Long-term post-acute sequelae of COVID-19 infection: a retrospective, multi-database cohort study in Hong Kong and the UK

Ivan Chun Hang Lam; Carlos King Ho Wong; Ran Zhang; Celine Sze Ling Chui; Francisco Tsz Tsun Lai; Xue Li; Esther Wai Yin Chan; Hao Luo; Qingpeng Zhang; Kenneth Keng Cheung Man; Bernard Man Yung Cheung; Sydney Chi Wai Tang; Chak Sing Lau; Eric Yuk Fai Wan; Ian Chi Kei Wong

doi:10.1016/j.eclinm.2023.102000

Long-term post-acute sequelae of COVID-19 infection: a retrospective, multi-database cohort study in Hong Kong and the UK

Ivan Chun Hang Lam, Carlos King Ho Wong, Ran Zhang, Celine Sze Ling Chui, Francisco Tsz Tsun Lai, Xue Li, Esther Wai Yin Chan, Hao Luo, Qingpeng Zhang, Kenneth Keng Cheung Man, Bernard Man Yung Cheung, Sydney Chi Wai Tang, Chak Sing Lau, Eric Yuk Fai Wan^*, Ian Chi Kei Wong^*

^*Corresponding author for this work

Department of Data Science

Research output: Journal Publications and Reviews › RGC 21 - Publication in refereed journal › peer-review

69 Citations (Scopus)

59 Downloads (CityUHK Scholars)

Abstract

Background  Evidence on post-acute sequelae of SARS-CoV-2 (PASC) has shown inconsistent findings. This study aimed to generate coherent evidence on the post-acute sequelae of COVID-19 infection using electronic healthcare records across two regions.

Methods  In this retrospective, multi-database cohort study, patients with COVID-19 aged 18 or above between April 1st 2020 and May 31st 2022 from the Hong Kong Hospital Authority (HKHA) and March 16th 2020 and May 31st 2021 from the UK Biobank (UKB) databases and their matched controls were followed for up to 28 and 17 months, respectively. Covariates between patients with COVID-19 and non-COVID-19 controls were adjusted using propensity score-based inverse probability treatment weighting. Cox proportional regression was used to estimate the hazard ratio (HR) of clinical sequelae, cardiovascular, and all-cause mortality 21 days after COVID-19 infection.

Findings  A total of 535,186 and 16,400 patients were diagnosed with COVID-19 from HKHA and UKB, of whom 253,872 (47.4%) and 7613 (46.4%) were male, with a mean age (±SD) of 53.6 (17.8) years and 65.0 (8.5) years, respectively. Patients with COVID-19 incurred greater risk of heart failure (HR 1.82; 95% CI 1.65, 2.01), atrial fibrillation (1.31; 1.16, 1.48), coronary artery disease (1.32; 1.07, 1.63), deep vein thrombosis (1.74; 1.27, 2.37), chronic pulmonary disease (1.61; 1.40, 1.85), acute respiratory distress syndrome (1.89; 1.04, 3.43), interstitial lung disease (3.91; 2.36, 6.50), seizure (2.32; 1.12, 4.79), anxiety disorder (1.65; 1.29, 2.09), post-traumatic stress disorder (1.52; 1.23, 1.87), end-stage renal disease (1.76; 1.31, 2.38), acute kidney injury (2.14; 1.69, 2.71), pancreatitis (1.42; 1.10, 1.83), cardiovascular (2.86; 1.25, 6.51) and all-cause mortality (4.16; 2.11, 8.21) mortality during their post-acute phase of infection.

Interpretation  The consistent greater risk of PASC highlighted the need for sustained multi-disciplinary care for COVID-19 survivors.

© 2023 The Author(s). Published by Elsevier Ltd.

Original language	English
Article number	102000
Journal	EClinicalMedicine
Volume	60
Online published	11 May 2023
DOIs	https://doi.org/10.1016/j.eclinm.2023.102000
Publication status	Published - Jun 2023

Funding

This work is supported by the Health Bureau, The Government of the Hong Kong Special Administrative Region (Ref. No. COVID19F01), and Collaborative Research Fund, University Grants Committee, The Government of the Hong Kong Special Administrative Region (Ref. No. C7154-20GF).

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Research Keywords

COVID-19
PASC
Post-acute sequelae of SARS-CoV-2
SARS-CoV-2

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This full text is made available under CC-BY-NC-ND 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/

RGC Funding Information

RGC-funded

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Lam, I. C. H., Wong, C. K. H., Zhang, R., Chui, C. S. L., Lai, F. T. T., Li, X., Chan, E. W. Y., Luo, H., Zhang, Q., Man, K. K. C., Cheung, B. M. Y., Tang, S. C. W., Lau, C. S., Wan, E. Y. F., & Wong, I. C. K. (2023). Long-term post-acute sequelae of COVID-19 infection: a retrospective, multi-database cohort study in Hong Kong and the UK. EClinicalMedicine, 60, Article 102000. https://doi.org/10.1016/j.eclinm.2023.102000

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title = "Long-term post-acute sequelae of COVID-19 infection: a retrospective, multi-database cohort study in Hong Kong and the UK",

abstract = "Background Evidence on post-acute sequelae of SARS-CoV-2 (PASC) has shown inconsistent findings. This study aimed to generate coherent evidence on the post-acute sequelae of COVID-19 infection using electronic healthcare records across two regions. Methods In this retrospective, multi-database cohort study, patients with COVID-19 aged 18 or above between April 1st 2020 and May 31st 2022 from the Hong Kong Hospital Authority (HKHA) and March 16th 2020 and May 31st 2021 from the UK Biobank (UKB) databases and their matched controls were followed for up to 28 and 17 months, respectively. Covariates between patients with COVID-19 and non-COVID-19 controls were adjusted using propensity score-based inverse probability treatment weighting. Cox proportional regression was used to estimate the hazard ratio (HR) of clinical sequelae, cardiovascular, and all-cause mortality 21 days after COVID-19 infection. Findings A total of 535,186 and 16,400 patients were diagnosed with COVID-19 from HKHA and UKB, of whom 253,872 (47.4%) and 7613 (46.4%) were male, with a mean age (±SD) of 53.6 (17.8) years and 65.0 (8.5) years, respectively. Patients with COVID-19 incurred greater risk of heart failure (HR 1.82; 95% CI 1.65, 2.01), atrial fibrillation (1.31; 1.16, 1.48), coronary artery disease (1.32; 1.07, 1.63), deep vein thrombosis (1.74; 1.27, 2.37), chronic pulmonary disease (1.61; 1.40, 1.85), acute respiratory distress syndrome (1.89; 1.04, 3.43), interstitial lung disease (3.91; 2.36, 6.50), seizure (2.32; 1.12, 4.79), anxiety disorder (1.65; 1.29, 2.09), post-traumatic stress disorder (1.52; 1.23, 1.87), end-stage renal disease (1.76; 1.31, 2.38), acute kidney injury (2.14; 1.69, 2.71), pancreatitis (1.42; 1.10, 1.83), cardiovascular (2.86; 1.25, 6.51) and all-cause mortality (4.16; 2.11, 8.21) mortality during their post-acute phase of infection. Interpretation The consistent greater risk of PASC highlighted the need for sustained multi-disciplinary care for COVID-19 survivors. {\textcopyright} 2023 The Author(s). Published by Elsevier Ltd.",

keywords = "COVID-19, PASC, Post-acute sequelae of SARS-CoV-2, SARS-CoV-2",

author = "Lam, {Ivan Chun Hang} and Wong, {Carlos King Ho} and Ran Zhang and Chui, {Celine Sze Ling} and Lai, {Francisco Tsz Tsun} and Xue Li and Chan, {Esther Wai Yin} and Hao Luo and Qingpeng Zhang and Man, {Kenneth Keng Cheung} and Cheung, {Bernard Man Yung} and Tang, {Sydney Chi Wai} and Lau, {Chak Sing} and Wan, {Eric Yuk Fai} and Wong, {Ian Chi Kei}",

year = "2023",

month = jun,

doi = "10.1016/j.eclinm.2023.102000",

language = "English",

volume = "60",

journal = "EClinicalMedicine",

issn = "2589-5370",

publisher = "Elsevier Ltd.",

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TY - JOUR

T1 - Long-term post-acute sequelae of COVID-19 infection

T2 - a retrospective, multi-database cohort study in Hong Kong and the UK

AU - Lam, Ivan Chun Hang

AU - Wong, Carlos King Ho

AU - Zhang, Ran

AU - Chui, Celine Sze Ling

AU - Lai, Francisco Tsz Tsun

AU - Li, Xue

AU - Chan, Esther Wai Yin

AU - Luo, Hao

AU - Zhang, Qingpeng

AU - Man, Kenneth Keng Cheung

AU - Cheung, Bernard Man Yung

AU - Tang, Sydney Chi Wai

AU - Lau, Chak Sing

AU - Wan, Eric Yuk Fai

AU - Wong, Ian Chi Kei

PY - 2023/6

Y1 - 2023/6

N2 - Background Evidence on post-acute sequelae of SARS-CoV-2 (PASC) has shown inconsistent findings. This study aimed to generate coherent evidence on the post-acute sequelae of COVID-19 infection using electronic healthcare records across two regions. Methods In this retrospective, multi-database cohort study, patients with COVID-19 aged 18 or above between April 1st 2020 and May 31st 2022 from the Hong Kong Hospital Authority (HKHA) and March 16th 2020 and May 31st 2021 from the UK Biobank (UKB) databases and their matched controls were followed for up to 28 and 17 months, respectively. Covariates between patients with COVID-19 and non-COVID-19 controls were adjusted using propensity score-based inverse probability treatment weighting. Cox proportional regression was used to estimate the hazard ratio (HR) of clinical sequelae, cardiovascular, and all-cause mortality 21 days after COVID-19 infection. Findings A total of 535,186 and 16,400 patients were diagnosed with COVID-19 from HKHA and UKB, of whom 253,872 (47.4%) and 7613 (46.4%) were male, with a mean age (±SD) of 53.6 (17.8) years and 65.0 (8.5) years, respectively. Patients with COVID-19 incurred greater risk of heart failure (HR 1.82; 95% CI 1.65, 2.01), atrial fibrillation (1.31; 1.16, 1.48), coronary artery disease (1.32; 1.07, 1.63), deep vein thrombosis (1.74; 1.27, 2.37), chronic pulmonary disease (1.61; 1.40, 1.85), acute respiratory distress syndrome (1.89; 1.04, 3.43), interstitial lung disease (3.91; 2.36, 6.50), seizure (2.32; 1.12, 4.79), anxiety disorder (1.65; 1.29, 2.09), post-traumatic stress disorder (1.52; 1.23, 1.87), end-stage renal disease (1.76; 1.31, 2.38), acute kidney injury (2.14; 1.69, 2.71), pancreatitis (1.42; 1.10, 1.83), cardiovascular (2.86; 1.25, 6.51) and all-cause mortality (4.16; 2.11, 8.21) mortality during their post-acute phase of infection. Interpretation The consistent greater risk of PASC highlighted the need for sustained multi-disciplinary care for COVID-19 survivors. © 2023 The Author(s). Published by Elsevier Ltd.

AB - Background Evidence on post-acute sequelae of SARS-CoV-2 (PASC) has shown inconsistent findings. This study aimed to generate coherent evidence on the post-acute sequelae of COVID-19 infection using electronic healthcare records across two regions. Methods In this retrospective, multi-database cohort study, patients with COVID-19 aged 18 or above between April 1st 2020 and May 31st 2022 from the Hong Kong Hospital Authority (HKHA) and March 16th 2020 and May 31st 2021 from the UK Biobank (UKB) databases and their matched controls were followed for up to 28 and 17 months, respectively. Covariates between patients with COVID-19 and non-COVID-19 controls were adjusted using propensity score-based inverse probability treatment weighting. Cox proportional regression was used to estimate the hazard ratio (HR) of clinical sequelae, cardiovascular, and all-cause mortality 21 days after COVID-19 infection. Findings A total of 535,186 and 16,400 patients were diagnosed with COVID-19 from HKHA and UKB, of whom 253,872 (47.4%) and 7613 (46.4%) were male, with a mean age (±SD) of 53.6 (17.8) years and 65.0 (8.5) years, respectively. Patients with COVID-19 incurred greater risk of heart failure (HR 1.82; 95% CI 1.65, 2.01), atrial fibrillation (1.31; 1.16, 1.48), coronary artery disease (1.32; 1.07, 1.63), deep vein thrombosis (1.74; 1.27, 2.37), chronic pulmonary disease (1.61; 1.40, 1.85), acute respiratory distress syndrome (1.89; 1.04, 3.43), interstitial lung disease (3.91; 2.36, 6.50), seizure (2.32; 1.12, 4.79), anxiety disorder (1.65; 1.29, 2.09), post-traumatic stress disorder (1.52; 1.23, 1.87), end-stage renal disease (1.76; 1.31, 2.38), acute kidney injury (2.14; 1.69, 2.71), pancreatitis (1.42; 1.10, 1.83), cardiovascular (2.86; 1.25, 6.51) and all-cause mortality (4.16; 2.11, 8.21) mortality during their post-acute phase of infection. Interpretation The consistent greater risk of PASC highlighted the need for sustained multi-disciplinary care for COVID-19 survivors. © 2023 The Author(s). Published by Elsevier Ltd.

KW - COVID-19

KW - PASC

KW - Post-acute sequelae of SARS-CoV-2

KW - SARS-CoV-2

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DO - 10.1016/j.eclinm.2023.102000

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SN - 2589-5370

VL - 60

JO - EClinicalMedicine

JF - EClinicalMedicine

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ER -

Long-term post-acute sequelae of COVID-19 infection: a retrospective, multi-database cohort study in Hong Kong and the UK

Abstract

Funding

UN SDGs

Research Keywords

Publisher's Copyright Statement

RGC Funding Information

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