Health outcomes in people 2 years after surviving hospitalisation with COVID-19: a longitudinal cohort study

Health outcomes in people 2 years after surviving hospitalisation with COVID-19: a longitudinal cohort study

Sequelae symptoms Any of the following symptoms 777/1149 (68%) 583/1188 (49%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

650/1190 (55%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

194/286 (68%) 141 (48%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

158/294 (54%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

509/774 (66%) 395/802 (49%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

440/805 (55%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

74/89 (83%) 47 (52%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

52 (57%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

Fatigue or muscle weakness 593/1151 (52%) 240/1188 (20%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

357/1190 (30%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

143/286 (50%) 60 (20%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

89/294 (30%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

385/776 (50%) 161/802 (20%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

235/805 (29%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

65/89 (73%) 19 (21%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

33 (36%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

Sleep difficulties 313/1151 (27%) 206/1188 (17%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

298/1190 (25%)

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

75/286 (26%) 47 (16%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

70/294 (24%)

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

205/776 (26%) 146/802 (18%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

203/805 (25%)

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

33/89 (37%) 13 (14%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

25 (27%) Hair loss 252/1151 (22%) 131/1188 (11%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

142/1190 (12%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

61/286 (21%) 27 (9%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

41/294 (14%) 169/776 (22%) 97/802 (12%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

88/805 (11%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

22/89 (25%) 7 (8%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

13 (14%) Smell disorder 128/1151 (11%) 56/1188 (5%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

67/1190 (6%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

32/286 (11%) 16 (5%) 21/294 (7%) 82/776 (11%) 34/802 (4%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

42/805 (5%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

14/89 (16%) 6 (7%) 4 (4%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

Joint pain 126/1147 (11%) 141/1188 (12%) 117/1190 (10%) 40/287 (14%) 33 (11%) 30/294 (10%) 70/772 (9%) 93/802 (12%) 79/805 (10%) 16/88 (18%) 15 (16%) 8 (9%) Palpitations 108/1151 (9%) 110/1188 (9%) 145/1190 (12%) 28/286 (10%) 19 (6%) 41/294 (14%)

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

66/776 (9%) 84/802 (10%) 95/805 (12%) 14/89 (16%) 7 (8%) 9 (10%) Decreased appetite 92/1151 (8%) 34/1188 (3%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

33/1190 (3%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

25/286 (9%) 6 (2%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

10/294 (3%) 56/776 (7%) 25/802 (3%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

21/805 (3%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

11/89 (12%) 3 (3%) 2 (2%) Taste disorder 87/1151 (8%) 35/1188 (3%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

35/1190 (3%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

21/286 (7%) 6 (2%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

11/294 (4%) 58/776 (7%) 29/802 (4%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

20/805 (2%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

8/89 (9%) 0 (0%) 4 (4%) Dizziness 64/1151 (6%) 61/1188 (5%) 131/1190 (11%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

19/286 (7%) 15 (5%) 31/294 (11%) 39/776 (5%) 38/802 (5%) 90/805 (11%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

6/89 (7%) 8 (9%) 10 (11%) Chest pain 53/1147 (5%) 86/1188 (7%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

83/1190 (7%) 15/287 (5%) 23 (8%) 19/294 (6%) 34/772 (4%) 59/802 (7%) 54/805 (7%) 4/88 (5%) 4 (4%) 10 (11%) Sore throat or difficult to swallow 45/1151 (4%) 40/1188 (3%) 64/1190 (5%) 18/286 (6%) 11 (4%) 20/294 (7%) 23/776 (3%) 26/802 (3%) 40/805 (5%) 4/89 (4%) 3 (3%) 4 (4%) Skin rash 36/1151 (3%) 50/1188 (4%) 34/1190 (3%) 11/286 (4%) 13 (4%) 6/294 (2%) 21/776 (3%) 35/802 (4%) 25/805 (3%) 4/89 (4%) 2 (2%) 3 (3%) Myalgia 31/1147 (3%) 50/1188 (4%) 88/1190 (7%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

9/287 (3%) 11 (4%) 22/294 (7%) 19/772 (2%) 34/802 (4%) 59/805 (7%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

3/88 (3%) 5 (5%) 7 (8%) Headache 20/1147 (2%) 55/1188 (5%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

81/1190 (7%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

6/287 (2%) 15 (5%) 23/294 (8%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

11/772 (1%) 36/802 (4%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

50/805 (6%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

3/88 (3%) 4 (4%) 8 (9%) Nausea or vomiting 17/1150 (1%) 10/1188 (1%) 27/1190 (2%)

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

8/286 (3%) 4 (1%) 8/294 (3%) 9/775 (1%) 4/802 (0%) 18/805 (2%)

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

0/89 (0%) 2 (2%) 1 (1%) mMRC dyspnoea score 0 816/1104 (74%) 834/1187 (70%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

1023/1191 (86%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

216/288 (75%) 222/294 (76%) 253 (86%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

551/734 (75%) 556/802 (69%) 694/805 (86%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

49/82 (60%) 56 (62%) 76 (84%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

≥1 288/1104 (26%) 353/1187 (30%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

168/1191 (14%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

72/288 (25%) 72/294 (24%) 42 (14%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

183/734 (25%) 246/802 (31%) 111/805 (14%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

33/82 (40%) 35 (38%) 15 (16%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

EQ-5D-5L
§

Detailed results of EQ-5D-5L questionnaire of COVID-19 survivors are shown in the appendix (p 17); EQ-VAS scores range from 0–100, with higher scores indicating better health status.

Pain or discomfort 300/1104 (27%) 348/1187 (29%) 284/1191 (24%)

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

78/286 (27%) 78/294 (27%) 73 (25%) 189/736 (26%) 240/802 (30%) 189/805 (23%)

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

33/82 (40%) 30 (33%) 22 (24%) Anxiety or depression 256/1105 (23%) 312/1187 (26%) 143/1191 (12%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

70/288 (24%) 73/294 (25%) 34 (12%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

158/736 (21%) 213/802 (27%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

98/805 (12%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

28/81 (35%) 26 (29%) 11 (12%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

Mobility problem 68/1109 (6%) 106/1187 (9%)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

42/1191 (4%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

15/289 (5%) 21/294 (7%) 10 (3%) 40/738 (5%) 78/802 (10%) 27/805 (3%)

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

13/82 (16%) 7 (8%) 5 (5%) Personal care problem 8/1109 (1%) 17/1187 (1%) 14/1191 (1%) 0/289 (0%) 3/294 (1%) 4 (1%) 7/738 (1%) 11/802 (1%) 8/805 (1%) 1/82 (1%) 3 (3%) 2 (2%) Usual activity problem 16/1100 (1%) 14/1187 (1%) 35/1191 (3%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

3/288 (1%) 2/294 (1%) 8 (3%) 10/731 (1%) 10/802 (1%) 20/805 (2%) 3/81 (4%) 2 (2%) 7 (8%) Utility index score

Utility index score: 1 indicates perfect health, 0 indicates death, and negative scores represent values as worse than death.

1·0 (0·9–1·0) 1·0 (0·9–1·0)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

1·0 (0·9–1·0)

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

1·0 (0·9–1·0) 1·0 (0·9–1·0) 1·0 (0·9–1·0) 1·0 (0·9–1·0) 1·0 (0·9–1·0)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

1·0 (0·9–1·0)

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

1·0 (0·9–1·0) 1·0 (0·9–1·0) 1·0 (0·9–1·0) EQ-VAS score 80·0 (75·0–90·0) 80·0 (70·0–90·0) 80·0 (70·0–90·0)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

80·0 (70·0–90·0) 80·0 (70·0–90·0) 80·0 (70·0–90·0) 80·0 (75·0–90·0) 80·0 (75·0–90·0)
*

p<4·17 × 10−3 for the comparison of 12-month with 6-month follow-up.

80·0 (70·0–90·0)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

80·0 (70·0–90·0) 80·0 (70·0–85·0) 80·0 (70·0–90·0) Distance walked in 6 min, m 495·0 (450·0–540·0) 495·0 (445·0–545·0) 512·0 (458·0–563·0)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

494·5 (450·0–540·0) 495·0 (440·0–540·0) 510·0 (455·0–564·0)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

496·0 (450·0–540·0) 495·0 (445·0–545·0) 510·0 (457·0–555·0)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

495·0 (430·0–528·0) 496·5 (455·0–551·0) 530·0 (480·0–600·0)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

Percentage of predicted value

Predicted values were calculated according to the method of Enright and Sherrill.

88·1 (79·7–96·2) 90·2 (81·6–98·8) 94·0 (84·7–104·1)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

86·9 (78·5–94·9) 89·6 (81·0–96·7) 93·8 (85·0–103·5)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

88·7 (80·5–97·1) 90·7 (82·6–100·2) 94·1 (84·6–104·0)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

83·6 (76·0–92·8) 87·9 (80·4–98·0) 95·0 (84·5–105·9)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

p<4·17 × 10−3 for the comparison of 2-year with 12-month follow-up.

Less than LLN
**

The LLN was calculated by subtracting 153 m from the predicted value for men or by subtracting 139 m for women.

156/1105 (14%) 132/1167 (11%) 89/1065 (8%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

45/287 (16%) 36/286 (13%) 17/254 (7%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

91/738 (12%) 81/793 (10%) 65/726 (9%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

20/80 (25%) 15/88 (17%) 7/85 (8%)

p<4·17 × 10−3 for the comparison of 2-year with 6-month follow-up.

Mental health Anxiety symptom (GAD-7≥5) NA NA 98/1187 (8%) NA NA 26/294 (9%) NA NA 66/802 (8%) NA NA 6 (7%) Depression symptom (PHQ-9≥5) NA NA 75/1190 (6%) NA NA 25 (8%) NA NA 45/804 (6%) NA NA 5 (5%) PTSD symptom (PCL-C ≥38) NA NA 27/1189 (2%) NA NA 12 (4%) NA NA 14/803 (2%) NA NA 1 (1%) Health-care use Outpatient clinic visit NA 215/1169 (18%) 226/1187 (19%) NA 54/290 (19%) 56/294 (19%) NA 149/790 (19%) 150/803 (19%) NA 12/89 (13%) 20/90 (22%) Hospitalisation NA 152/1169 (13%) 159/1187 (13%) NA 38/290 (13%) 45/294 (15%) NA 100/790 (13%) 95/803 (12%) NA 14/89 (16%) 19/90 (21%) Emergency department visit NA 12/1169 (1%) 7/1187 (1%) NA 3/290 (1%) 2/294 (1%) NA 8/790 (1%) 5/803 (1%) NA 1/89 (1%) 0/90 (0%) Returned to original work

This category only includes those who had a full-time or part-time job before COVID-19.

NA 401/455 (88%) 438/494 (89%) NA 99/115 (86%) 112/124 (90%) NA 268/300 (89%) 282/321 (88%) NA 34/40 (85%) 44/49 (90%)

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