Assessing the Prevalence of Anemia Post-COVID-19 Infection in Adult Members of a Southeastern U.S. Integrated Healthcare System

Abstract

Background COVID-19 may cause or worsen anemia, leading to fatigue, lower quality of life, increased risk of comorbidities, and significantly associated with worse outcomes in patients hospitalized with COVID-19. Little is known among a community-based population. We aimed to investigate the incidence and risk factors of anemia post-COVID diagnosis in a community-based population. Methods We identified all adult members of KPGA with a confirmed diagnosis of COVID-19 between January 2020 and March 2022 and followed through March 2023. Anemia was defined using hemoglobin (Hgb) labs 180-days (±30-days) and 365-days (±30-days) after COVID-19 diagnosis and sex-specific thresholds. Potential risk factors included demographics and clinical characteristics (defined by diagnosis codes) at the time of COVID-19 diagnosis. Hospitalization with COVID-19 was used as a marker of COVID-19 severity. Logistic regression among individuals not diagnosed with anemia pre-COVID investigated the association between each risk factor and anemia 180- and 365-days post-COVID-19 infection. We stratified fully adjusted model by hospitalization with COVID-19 to assess effect modification. Results We included 3,450 and 3,043 individuals who met the inclusion criteria and had Hgb results available 180- and 365- days post-COVID-19 diagnosis. One-third of our population had anemia 180-days (n=1,100, 32.17%) and 365-days (n=1,007, 33.09%) post-COVID-19, with approximately 11% of the cohort being newly diagnosed cases of anemia. In the fully adjusted models females (vs. males) (OR=1.71, 95% CI: 1.42, 2.06), Black or African American individuals (vs. non-Black individuals) (OR=2.34, 95% CI: 1.98, 2.76), adults diagnosed with kidney disease (OR=1.79, 95% CI: 1.42, 2.25) or diabetes (OR=1.26, 95% CI: 1.12, 1.64), and adults hospitalized with COVID-19 (OR=1.43, 95% CI: 1.15, 1.78) were more likely to be diagnosed with anemia 365-days after COVID-19 diagnosis. Analyses stratified by hospitalization status showed a possible effect modification between hospitalization status and post-COVID-19 anemia. Discussion Our study showed that one in three people in a community-based population have anemia 180-days and 365-days after their first COVID-19 diagnosis. Anemia can cause fatigue, a lingering symptom of COVID-19 infection. Though more research is needed, ongoing surveillance of COVID-19 patients for anemia may be an important component of management of long COVID-19.

Circulating Naturally-Occurring Anticoagulants before Treatment and after Recovery from SARS-CoV-2 Infection in Ghana

“…The present study agrees with the negative effects of severe COVID-19 on red cell parameters, as this has been described by earlier studies where RBC, HCT, and Hb were reduced in Ghana [40,41] and other parts of the world [4][5][6][7]. The 58.6% prevalence of anaemia among COVID-19 patients recorded in this study is higher than the 19.23% identified in Liaocheng, China [42], 35.6% [43], and 38.2% [44] of hospitalized COVID-19 patients in Wuhan, China, and 42.7% among COVID-19 survivors in a 30-day prospective cohort study during the initial wave of the outbreak in Italy [5].…”

“…The 58.6% prevalence of anaemia among COVID-19 patients recorded in this study is higher than the 19.23% identified in Liaocheng, China [42], 35.6% [43], and 38.2% [44] of hospitalized COVID-19 patients in Wuhan, China, and 42.7% among COVID-19 survivors in a 30-day prospective cohort study during the initial wave of the outbreak in Italy [5]. The prevalence is, however, lower compared to the 62.8% found in a retrospective study in Riyadh, Kingdom of Saudi Arabia [6], 66.7% among COVID-19 non-survivors in Italy [5], and 74.3% from the CURE cohort (from Kaiser Permanente Georgia's (KPGA) electronic medical record (EMR), which used data generated from members of a southeastern integrated healthcare system testing positive for COVID-19 [7]. The anaemia may be due to the COVID-19-associated cytokine storm that influences iron absorption and re-uptake, and inhibits erythropoietin.…”

“…Severe COVID-19 patients suffer various haematological and biochemical derangements, and these have been linked to the associated cytokine storm and disruption of the endothelium [4][5][6][7], activation of procoagulants, hypofibrinolysis [8], altered synthesis and activation of naturally-occurring anticoagulants [9,10], and stimulation of cell-death mechanisms [11]. Previous studies have suggested the occurrence of decreased haemoglobin (Hb) or anaemia [4][5][6][7], thrombocytopaenia [6,12], leucocytosis [13,14], and abnormal leucocyte differentials [12,15] among severe COVID-19 patients. The deranged blood cell parameters have been linked to the cytokine storms with the subsequent increase and activation of circulating pro-inflammatory cytokines such as interleukin (IL)-6, IL-1, and tumour necrosis factoralpha (TNF-α) during COVID-19 [16].…”

Hematological Impact of COVID-19: Anemia in Post-COVID

“…Our binary logistic regression analysis underscores that on-admission anemia, lower Hb levels, and reduced MCH levels are significant predictors of post-COVID anemia. This agrees with the study of Hudgins et al (2023) (34) who demonstrated that anemia on admission was a significant risk factor for the prolonged presence of anemia in post-COVID patients. Identifying individuals at higher risk and implementing appropriate interventions, such as iron supplementation or other treatments-is crucial in managing and reducing the incidence of anemia in individuals recovering from COVID-19.…”

“…Similarly, of Hudgins et al (2023) (34) highlighted the prolonged presence of anemia in post-COVID patients, drawing attention to the large proportion (about one in three) of individuals diagnosed with COVID-19-displaying signs of anemia at both the 180-day and 365-day marks postinfection.…”