Age, Sex and Previous Comorbidities as Risk Factors Not Associated with SARS-CoV-2 Infection for Long COVID-19: A Systematic Review and Meta-Analysis
Open accessAbstract
Identification of predictors of long COVID-19 is essential for managing healthcare plans of patients. This systematic literature review and meta-analysis aimed to identify risk factors not associated with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, but rather potentially predictive of the development of long COVID-19. MEDLINE, CINAHL, PubMed, EMBASE, and Web of Science databases, as well as medRxiv and bioRxiv preprint servers were screened through 15 September 2022. Peer-reviewed studies or preprints evaluating potential pre-SARS-CoV-2 infection risk factors for the development of long-lasting symptoms were included. The methodological quality was assessed using the Quality in Prognosis Studies (QUIPSs) tool. Random-effects meta-analyses with calculation of odds ratio (OR) were performed in those risk factors where a homogenous long COVID-19 definition was used. From 1978 studies identified, 37 peer-reviewed studies and one preprint were included. Eighteen articles evaluated age, sixteen articles evaluated sex, and twelve evaluated medical comorbidities as risk factors of long COVID-19. Overall, single studies reported that old age seems to be associated with long COVID-19 symptoms (n = 18); however, the meta-analysis did not reveal an association between old age and long COVID-19 (n = 3; OR 0.86, 95% CI 0.73 to 1.03, p = 0.17). Similarly, single studies revealed that female sex was associated with long COVID-19 symptoms (n = 16); which was confirmed in the meta-analysis (n = 7; OR 1.48, 95% CI 1.17 to 1.86, p = 0.01). Finally, medical comorbidities such as pulmonary disease (n = 4), diabetes (n = 1), obesity (n = 6), and organ transplantation (n = 1) were also identified as potential risk factors for long COVID-19. The risk of bias of most studies (71%, n = 27/38) was moderate or high. In conclusion, pooled evidence did not support an association between advancing age and long COVID-19 but supported that female sex is a risk factor for long COVID-19. Long COVID-19 was also associated with some previous medical comorbidities.
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Pre-existing comorbidities, such as asthma, diabetes, obesity, and immunosuppressive conditions, can also be associated with higher risks of long COVID.
“Since pre-existing comorbidities, such as asthma, diabetes, obesity, and immunosuppressive conditions, can also be associated with higher risks of long COVID [3,7,8]”
From Protective effect of COVID-19 vaccination against long COVID syndrome: A systematic review and meta-analysis (2023) · cites this paper as [7]
Results §3.4 links asthma, obesity, and kidney transplantation to aspects of long COVID, supporting the cautious claim for those groups. It reports no difference in the number of long-COVID symptoms between patients with and without diabetes, however, and its transplant finding does not establish a risk for immunosuppressive conditions generally. The Discussion (§4.3) also cautions that the obesity association may be confounded. (LLM, conf=0.88)
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Weathering the Storm: How Age and Biologics Influence the COVID-19 Cytokine Surge
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Schizophrenia, Bipolar, or Major Depressive Disorder and Postacute Sequelae of COVID-19
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- Authors
- Notarte, K. I., de Oliveira, M. H. S., Peligro, P. J., Velasco, J. V., Macaranas, I., Ver, A. T., Pangilinan, F. C., Pastrana, A., Goldrich, N., Kavteladze, D., Gellaco, M. M. L., Liu, J., Lippi, G., Henry, B. M., & Fernández-de-las-Peñas, C.
- Affiliations
- Johns Hopkins University (US)
- Department of Biostatistics, State University of Maringa, Maringá 87020-900, Brazil
- University of Santo Tomas (PH)
- New York Medical College (US)
- University of Verona (IT)
- Cincinnati Children's Hospital Medical Center (US)
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, 28933 Madrid, Spain
- ORCID
- Venue
- Journal of Clinical Medicine
- Publisher
- MDPI AG
- Published
- 2022-12-09
- Volume
- 11
- Issue
- 24
- Pages
- 7314
- ISSN
- 2077-0383 (ISSN-L)
- PMC
- PMC9787827
- OpenAlex
- W4311974713
- Cited by
- 209
- References
- 71
- Citations by year
- 2026: 19 · 2025: 55 · 2024: 78 · 2023: 56 · 2022: 1
- FWCI
- 6.86
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Clinical Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Fondo Europeo De Desarrollo Regional—Recursos REACT-UE del Programa Operativo de Madrid 2014–2020
- Topics
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- long COVID, risk factors, age, sex differences, female sex as risk factor, comorbidities, obesity, diabetes mellitus, lung disease, organ transplantation, COVID-19 pandemic, prognostic factors, risk of bias
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