One-Year Adverse Outcomes Among US Adults With Post–COVID-19 Condition vs Those Without COVID-19 in a Large Commercial Insurance Database

Abstract

ImportanceMany individuals experience ongoing symptoms following the onset of COVID-19, characterized as postacute sequelae of SARS-CoV-2 or post–COVID-19 condition (PCC). Less is known about the long-term outcomes for these individuals.ObjectiveTo quantify 1-year outcomes among individuals meeting a PCC definition compared with a control group of individuals without COVID-19.Design, Setting, and ParticipantsThis case-control study with a propensity score–matched control group included members of commercial health plans and used national insurance claims data enhanced with laboratory results and mortality data from the Social Security Administration’s Death Master File and Datavant Flatiron data. The study sample consisted of adults meeting a claims-based definition for PCC with a 2:1 matched control cohort of individuals with no evidence of COVID-19 during the time period of April 1, 2020, to July 31, 2021.ExposuresIndividuals experiencing postacute sequelae of SARS-CoV-2 using a Centers for Disease Control and Prevention–based definition.Main Outcomes and MeasuresAdverse outcomes, including cardiovascular and respiratory outcomes and mortality, for individuals with PCC and controls assessed over a 12-month period.ResultsThe study population included 13 435 individuals with PCC and 26 870 individuals with no evidence of COVID-19 (mean [SD] age, 51 [15.1] years; 58.4% female). During follow-up, the PCC cohort experienced increased health care utilization for a wide range of adverse outcomes: cardiac arrhythmias (relative risk [RR], 2.35; 95% CI, 2.26-2.45), pulmonary embolism (RR, 3.64; 95% CI, 3.23-3.92), ischemic stroke (RR, 2.17; 95% CI, 1.98-2.52), coronary artery disease (RR, 1.78; 95% CI, 1.70-1.88), heart failure (RR, 1.97; 95% CI, 1.84-2.10), chronic obstructive pulmonary disease (RR, 1.94; 95% CI, 1.88-2.00), and asthma (RR, 1.95; 95% CI, 1.86-2.03). The PCC cohort also experienced increased mortality, as 2.8% of individuals with PCC vs 1.2% of controls died, implying an excess death rate of 16.4 per 1000 individuals.Conclusions and RelevanceThis case-control study leveraged a large commercial insurance database and found increased rates of adverse outcomes over a 1-year period for a PCC cohort surviving the acute phase of illness. The results indicate a need for continued monitoring for at-risk individuals, particularly in the area of cardiovascular and pulmonary management.

Cardiovascular Risks in Patients With Post–COVID-19 Condition

“…4 Therefore, PCC is a defining challenge for health care systems.A study in this issue of JAMA Health Forum by DeVries and colleagues directly addresses this evolving public health challenge. 5 The study of US adults in a large commercial insurance database describes markedly increased risks of adverse cardiovascular events and excess all-cause mortality in the postacute phase of COVID-19. These findings, together with increasing evidence of long-term consequences of SARS-CoV-2 infections spanning a wide range of organ systems, 6 call for enhanced and extended health monitoring of individuals with SARS-CoV-2 infections and raise questions about public health goals at this stage of the pandemic.DeVries and colleagues used propensity score matching on a comprehensive set of variables in commercial insurance claims to compare a cohort of 13 435 persons who had experienced PCC symptoms with a cohort of 26 870 persons without evidence of COVID-19.…”

“…These findings, together with increasing evidence of long-term consequences of SARS-CoV-2 infections spanning a wide range of organ systems, 6 call for enhanced and extended health monitoring of individuals with SARS-CoV-2 infections and raise questions about public health goals at this stage of the pandemic.DeVries and colleagues used propensity score matching on a comprehensive set of variables in commercial insurance claims to compare a cohort of 13 435 persons who had experienced PCC symptoms with a cohort of 26 870 persons without evidence of COVID-19. 5 Additional analyses were conducted among persons who had experienced PCC and been hospitalized within a month of SARS-CoV-2 infection. For both analyses, claims-based utilization tied to cardiovascular disorders, chronic respiratory disorders, and mortality over 12 months were compared between cohorts.Between 1 month and 12 months postinfection, individuals who had experienced COVID-19 exhibited increased incident cardiovascular disease relative to those who had not, including more than a doubling in the relative risk (RR) of pulmonary embolism or deep vein thrombosis (8.0% vs 2.2%; RR, 3.64), cardiac arrhythmias (29.5% vs 12.5%; RR, 2.35), and ischemic stroke (3.9% vs 1.8%; RR, 2.17).…”

“…DeVries and colleagues build on these studies by demonstrating findings of similar magnitude in a cohort that was 58% female with a mean age of 50 years and had representation across US racial and ethnic groups and geographic regions. 5 Perhaps the most comparable published study is an analysis of UK Biobank participants by Raisi-Estabragh and colleagues, which primarily highlighted markedly increased cardiovascular and…”

“…A study in this issue of JAMA Health Forum by DeVries and colleagues directly addresses this evolving public health challenge. 5 The study of US adults in a large commercial insurance database describes markedly increased risks of adverse cardiovascular events and excess all-cause mortality in the postacute phase of COVID-19. These findings, together with increasing evidence of long-term consequences of SARS-CoV-2 infections spanning a wide range of organ systems, 6 call for enhanced and extended health monitoring of individuals with SARS-CoV-2 infections and raise questions about public health goals at this stage of the pandemic.…”

“…DeVries and colleagues used propensity score matching on a comprehensive set of variables in commercial insurance claims to compare a cohort of 13 435 persons who had experienced PCC symptoms with a cohort of 26 870 persons without evidence of COVID-19. 5 Additional analyses were conducted among persons who had experienced PCC and been hospitalized within a month of SARS-CoV-2 infection. For both analyses, claims-based utilization tied to cardiovascular disorders, chronic respiratory disorders, and mortality over 12 months were compared between cohorts.…”