Prevalence, Risk Factors and Characterisation of Individuals with Long COVID Using Electronic Health Records in Over 1.5 Million COVID Cases in England

Background: Long-COVID has a significant and long-lasting impact on individuals’ health and well-being, but little is known about its clinical risk factors. This study aims to describe the prevalence of clinically confirmed long-COVID symptoms among individuals seeking medical attention and explore associated risk factors using electronic health records in England. Method: A population-based longitudinal cohort study was conducted using the linked data from Clinical Practice Research Datalink for 1,554,040 individuals with confirmed SARS-CoV-2 infection. Descriptive statistics were used to explore the prevalence of long-COVID symptoms after 12-weeks from index date and Cox regression models for risk factors for having long-COVID symptoms. Sensitivity analysis was conducted to test the impact of right-censoring data. Findings: During an average 400-day follow-up, 7.4% of those seeking medical attention following acute COVID-19 had at least one long-COVID symptom. However, only 0.5% had long-COVID diagnostic codes recorded in the electronic medical records. The most common long-COVID symptoms were cough (17·7%), back pain (15·2%), stomach-ache (11·2%), headache (11·1%), and sore throat (10·0%). Risk factors associated with long-COVID symptoms were: female sex, non-white ethnicity, obesity, and pre-existing medical conditions such as anxiety, depression, type II diabetes, and somatic symptom disorders. Interpretation: This study is the first to investigate the prevalence and risk factors of clinically confirmed long-COVID in the general population. The findings could help clinicians identify higher risk individuals for timely intervention and allow decision-makers to more efficiently allocate resources for managing long-COVID.Funding: Funded by NIHR (COV-LT2-0043) as part of the STIMULATE-ICP study.Declaration of Interest: CFC received travel and accommodation in UK for lectures from The Lloyd Register Foundation and honoraries from Janssen UK and royalties for books on psychiatry. CFC has also received grants from the National Institute for Health Research, British Medical Association, European Union’s Horizon 2020 research programme and the Netherlands Organisation for Health Research and Development. AB has received grants and/or fees from the National Institute for Health Research, British Medical Association, UK Research and Innovation, European Union’s Horizon 2020 research and innovation programme and EFPIA, and AstraZeneca. MGC has received grants, fees and/or non-financial support from the National Institute for Health and Care Research, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Philips, and Pfizer. All other authors have no conflicts of interest to report.Ethical Approval: A data-use agreement for CPRD records and linked HES and Office for National Statistics mortality data was granted by the CPRD Independent Scientific Advisory Committee (protocol number: 22_001739). Individual consent is not required for observational CPRD studies, but individuals can opt out of contributing to the database.