Incidence of post-COVID syndrome and associated symptoms in outpatient care in Bavaria, Germany: a retrospective cohort study using routinely collected claims data

Abstract

ObjectivesTo estimate the treatment incidence of post-COVID syndrome (postinfectious sequelae present at least 12 weeks following infection) in the context of ambulatory care in Bavaria, Germany, and to establish whether related diagnoses occur more frequently than in patients with no known history of COVID-19.DesignRetrospective cohort analysis of routinely collected claims data.SettingAmbulatory care in Bavaria, Germany, observed from January 2020 to March 2022 (data accessed May 2022).Participants391 990 patients with confirmed COVID-19 diagnosis, 62 659 patients with other respiratory infection and a control group of 659 579 patients with no confirmed or suspected diagnosis of COVID-19.Primary and secondary outcome measuresPrimary outcome is diagnosis of post-COVID syndrome documented in ambulatory care. Secondary outcomes are: chronic fatigue syndrome, psychological disorder, fatigue, mild cognitive impairment, disturbances of taste and smell, dyspnoea, pulmonary embolism and myalgia.ResultsAmong all patients with confirmed COVID-19, 14.2% (95% CI 14.0% to 14.5%) received a diagnosis of a post-COVID syndrome, and 6.7% (95% CI 6.5% to 6.9%) received the diagnosis in at least two quarterly periods during a 2-year follow-up. Compared with patients with other respiratory infections and with controls, patients with COVID-19 more frequently received a variety of diagnoses including chronic fatigue syndrome (1.6% vs 0.6% and 0.3%, respectively), fatigue (13.3% vs 9.2% and 6.0%), dyspnoea (9.9% vs 5.1% and 3.2%) and disturbances of taste and smell (3.2% vs 1.2% and 0.5%). The treatment incidence of post-COVID syndrome was highest among adults aged 40–59 (19.0%) and lowest among children aged below 12 years (2.6%).ConclusionsOur results demonstrate a moderately high incidence of post-COVID syndrome 2 years after COVID-19 diagnosis. There is an urgent need to find efficient and effective solutions to help patients with dyspnoea, fatigue, cognitive impairment and loss of smell. Guidelines and treatment algorithms, including referral criteria, and occupational and physical therapy, require prompt and coherent implementation.

Associations between SARS-CoV-2 infection and incidence of new chronic condition diagnoses: a systematic review

“…Attempt to contact authors to obtain the data was not successful. Cohen 2022 [ 36 ] United States UnitedHealth Database Jan 2020 to Dec 2020 Retrospective cohort N = 226,380 Median (IQR) – 78 (30–175) days Mixed 65+ 58% 27 6.4 Concurrent No confirmed/ suspected SARS-CoV-2 infection Cardiovascular disease (acute coronary disease, cardiogenic shock, cardiac arrhythmia, cardiomyopathy, congestive heart failure, coronary disease, hypertension, myocardial infarction, tachycardia); Chronic kidney disease; Diabetes (type 2); Mental disorders (mental health diagnosis, psychosis); Neurological conditions (dementia, encephalopathy, Guillain-Barre syndrome, migraine, peripheral neuropathy, seizure); Respiratory disorders (chronic respiratory failure, interstitial lung disease); Stroke Daugherty 2021 [ 37 ] United States UnitedHealth Database Jan 2019 to Oct 2020 Retrospective cohort N = 488,552 Median (IQR) – 87 (45-124) days Mixed 18–65 52.5% 8.2 1.1 Concurrent No confirmed/ suspected SARS-CoV-2 infection Cardiovascular disease (acute coronary disease, arrythmia, cardiogenic shock, cardiomyopathy, congestive heart failure, coronary disease, hypertension, myocardial infarction, tachycardia); Chronic kidney disease; Diabetes (type 2); Mental disorders (mental health diagnosis, psychosis); Neurological conditions (Alzheimer’s disease, dementia, encephalopathy, Guillain-Barre syndrome, migraine, peripheral neuropathy, seizure); Respiratory disorders (chronic respiratory failure, interstitial lung disease); Stroke Donnachie 2022 [ 38 ] Germany Bavarian COVID-19 Cohort Jan 2020 to Jun 2021 Retrospective cohort N = 454,649 NR Followed up for 2 years Outpatient 0–60+ 54% NA Concurrent >90% had test negative Mental disorders (anxiety disorders, mood disorders); Neurological conditions (mild cognitive impairment) Jacob 2022 [ 39 ] Germany IQVIA Disease Analyzer database …”

A prospective cohort study assessing the relationship between long-COVID symptom incidence in COVID-19 patients and COVID-19 vaccination

“…For example, a Mediterranean cohort study found that approximately 50% of patients had persistent symptoms 10–14 weeks after the first episode 36 , while a Jordanian study showed that 71.8% of patients still have one physical or psychological symptom 3 months or more after the first infection 37 . In two German studies, 14.2% of patients developed post-COVID-19 symptoms 38 , whereas 27.8% of non-hospitalized COVID-19 patients reported at least one symptom 4 months after the initial symptom 3 . The differing results could be attributed to the various types of studies used, the length of follow-up, vaccination rates, and healthcare system differences.…”

scRNA-seq reveals persistent aberrant differentiation of nasal epithelium driven by TNFα and TGFβ in post-COVID syndrome

“…The incidence of post-COVID syndrome varies across different patient populations, estimated at 10– 30% among non-hospitalized cases, 50–70% among hospitalized cases, and 10–12% among vaccinated cases, however clear diagnostic criteria are still lacking making precise estimates difficult [33, 34]. PCS affects individuals of all ages, with the highest percentage of diagnoses typically observed between the ages of 36 and 50 years, with a noteworthy observation that the relative frequency of PCS cases is highest among in non-hospitalized patients [9, 35].…”