individuals with a history of COVID-19. To elucidate the burden and possible causes of long COVID in the community, we coordinated analyses of survey data from 6907 individuals with self-reported COVID-19 from 10 UK longitudinal study (LS) samples and 1.1 million individuals with COVID-19 diagnostic codes in electronic healthcare records (EHR) collected by spring 2021. Proportions of presumed COVID-19 cases in LS reporting any symptoms for 12+ weeks ranged from 7.8% and 17% (with 1.2 to 4.8% reporting debilitating symptoms). Increasing age, female sex, white ethnicity, poor pre-pandemic general and mental health, overweight/obesity, and asthma were associated with prolonged symptoms in both LS and EHR data, but findings for other factors, such as cardio-metabolic parameters, were inconclusive.

Original languageEnglish
Article number3528
JournalNature Communications
Volume13
Issue number1
DOIs
Publication statusPublished - 28 Jun 2022
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported by the National Core Studies, an initiative funded by UKRI, NIHR, and the Health and Safety Executive. The COVID-19 Longitudinal Health and Wellbeing National Core Study was funded by the Medical Research Council (MC_PC_20030). Related funding was also provided by the NIHR (CONVALESCENCE grant COV-LT-0009). The contributing studies have been made possible because of the tireless dedication, commitment and enthusiasm of the many people who have taken part. We would like to thank the participants and the numerous team members involved in the studies including interviewers, technicians, researchers, administrators, managers, health professionals and volunteers. We are additionally grateful to our funders for their financial input and support in making this research happen. Data gathered from questionnaires was provided by Wellcome Longitudinal Population Study (LPS) COVID-19 Steering Group and Secretariat (221574/Z/20/Z). Understanding Society is an initiative funded by the Economic and Social Research Council and various Government Departments, with scientific leadership by the Institute for Social and Economic Research, University of Essex, and survey delivery by NatCen Social Research and Kantar Public. The Understanding Society COVID-19 study is funded by the Economic and Social Research Council (ES/K005146/1) and the Health Foundation (2076161). The research data are distributed by the UK Data Service.

Funding Information:
This work was supported by the National Core Studies, an initiative funded by UKRI, NIHR, and the Health and Safety Executive. The COVID-19 Longitudinal Health and Wellbeing National Core Study was funded by the Medical Research Council (MC_PC_20030). Related funding was also provided by the NIHR (CONVALESCENCE grant COV-LT-0009). The contributing studies have been made possible because of the tireless dedication, commitment and enthusiasm of the many people who have taken part. We would like to thank the participants and the numerous team members involved in the studies including interviewers, technicians, researchers, administrators, managers, health professionals and volunteers. We are additionally grateful to our funders for their financial input and support in making this research happen. Data gathered from questionnaires was provided by Wellcome Longitudinal Population Study (LPS) COVID-19 Steering Group and Secretariat (221574/Z/20/Z). Understanding Society is an initiative funded by the Economic and Social Research Council and various Government Departments, with scientific leadership by the Institute for Social and Economic Research, University of Essex, and survey delivery by NatCen Social Research and Kantar Public. The Understanding Society COVID-19 study is funded by the Economic and Social Research Council (ES/K005146/1) and the Health Foundation (2076161). The research data are distributed by the UK Data Service. The Millennium Cohort Study, Next Steps, British Cohort Study 1970 and National Child Development Study 1958 are supported by the Centre for Longitudinal Studies, Resource Centre 2015-20 grant (ES/M001660/1) and a host of other co-funders. The COVID-19 data collections in these five cohorts were funded by the UKRI grant Understanding the economic, social and health impacts of COVID-19 using lifetime data: evidence from 5 nationally representative UK cohorts (ES/V012789/1). The UK Medical Research Council and Wellcome (Grant Ref: 217065/Z/19/Z) and the University of Bristol provide core support for ALSPAC. A comprehensive list of grants funding is available on the ALSPAC website ( http://www.bristol.ac.uk/alspac/external/documents/grant-acknowledgements.pdf ). We are extremely grateful to all the families who took part in this study, the midwives for their help in recruiting them, and the whole ALSPAC team, which includes interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists, and nurses. TwinsUK receives funding from the Wellcome Trust (WT212904/Z/18/Z), the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London. The TwinsUK COVID-19 personal experience study was funded by the King’s Together Rapid COVID-19 Call award, under the projects original title ‘Keeping together through coronavirus: The physical and mental health implications of self-isolation due to the Covid-19 TwinsUK is also supported by the Chronic Disease Research Foundation and Zoe Global Ltd. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Generation Scotland received core support from the Chief Scientist Office of the Scottish Government Health Directorates [CZD/16/6] and the Scottish Funding Council [HR03006]. Genotyping of the GS:SFHS samples was carried out by the Genetics Core Laboratory at the Wellcome Trust Clinical Research Facility, Edinburgh, Scotland and was funded by the Medical Research Council UK and the Wellcome Trust (Wellcome Trust Strategic Award “STratifying Resilience and Depression Longitudinally” (STRADL) Reference 104036/Z/14/Z). Generation Scotland is funded by the Wellcome Trust (216767/Z/19/Z) and (221574/Z/20/Z). Born in Bradford (BiB) receives core infrastructure funding from the Wellcome Trust (WT101597MA), and a joint grant from the UK Medical Research Council (MRC) and UK Economic and Social Science Research Council (ESRC) (MR/N024397/1), the British Heart Foundation (BHF) (CS/16/4/32482), and The Health Foundation COVID-19 award (2301201). The National Institute for Health Research Yorkshire and Humber Applied Research Collaboration (ARC) (NIHR200166), and Clinical Research Network both provide support for BiB research. Born in Bradford is only possible because of the enthusiasm and commitment of the children and parents in BiB. We are grateful to all the participants, health professionals, schools and researchers who have made Born in Bradford happen. OpenSAFELY is jointly funded by UKRI, NIHR and Asthma UK-BLF [COV0076; MR/V015737/] and the Longitudinal Health and Wellbeing strand of the National Core Studies programme. E.M.I.S. and T.P.P. provided technical expertise and infrastructure within their data environments pro bono in the context of a national emergency. The OpenSAFELY software platform is supported by a Wellcome Discretionary Award. B.G.’s work on clinical informatics is supported by the NIHR Oxford Biomedical Research Centre and the NIHR Applied Research Collaboration Oxford and Thames Valley. Funders had no role in the study design, collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. The views expressed are those of the authors and not necessarily those of the NIHR, NHS England, Public Health England or the Department of Health and Social Care. N.J.T. is a Wellcome Trust Investigator (202802/Z/16/Z), is the PI of the Avon Longitudinal Study of Parents and Children (MRC & WT 217065/Z/19/Z), is supported by the University of Bristol NIHR Biomedical Research Centre, the MRC Integrative Epidemiology Unit (MC_UU_00011/1) and works within the CRUK Integrative Cancer Epidemiology Programme (C18281/A29019). S.V.K. acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). A.S.F.K. acknowledges funding from the ESRC (ES/V011650/1). E.J.T. acknowledges funding from the Wellcome Trust (WT212904/Z/18/Z). R.M. acknowledges support from the Elizabeth Blackwell Institute for Health Research, University of Bristol, and the Wellcome Trust Institutional Strategic Support Fund (204813/Z/16/Z). G.B.P. acknowledges funding from the Economic and Social Research Council (ES/V012789/1). C.L.N. acknowledges funding from the Medical Research Council (MR/R024774/1). K.T. works in a Unit that is supported by the University of Bristol and UK Medical Research Council (MC_UU_00011/3). D.M.W. is supported by funding from UK Medical Research Council (MC_PC_20030). N.C. is supported by funding from the UK Medical Research Council (MC_UU_00019/2). We would also like to achnowledge the following individuals: Generation Scotland: Drew Altschul, Chloe Fawns-Ritchie, Archie Campbell, Robin Flaig; ALSPAC: Daniel J Smith; Understanding Society: Michaela Benzeval; TwinsUK: Deborah Hart, María Paz García, Rachel Horsfall; Centre for Longitudinal Studies: Matt Brown, Lisa Calderwood, Emla Fitzsimons, Alissa Goodman, Aida Sanchez; Born in Bradford: John Wright, Dan Mason.

Funding Information:
No competing interests were declared by E.J.T., D.M.W., A.J.W., R.E.M., C.L.N., T.C.Y., C.F.H., A.S.F.K., R.J.S., G.D., R.C.E.B., K.N. B.H., M.J.G., B.D., K.J.D., E.L.D., F.M.K.W., A.S., L.T., B.G., P.P., G.B.P., K.T., C.T.R., N.J.T., N.C., C.J.S. B.G. has received research funding from the Laura and John Arnold Foundation, the NHS National Institute for Health Research (NIHR), the NIHR School of Primary Care Research, the NIHR Oxford Biomedical Research Centre, the Mohn-Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, the Wellcome Trust, the Good Thinking Foundation, Health Data Research UK (HDRUK), the Health Foundation, and the World Health Organisation; he also receives personal income from speaking and writing for lay audiences on the misuse of science. S.V.K. is a member of the Scientific Advisory Group on Emergencies subgroup on ethnicity and COVID-19 and is co-chair of the Scottish Government’s Ethnicity Reference Group on COVID-19. N.C. serves on a data safety monitoring board for trials sponsored by AstraZeneca. C.J.S. is an academic lead on KCL Zoe Global Ltd. COVID symptoms study. The remaining authors declare no competing interests.

Publisher Copyright:
© 2022, The Author(s).

ASJC Scopus subject areas

  • Chemistry(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • General
  • Physics and Astronomy(all)

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