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Wong MCS, Huang J, Wong YY, Wong GLH, Yip TCF, Chan RNY, Chau SWH, Ng SC, Wing YK, Chan FKL. Epidemiology, Symptomatology, and Risk Factors for Long COVID Symptoms: Population-Based, Multicenter Study. JMIR Public Health Surveill 2023; 9:e42315. [PMID: 36645453 PMCID: PMC9994465 DOI: 10.2196/42315] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Long COVID induces a substantial global burden of disease. The pathogenesis, complications, and epidemiological and clinical characteristics of patients with COVID-19 in the acute phase have been evaluated, while few studies have characterized the epidemiology, symptomatology, and risk factors of long COVID symptoms. Its characteristics among patients with COVID-19 in the general population remain unaddressed. OBJECTIVE We examined the prevalence of long COVID symptoms, its symptom patterns, and its risk factors in 4 major Chinese cities in order to fill the knowledge gap. METHODS We performed a population-based, multicenter survey using a representative sampling strategy via the Qualtrics platform in Beijing, Shanghai, Guangzhou, and Hong Kong in June 2022. We included 2712 community-dwelling patients with COVID-19 and measured the prevalence of long COVID symptoms defined by the World Health Organization (WHO), and their risk factors. The primary outcomes were the symptoms of long COVID, with various levels of impact. A descriptive analysis of the prevalence and distribution of long COVID symptoms according to disease severity was conducted. A sensitivity analysis of increasing the number of long COVID symptoms was also conducted. Univariate and multivariate regression analyses were performed to examine the risk factors of severe long COVID symptoms, including age, gender, marital status, current occupation, educational level, living status, smoking habits, monthly household income, self-perceived health status, the presence of chronic diseases, the use of chronic medication, COVID-19 vaccination status, and the severity of COVID-19. RESULTS The response rate was 63.6% (n=2712). The prevalence of long COVID, moderate or severe long COVID, and severe long COVID was 90.4% (n=2452), 62.4% (n=1692), and 31.0% (n=841), respectively. Fatigue (n=914, 33.7%), cough (n=865, 31.9%), sore throat (n=841, 31.0%), difficulty in concentrating (n=828, 30.5%), feeling of anxiety (n=817, 30.2%), myalgia (n=811, 29.9%), and arthralgia (n=811, 29.9%) were the most common severe long COVID symptoms. From multivariate regression analysis, female gender (adjusted odds ratio [aOR]=1.49, 95% CI 1.13-1.95); engagement in transportation, logistics, or the discipline workforce (aOR=2.52, 95% CI 1.58-4.03); living with domestic workers (aOR=2.37, 95% CI 1.39-4.03); smoking (aOR=1.55, 95% CI 1.17-2.05); poor or very poor self-perceived health status (aOR=15.4, 95% CI 7.88-30.00); ≥3 chronic diseases (aOR=2.71, 95% CI 1.54-4.79); chronic medication use (aOR=4.38, 95% CI 1.66-11.53); and critical severity of COVID-19 (aOR=1.52, 95% CI 1.07-2.15) were associated with severe long COVID. Prior vaccination with ≥2 doses of COVID-19 vaccines was a protective factor (aOR=0.35-0.22, 95% CI 0.08-0.90). CONCLUSIONS We examined the prevalence of long COVID symptoms in 4 Chinese cities according to the severity of COVID-19. We also evaluated the pattern of long COVID symptoms and their risk factors. These findings may inform early identification of patients with COVID-19 at risk of long COVID and planning of rehabilitative services.
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Affiliation(s)
- Martin Chi-Sang Wong
- Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Sha Tin, China.,Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, China.,School of Public Health, Peking University, Beijing, China.,School of Public Health, The Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junjie Huang
- Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Sha Tin, China.,Centre for Health Education and Health Promotion, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, China
| | - Yuet-Yan Wong
- Jockey Club School of Public Health & Primary Care, The Chinese University of Hong Kong, Sha Tin, China
| | - Grace Lai-Hung Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, China.,Medical Data Analytics Centre, The Chinese University of Hong Kong, Sha Tin, China.,Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, China
| | - Terry Cheuk-Fung Yip
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, China.,Medical Data Analytics Centre, The Chinese University of Hong Kong, Sha Tin, China.,Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, China
| | - Rachel Ngan-Yin Chan
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Tai Po, China
| | - Steven Wai-Ho Chau
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Tai Po, China
| | - Siew-Chien Ng
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, China.,Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, China
| | - Yun-Kwok Wing
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Tai Po, China
| | - Francis Ka-Leung Chan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, China.,Institute of Digestive Disease, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, China
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Ai S, Zhang J, Zhao G, Wang N, Li G, So HC, Liu Y, Chau SWH, Chen J, Tan X, Jia F, Tang X, Shi J, Lu L, Wing YK. Causal associations of short and long sleep durations with 12 cardiovascular diseases: linear and nonlinear Mendelian randomization analyses in UK Biobank. Eur Heart J 2021; 42:3349-3357. [PMID: 33822910 DOI: 10.1093/eurheartj/ehab170] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/15/2020] [Accepted: 03/06/2021] [Indexed: 02/05/2023] Open
Abstract
AIMS Observational studies have suggested strong associations between sleep duration and many cardiovascular diseases (CVDs), but causal inferences have not been confirmed. We aimed to determine the causal associations between genetically predicted sleep duration and 12 CVDs using both linear and nonlinear Mendelian randomization (MR) designs. METHODS AND RESULTS Genetic variants associated with continuous, short (≤6 h) and long (≥9 h) sleep durations were used to examine the causal associations with 12 CVDs among 404 044 UK Biobank participants of White British ancestry. Linear MR analyses showed that genetically predicted sleep duration was negatively associated with arterial hypertension, atrial fibrillation, pulmonary embolism, and chronic ischaemic heart disease after correcting for multiple tests (P < 0.001). Nonlinear MR analyses demonstrated nonlinearity (L-shaped associations) between genetically predicted sleep duration and four CVDs, including arterial hypertension, chronic ischaemic heart disease, coronary artery disease, and myocardial infarction. Complementary analyses provided confirmative evidence of the adverse effects of genetically predicted short sleep duration on the risks of 5 out of the 12 CVDs, including arterial hypertension, pulmonary embolism, coronary artery disease, myocardial infarction, and chronic ischaemic heart disease (P < 0.001), and suggestive evidence for atrial fibrillation (P < 0.05). However, genetically predicted long sleep duration was not associated with any CVD. CONCLUSION This study suggests that genetically predicted short sleep duration is a potential causal risk factor of several CVDs, while genetically predicted long sleep duration is unlikely to be a causal risk factor for most CVDs.
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Affiliation(s)
- Sizhi Ai
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, 33 A Kung Kok Street, Sha Tin District, Hong Kong SAR 000000, China.,Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 123 Huifu West Road, Yuexiu District, Guangzhou 510000, China.,Department of Cardiology, Heart Center, The First Affiliated Hospital of Xinxiang Medical University, 88 Jiankang Road, Weihui 453100, China
| | - Jihui Zhang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, 33 A Kung Kok Street, Sha Tin District, Hong Kong SAR 000000, China.,Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 123 Huifu West Road, Yuexiu District, Guangzhou 510000, China.,The Second School of Clinical Medicine, Southern Medical University, 253 Industrial Avenue Middle, Haizhu District, Guangzhou 510280, China
| | - Guoan Zhao
- Department of Cardiology, Heart Center, The First Affiliated Hospital of Xinxiang Medical University, 88 Jiankang Road, Weihui 453100, China
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639 Manufacturing Bureau Road, Huangpu District, Shanghai 200011, China
| | - Guohua Li
- Department of Cardiology, Heart Center, The First Affiliated Hospital of Xinxiang Medical University, 88 Jiankang Road, Weihui 453100, China
| | - Hon-Cheong So
- School of Biomedical Sciences, Department of Psychiatry, KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research of Common Diseases, Cheung Research Centre for Management of Parkinsonism, Faculty of Medicine, The Chinese University of Hong Kong, Da Xue Road, Horse Material Water, Sha Tin District, Hong Kong SAR 000000, China
| | - Yaping Liu
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, 33 A Kung Kok Street, Sha Tin District, Hong Kong SAR 000000, China
| | - Steven Wai-Ho Chau
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, 33 A Kung Kok Street, Sha Tin District, Hong Kong SAR 000000, China
| | - Jie Chen
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, 33 A Kung Kok Street, Sha Tin District, Hong Kong SAR 000000, China
| | - Xiao Tan
- Department of Neuroscience, Uppsala University, BMC, 3 Husargatan, Uppsala 75124, Sweden
| | - Fujun Jia
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 123 Huifu West Road, Yuexiu District, Guangzhou 510000, China
| | - Xiangdong Tang
- Sleep Medicine Center, Department of Respiratory and Critical Care Medicine, Mental Health Center, Translational Neuroscience Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu 610041, China
| | - Jie Shi
- National Institute on Drug Dependence, Peking University Sixth Hospital, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Lin Lu
- National Institute on Drug Dependence, Peking University Sixth Hospital, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yun-Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, 33 A Kung Kok Street, Sha Tin District, Hong Kong SAR 000000, China
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