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Excess burden of respiratory and abdominal conditions following COVID-19 infections during the ancestral and Delta variant periods in the United States: An EHR-based cohort study from the RECOVER Program

Varma, JK; Zang, C; Carton, TW; et. al.RECOVER Consortium, PLOS ONE

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June 2024




Importance: The frequency and characteristics of post-acute sequelae of SARS-CoV-2 infection (PASC) may vary by SARS-CoV-2 variant. Objective: To characterize PASC-related conditions among individuals likely infected by the ancestral strain in 2020 and individuals likely infected by the Delta variant in 2021. Design: Retrospective cohort study of electronic medical record data for approximately 27 million patients from March 1, 2020-November 30, 2021. Setting: Healthcare facilities in New York and Florida. Participants: Patients who were at least 20 years old and had diagnosis codes that included at least one SARS-CoV-2 viral test during the study period. Exposure: Laboratory-confirmed COVID-19 infection, classified by the most common variant prevalent in those regions at the time. Main outcome(s) and measure(s): Relative risk (estimated by adjusted hazard ratio [aHR]) and absolute risk difference (estimated by adjusted excess burden) of new conditions, defined as new documentation of symptoms or diagnoses, in persons between 31-180 days after a positive COVID-19 test compared to persons without a COVID-19 test or diagnosis during the 31-180 days after the last negative test. Results: We analyzed data from 560,752 patients. The median age was 57 years; 60.3% were female, 20.0% non-Hispanic Black, and 19.6% Hispanic. During the study period, 57,616 patients had a positive SARS-CoV-2 test; 503,136 did not. For infections during the ancestral strain period, pulmonary fibrosis, edema (excess fluid), and inflammation had the largest aHR, comparing those with a positive test to those without a COVID-19 test or diagnosis (aHR 2.32 [95% CI 2.09 2.57]), and dyspnea (shortness of breath) carried the largest excess burden (47.6 more cases per 1,000 persons). For infections during the Delta period, pulmonary embolism had the largest aHR comparing those with a positive test to a negative test (aHR 2.18 [95% CI 1.57, 3.01]), and abdominal pain carried the largest excess burden (85.3 more cases per 1,000 persons). Conclusions and relevance: We documented a substantial relative risk of pulmonary embolism and a large absolute risk difference of abdomen-related symptoms after SARS-CoV-2 infection during the Delta variant period. As new SARS-CoV-2 variants emerge, researchers and clinicians should monitor patients for changing symptoms and conditions that develop after infection. 


Jay K Varma, Chengxi Zang, Thomas W Carton, Jason P Block, Dhruv J Khullar, Yongkang Zhang, Mark G Weiner, Russell L Rothman, Edward J Schenck, Zhenxing Xu, Kristin Lyman, Jiang Bian, Jie Xu, Elizabeth A Shenkman, Christine Maughan, Leah Castro-Baucom, Lisa O'Brien, Fei Wang, Rainu Kaushal


Humans; COVID-19/epidemiology/diagnosis; Female; Male; Middle Aged; SARS-CoV-2/isolation & purification; Retrospective Studies; Electronic Health Records; Adult; Aged; United States/epidemiology; Post-Acute COVID-19 Syndrome; Florida/epidemiology; Cohort Studies



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