Key points Is the risk of selected new medical and mental health conditions higher within one year after hospitalization for severe COVID-19 compared to influenza or sepsis? Findings This population-based cohort study of 26,499 people hospitalized with COVID-19 compared to 17,516 historical controls with influenza, 282,473 historical controls with sepsis, and 52,878 people simultaneously hospitalized with sepsis found that COVID-19 was associated with elevated levels of 1 - year risk of venous thromboembolism but not 12 other prespecified conditions. Meaning Aside from an elevated risk of venous thromboembolism, the burden of post-acute conditions among those who survive hospitalization for COVID-19 may be comparable to other acute infections. |
Importance
People who survive hospitalization for COVID-19 are at risk of developing new cardiovascular, neurological, mental health, and inflammatory autoimmune conditions. It is unclear how the risks following hospitalization for COVID-19 compare to those of other serious infectious diseases.
Aim
To compare the risks of incident cardiovascular, neurological, and mental health conditions and rheumatoid arthritis at 1 year after COVID-19 hospitalization with 3 comparison groups: pre-pandemic influenza hospitalization and sepsis hospitalization before and during the COVID-19 pandemic. .
Design, environment and participants
This population-based cohort study included all adults hospitalized for COVID-19 between April 1, 2020 and October 31, 2021, historical comparison groups of people hospitalized for influenza or sepsis, and a comparison group contemporary of people hospitalized for sepsis in Ontario, Canada.
Exposure
Hospitalization due to COVID-19, influenza or sepsis.
Main result and measures
New onset of 13 prespecified conditions, including cardiovascular, neurological, and mental health conditions and rheumatoid arthritis, within 1 year of hospitalization.
Results
Of 379,366 included adults (median [IQR] age, 75 [63-85] years; 54% women), there were 26,499 people who survived hospitalization for COVID-19, 299,989 historical controls (17,516 for influenza and 282,473 for sepsis ), and 52,878 contemporary controls hospitalized for sepsis.
Hospitalization for COVID-19 was associated with an increased 1-year risk of venous thromboembolic disease compared with influenza (adjusted hazard ratio, 1.77; 95% CI, 1.36-2.31), but increased risks of developing selected ischemic and non-ischemic cerebrovascular and cardiovascular diseases, neurological disorders, rheumatoid arthritis, or mental health conditions compared to influenza or sepsis cohorts.
Conclusions and relevance In this cohort study, in addition to an elevated risk of venous thromboembolism within 1 year, the burden of post-acute medical and mental health conditions among those who survived COVID-19 hospitalization was comparable to other acute infectious diseases. This suggests that many of the post-acute consequences of COVID-19 may be related to the severity of the infectious disease requiring hospitalization rather than being direct consequences of SARS-CoV-2 infection. |
