Prevalence and Risk Factors of Post-Acute Sequelae of COVID-19 Among United States Veterans Open Access

Abstract

Introduction: There is evidence for persisting symptoms and incident conditions after an acute infection with SARS-CoV-2. Early identification of the prevalence and key risk factors for post-acute sequelae of COVID-19 (PASC) is a public health priority. To better understand PASC in the Veteran population, this study aims to determine the prevalence of PASC and identify risk factors associated with its development. This study also aims to determine if post-acute sequalae of COVID-19 risk varies by time period of infection.

 

Methods: This retrospective cohort study included 363,825 active Veterans that tested positive for COVID-19 between February 1, 2020, and September 30, 2022. risk factors of interest included sociodemographic, social determinants of health (SDOH), and clinical characteristics, The primary outcome was the development of PASC 90 to 180 days following an acute infection with SARS-CoV-2. Multivariate logistic regression was utilized to examine factors associated with post-acute sequelae of COVID-19.

 

Results: Of the 363,825 Veterans included in the analysis, 164,315 (45%) displayed symptoms of Post-Acute Sequelae of COVID-19 (PASC) 30 to 180 days following an acute infection with COVID-19. The Veterans in this analysis were predominantly male, non-Hispanic White, under the age of 65 years old, and lived in an urban residence. The strongest sociodemographic predictors for PASC included Hispanic ethnicity compared to Non-Hispanic White race (aOR=1.08), being between the ages of 50 and 64 compared to ages 50 and below (aOR=1.17) and living in an urban residence compared to living in a rural residence (aOR=1.04). The strongest clinical predictors for PASC included: depression (aOR=1.33), diabetes (aOR=8.46), alcohol abuse (aOR=2.71), drug abuse (aOR=2.94), and severe acute infection (aOR=1.42).

 

Discussion: Results demonstrate potential health inequities for vulnerable individuals, as well as increased risk for individuals with pre-existing comorbidities. Future research is necessary to continue identifying risk factors and pathophysiology to reduce the burden of PASC. The prevalence of PASC provides estimates for future health care utilization. This can be used by healthcare professionals to develop strategies in preparation of higher utilization. Additionally, these sociodemographic, SDOH, and clinical risk factors can aid in public health interventions to reduce the burden of PASC for individuals who had COVID-19.  

 

Table of Contents

Table of Contents

I.     Background

    A. Symptoms

       B. Risk Factors

    C. Veteran Population

    D. Gaps in the Literature

    E. Study Objectives

II.   Methods

    A. Study Population

    B. Data Sources

    C. Data Measures

    D. Statistical Analysis

III.  Results

IV.  Discussion

V.   References

VI.  Figures and Tables

 

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	United States Veterans Long COVID Infectious Diseases COVID-19
Committee Chair / Thesis Advisor	Julie Gazmararian, Emory University

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