National Questionnaire Survey on Post-Acute Symptoms and Health Problems After SARS-CoV-2 Infection in Denmark

participant

In this study, 430,173 people (40.0% were test positive) were invited to complete the questionnaire. A total of 153,412 (35.7%) participants answered the questionnaire completely, while 16,125 (3.7%) partially answered the questionnaire, while 260,637 (60.7%) individuals did not. did. Of those who responded to the questionnaire, 532 test negatives were excluded because they were reported to be seropositive, and responses from 152,880 participants became available for analysis. The survey was completed approximately 6 months (14.7%), 9 months (69.7%), and 12 months (15.5%) after the test.

Compared to non-responders, participants who completed the baseline questionnaire are more likely to be women born in Denmark, the elderly (ages 50-70), working in medical institutions, and living outside the metropolitan area. In many cases (supplementary table 1).

The response rates were very similar between the 171,992 test positives and the 258,181 test negatives that were asked to participate, at 35.5% and 35.8%, respectively.Participants consisted of 93,494 women (61.2%) and 59,386 men (38.8%) with median ages of 50 years (IQR: 36, 60) and 54 years (IQR: 41, 64), respectively. Was (table) 1).Compared to test negatives, test positives are more often: male, young, student or have full-time employment, are more physically active and less frequently: pensioners or smokers ( table 1).

At least one comorbidity was reported by 36.6% of participants (Supplementary Table) 1).

Symptoms before and after the test date (acute symptoms)

Of the test positives, 84.3% reported at least one acute symptom during the period from 1 week before the test to 4 weeks after the test, with a median of 6 symptoms, but a median of 4 negative tests. , The symptom was a trial indication. .. Of all test negatives, 13.5% reported at least one symptom before and after the test date, regardless of test indication, with a median of two different symptoms. The most common acute symptoms among positive tests were fever (55.0%), fatigue / fatigue (47.2%), and headache (44.1%) (supplementary figure). 1). The largest risk difference (RD) between test positive and test negative tested for symptoms is dysgeusia (change / decrease in taste) (RD = 34.49%, 95% CI 33.74–35.28%), dysosmia (Change / decrease) was observed. Smell) (RD = 33.87%, CI 95% 33.06–34.73%) and fever (RD = 23.90%, 95% CI 22.35–25.28%) (Supplementary figure. 1).

Symptoms 6 to 12 months after the test (post-acute symptoms)

Of the test positives, 29.6% reported at least one symptom 6-12 months after the test, compared to 13.0% of all test negatives. In both groups, two were median reported symptoms. The three most common symptoms 6-12 months after a positive test were fatigue / fatigue (11.1%), dysosmia (10.9%), and dysgeusia (8.8%) (Figure. 1). The most notable difference in risk between test positive and test negative 6-12 months after the test is dysosmia (RD = 10.92%, 95% CI 10.68-11.21%), dysgeusia (RD = 8.68%, It was 95% CI 8.43-8.93%). , And fatigue / fatigue (RD = 8.43%, 95% CI 8.14–8.74%) (Figure. 1). In addition, dyspnea, weakened legs / arms, sleeping legs / arms, muscle / joint pain, headache, dizziness, chest pain, loss of appetite, hot water / sweat, chills, fever, nausea, diarrhea, abdominal pain, and redness. All nasal discharges were significantly more common among test positives (figure. 1).

Note: Bars indicate risk differences (center), with 95% confidence intervals (error bar lengths) adjusted by age, gender, comorbidities, obesity, medical engagement, and post-test time (monthly). increase. For post-acute symptoms 6-12 months after the study date, all test negatives are used as the control population, regardless of study indication. All symptom questions were mandatory, so for every row, the ratio is based on 61,002 test-positive and 91,878 test-negative. Individuals could only participate in the study once, either as test positive or test negative.

New diagnosis and general health problems 6-12 months after test

At least one diagnosis of depression, anxiety, chronic fatigue symptoms (CFS), fibromyalgia, or post-traumatic stress disorder (PTSD) is within the first 6, 9, or 12 months after testing. New onset, reported by 7.2% of tests. Positive compared to 3.3% of test negatives. The most frequently reported diagnoses were chronic fatigue syndrome (4.0%), depression (3.5%), and anxiety (3.4%) (Figure. 2). All three diagnoses are more common among test positives compared to test negatives, with statistically significant risk differences of 2.53% (2.35–2.71%) and 1.00% (95% CI 0.81–1.19%). ), And 1.15% (95% CI 0.95–1.34). %), Each (figure). 2). PTSD was also slightly more common among test positives, with a statistically significant risk difference of 0.16% (95% CI 0.03–0.28%).

Note: Bars indicate risk differences (center), with 95% confidence intervals (error bar lengths) adjusted by age, gender, comorbidities, obesity, medical engagement, and post-test time (monthly). increase. PTSD = Post-traumatic stress disorder. For diagnoses that develop from test date to 6-12 months after test date, all test negatives are used as the control population, regardless of test indications. All symptom questions were mandatory, so for every row, the ratio is based on 61,002 test-positive and 91,878 test-negative. Individuals could only participate in the study once, either as test positive or test negative.

Of the test positives, 53.1% reported at least one of the following new problems within the first 6, 9, or 12 months from the date of the test. Memory problems; mental malaise; physical malaise or sleep disorders, while the test negative rate was 11.5%. The most common test positives are physical fatigue (RD = 40.45%, CI 95% 39.99–40.97%), mental fatigue (RD = 32.58%, 32.11–33.09%), and poor concentration. (RD = 28.34%, CI 95%). 27.91–28.78%) and memory issues (RD = 27.25%, CI 95% 26.80–27.71%) (Figure. 3). All of the aforementioned health problems were more often reported by test positives than by test negatives, which have a large risk difference (Figure). 3).

Note: Bars indicate risk differences (center), with 95% confidence intervals (error bar lengths) adjusted by age, gender, comorbidities, obesity, medical engagement, and post-test time (monthly). increase. For health problems that develop between the date of the study and 6 to 12 months after the date of the study, all test negatives are used as the control population, regardless of the indication of the study. All symptom questions were mandatory, so for every row, the ratio is based on 61,002 test-positive and 91,878 test-negative. Individuals could only participate in the study once, either as test positive or test negative.

Duration of individual symptoms

Looking at the estimated RD of the questionnaire, which was completed separately at 6, 9, or 12 months, the RD tended to decrease over time.Of the 10 symptoms with the highest overall RD, the estimates decreased over time for all symptoms except for dysosmia and dysgeusia, which had the highest estimates at 9 months (Supplementary Table). 3).

Post-acute symptoms of inpatients

We compared the occurrence of post-acute symptoms between test-positive individuals who were hospitalized for covid-19 (4.0%) and those who were not hospitalized (96.0%) (supplementary figure). 2). Significant fatigue / fatigue (RD = 8.64%, 95% CI 6.70–10.74%), weakened arms / legs (RD = 7.13%, 95% CI 5.55–8.66%), dyspnea (RD = 6.71) The risk difference was observed. %, 95% CI 5.17–8.39). The risk of all symptoms except dysgeusia, olfactory dysfunction, and runny nose was higher in hospitalized people than in non-hospitalized people.

Post-acute symptoms stratified by age and gender

To assess the presence of subgroups at high risk of post-acute symptoms, the risk differences for symptoms 6-12 months after the test were stratified by age group and gender (Figure. Four And supplementary data 1). Based on descriptive results, the majority of post-acute symptoms tended to be reported by women, especially participants aged 30-59 years. Stratified RDs who experienced at least one of fatigue / fatigue, dysgeusia, dysosmia, and 6-12 months post-test symptoms were female (RD = 18.5-18.5%) compared to males (RD = 18.5-18.5%). 18.0%, 95% CI 17.5-18.5%) were higher. 13.1%, 95% CI 12.6–13.5%). In addition, the RD for experiencing at least one of these symptoms is 30-59 years (RD = 18.2%, 95% CI 17.7-) compared to all other age groups (15-29 and 60+). It was high at 18.7%) (RD = 13.5%, 95% CI 13.0–13.9%).

Note: The 95% confidence interval (error band width) risk difference (center) was adjusted for comorbidity, obesity, health care, and post-test time (monthly).

Similar trends and more pronounced differences were observed for new developments of memory, concentration, or sleep problems, as well as mental or physical fatigue (supplementary figure). 3 And supplementary data 2). The risk difference for new onset of anxiety diagnosis was highest among women aged 20-29 years (supplementary figure). Four And supplementary data 3). Depression was reported more frequently between the ages of 30 and 39, regardless of gender.

Sick leave

Full-time or part-time sick leave was more common after SARS-CoV-2 infection. 12.0% of test positives reported taking sick leave 4 weeks and 6-12 months after the test until they completed the questionnaire. In contrast, 7.7% of test negatives (RD = 4.32%, 95% CI 4.00-4.64%). Full-time sick leave was reported in 9.4% of test positives and 6.5% of test negatives (RD = 3.20, 95% CI 2.88–3.47%), while part-time sick leave was compared to 1.7. It was reported in 4.2% of test positives. Test negative% (RD = 2.43%, 95% CI 2.25–2.62%). Some individuals reported both full-time and part-time sick leave.