Post-Acute COVID-19 Sequelae in Cases Managed in the Community or Hospital in the UK: A Population Based Study

Background: It is unknown whether post-COVID-19 sequelae differ depending on infection severity. Methods: This population-based study using Clinical Practice Research Database Aurum included COVID-19 cases between 1st August - 17th October 2020 . Patients were classified as hospitalised (hospitalisation within two weeks of diagnosis) or non-hospitalised and followed up to three months. Event rates were calculated for new symptoms, diseases, prescriptions, healthcare utilisation and compared across groups with Cox regression. Outcomes were compared at 6 and 12 months prior to index date, equating to the first UK wave and a pre-pandemic period. Non-hospitalised group outcomes were stratified by age and sex. Findings: Of 46,687 patients, 45,272 were managed in the community; 1,415 hospitalised. Hospitalised patients had higher risk of 13/26 symptoms and 11/20 diseases post-COVID-19 diagnosis than the community group. The largest differences were noted for rates per 100 000 person-weeks [95%CI] of breathlessness: 536 [432 - 663] v. 85 [77-93]; joint pain: 295 [221-392] v. 168 [158-179]; diabetes: 303 [225 - 416] v. 36 [32 - 42], hypertension: 244 [178-344] v. 47 [41-53]. Although low, rates of chest tightness, tinnitus and lung fibrosis were higher in the community group . The hospitalised group received more prescriptions and utilised more healthcare. 3·5% of the community group had a post-acute burden; anxiety, breathlessness, chest pain and fatigue were most frequently reported, alongside bronchodilator prescriptions. In those non-hospitalised, age and sex differences existed in rates of symptoms, diseases and prescriptions. Healthcare utilisation in the community group increased 28·5% post-COVID-19 relative to pre-pandemic. Interpretation: Post-COVID-19 sequelae differ between hospitalised and non-hospitalised individuals, with age and sex-specific differences in symptoms, diseases and prescriptions post-COVID-19 in the community. Most people who have COVID-19 managed in the community have no ongoing issues. Post-COVID-19 follow-up and management strategies need to be tailored to specific needs. Funding: This work is supported by BREATHE - The Health Data Research Hub for Respiratory Health [MC_PC_19004]. Declaration of Interest: HRW, CG, AK, CK, AM, CI, MW have nothing to declare. RG is a current employee of Gilead Sciences, outside the submitted work. JKQ reports grants from AUK-BLF, The Health Foundation, grants and personal fees from AZ, BI, GSK, Bayer, grants from Chiesi, outside the submitted work.Ethical Approval: This work is based on data from the Clinical Practice Research Datalink (CPRD) obtained under license from the United Kingdom (UK) Medicines and Healthcare products Regulatory Agency (MHRA). The data is provided by patients and collected by the National Health Service (NHS) as part of their care and support.