TY  - JOUR
AU  - Meza-Torres, Bernardo
AU  - Delanerolle, Gayathri
AU  - Okusi, Cecilia
AU  - Mayor, Nikhil
AU  - Anand, Sneha
AU  - Macartney, Jack
AU  - Gatenby, Piers
AU  - Glampson, Ben
AU  - Chapman, Martin
AU  - Curcin, Vasa
AU  - Mayer, Erik
AU  - Joy, Mark
AU  - Greenhalgh, Trisha
AU  - Delaney, Brendan
AU  - de Lusignan, Simon
PY  - 2022
DA  - 2022/8/16
TI  - Differences in Clinical Presentation With Long COVID After Community and Hospital Infection and Associations With All-Cause Mortality: English Sentinel Network Database Study
JO  - JMIR Public Health Surveill
SP  - e37668
VL  - 8
IS  - 8
KW  - medical record systems
KW  - computerized
KW  - Systematized Nomenclature of Medicine
KW  - post–acute COVID-19 syndrome
KW  - phenotype
KW  - COVID-19
KW  - post–COVID-19 syndrome
KW  - long COVID
KW  - ethnicity
KW  - social class
KW  - general practitioners
KW  - data accuracy
KW  - data extracts
KW  - biomedical ontologies
KW  - SARS-CoV-2
KW  - hospitalization
AB  - Background: Most studies of long COVID (symptoms of COVID-19 infection beyond 4 weeks) have focused on people hospitalized in their initial illness. Long COVID is thought to be underrecorded in UK primary care electronic records. Objective: We sought to determine which symptoms people present to primary care after COVID-19 infection and whether presentation differs in people who were not hospitalized, as well as post–long COVID mortality rates. Methods: We used routine data from the nationally representative primary care sentinel cohort of the Oxford–Royal College of General Practitioners Research and Surveillance Centre (N=7,396,702), applying a predefined long COVID phenotype and grouped by whether the index infection occurred in hospital or in the community. We included COVID-19 infection cases from March 1, 2020, to April 1, 2021. We conducted a before-and-after analysis of long COVID symptoms prespecified by the Office of National Statistics, comparing symptoms presented between 1 and 6 months after the index infection matched with the same months 1 year previously. We conducted logistic regression analysis, quoting odds ratios (ORs) with 95% CIs. Results: In total, 5.63% (416,505/7,396,702) and 1.83% (7623/416,505) of the patients had received a coded diagnosis of COVID-19 infection and diagnosis of, or referral for, long COVID, respectively. People with diagnosis or referral of long COVID had higher odds of presenting the prespecified symptoms after versus before COVID-19 infection (OR 2.66, 95% CI 2.46-2.88, for those with index community infection and OR 2.42, 95% CI 2.03-2.89, for those hospitalized). After an index community infection, patients were more likely to present with nonspecific symptoms (OR 3.44, 95% CI 3.00-3.95; P<.001) compared with after a hospital admission (OR 2.09, 95% CI 1.56-2.80; P<.001). Mental health sequelae were more strongly associated with index hospital infections (OR 2.21, 95% CI 1.64-2.96) than with index community infections (OR 1.36, 95% CI 1.21-1.53; P<.001). People presenting to primary care after hospital infection were more likely to be men (OR 1.43, 95% CI 1.25-1.64; P<.001), more socioeconomically deprived (OR 1.42, 95% CI 1.24-1.63; P<.001), and with higher multimorbidity scores (OR 1.41, 95% CI 1.26-1.57; P<.001) than those presenting after an index community infection. All-cause mortality in people with long COVID was associated with increasing age, male sex (OR 3.32, 95% CI 1.34-9.24; P=.01), and higher multimorbidity score (OR 2.11, 95% CI 1.34-3.29; P<.001). Vaccination was associated with reduced odds of mortality (OR 0.10, 95% CI 0.03-0.35; P<.001). Conclusions: The low percentage of people recorded as having long COVID after COVID-19 infection reflects either low prevalence or underrecording. The characteristics and comorbidities of those presenting with long COVID after a community infection are different from those hospitalized. This study provides insights into the presentation of long COVID in primary care and implications for workload. 
SN  - 2369-2960
UR  - https://publichealth.jmir.org/2022/8/e37668
UR  - https://doi.org/10.2196/37668
UR  - http://www.ncbi.nlm.nih.gov/pubmed/35605170
DO  - 10.2196/37668
ID  - info:doi/10.2196/37668
ER  -