Women, Smokers, and Overweight People Have a Higher Risk of Long COVID

By Rob Dillard - Last Updated: March 25, 2023

A new study finds that female sex, being over the age of 40, and being overweight are among the factors associated with post-COVID-19 condition, or Long COVID. The study also showed that being vaccinated significantly lowers the risk of Long COVID. The findings were reported this week in JAMA Internal Medicine.

The COVID-19 pandemic has appreciably increased morbidity and mortality worldwide. Its postviral symptoms – which include but are not limited to – dyspnea, headache, loss of smell and/or taste, and fatigue – have received many labels, but they are perhaps most commonly referred to as Long COVID. The World Health Organization defines Long COVID as post-acute COVID symptoms which persist 3 months post-infection with a duration of at least 2 months. Previous studies have assessed which individuals may be at a higher risk of Long COVID; however, as the researchers noted, these studies often had relatively few patients.

In this large-scale meta-analysis, researchers assayed Medline and Embase databases to identify 41 articles consisting of 860,783 patients with the goal of discerning risk factors and/or predictors of Long COVID in adult (18 years and older) patients. The risk factors for Long COVID which were measured included: patient age; sex; body mass index,  smoking status; comorbidities, including anxiety and/or depression, asthma, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, immunosuppression, and ischemic heart disease; as well as previous hospitalization or ICU admission as the result of COVID infection. Data analysis took place between December 5, 2022, and February 10, 2023.

A Concerning Link, but Vaccines Help!

The meta-analysis found that  female sex (OR=1.56; 95% CI, 1.41-1.73), age (OR=1.21; 95% CI, 1.11-1.33), high BMI (OR=1.15; 95% CI, 1.08-1.23), and smoking (OR=1.10; 95% CI, 1.07-1.13) were all correlated with an increased risk of developing PCC. Furthermore, the investigators noted, the presence of comorbidities and previous hospitalization or ICU admission were also linked with an elevated risk of PCC (OR= 2.48; 95% CI, 1.97-3.13 and OR, 2.37; 95% CI, 2.18-2.56, respectively). Encouragingly, the analysis showed that people who had been vaccinated against COVID-19 with 2 doses had a notably lower risk of developing PCC compared with patients who were not vaccinated (OR=0.57; 95% CI, 0.43-0.76).

“The findings of this systematic review and meta-analysis demonstrated that certain demographic characteristics (eg, age and sex) and comorbidities were significantly associated with an increased risk of developing PCC, whereas vaccination had a protective role against developing PCC sequelae,” the researchers concluded. “Given these results, a holistic approach and integrated care pathways may enable suitable support for patients who develop PCC and may allow physicians to be better prepared to care for patients at high risk of developing PCC. Moreover, in addition to preventing and diminishing the acute phase of the infection, COVID-19 vaccination may protect against PCC, giving vaccination additional evidence of benefit.”


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