Self-Reported Everyday Functioning After COVID-19 Infection
Authors: Iwashyna Theodore J. , Smith Valerie A. , Seelye Sarah , Bohnert Amy S. B. , Boyko Edward J. , Hynes Denise M. , Ioannou George N. , Maciejewski Matthew L. , O’Hare Ann M. , Viglianti Elizabeth M. , Berkowitz Theodore S. , Pura John , Womer James , Kamphuis Lee A. , Monahan Max L. , Bowling C. Barrett ,   VA HSR&D COVID-19 Observational Research Collaboratory (CORC), Admon Andrew , Akgun Kathleen , Anderson Stacy , Aslan Mihaela , Au David , Backus Lisa , Bajema Kristina , Baraff Aaron , Batten Lisa , Berkowitz Theodore , Bernstein Taylor , Berry Wyatt Kristin , Bogdan Joseph , Bosworth Hayden , Boucher Nathan , Burwick Nicholas , Cabrales Aissa , Cano Jennifer , Chai Wen , Chen Jason , Cheung Kei-Hoi , Crothers Kristina , Curtis Jeffrey , Davis Marie , Del Monico Emily , Dobalian Aram , Doll Jacob , Dominitz Jason , Eastment McKenna , Fan Vincent , Ferguson Jacqueline , Floyd Breanna , Fox Alexandra , Goetz Matthew , Govier Diana , Green Pamela , Hastings Susan Nicole , Hauschildt Katie , Hawkins Eric , Hebert Paul , Helfand Mark , Hickok Alex , Horowitz Dana , Hough Catherine , Hu Elaine , Ikuta Kevin , Jones Barbara , Jones Makoto , Kamphuis Lee , Kaufman Brystana , Knight Sara , Korpak Anna , Korpela Peggy , Kumbier Kyle , Langa Kenneth , Laundry Ryan , Lavin Stacy , Li Yuli , Linquist Jennifer , McCready Holly , Michel Martha , Miles Amy , Milne Jessie , Monahan Max , Morelli Daniel , Mutalik Pradeep , Naylor Jennifer , Neiderhausen Meike , Newell Summer , Nugent Shannon , Ong Michael , Osborne Thomas , Peterson Matthew , Peterson Alexander , Prescott Hallie , Rajeevan Nallakkandi , Reddy Ashok , Rouse Marylena , Rowneki Mazhgan , Saha Som , Saini Sameer , Shah Javeed , Shahoumian Troy , Shaukat Aasma , Shepherd-Banigan Megan , Showalter Whitney , Slatore Christopher , Smith Nicholas , Smith Battista , Suri Pradeep , Sussman Jeremy , Takata Yumie , Teo Alan , Thomas Eva , Thomas Laura , Tuepker Anais , Veigulis Zachary , Vig Elizabeth , Vranas Kelly , Wang Xiao Qing , Wicks Katrina , Winchell Kara , Wong Edwin , Woods Chris , Wysham Katherine , Yan Lei , Zulman Donna 
Published: March 2024

Importance

Changes in everyday functioning are crucial to assessing the long-term impact of COVID-19 infection.

Objective

To examine the impact of COVID-19 infection on everyday functioning 18 months after infection among veterans with and without histories of COVID-19 infection.

Design, Setting, and Participants

This cohort study used data from the US Veterans Affairs (VA) and included 186 veterans who had COVID-19 between October 2020 and April 2021 (ie, COVID-19 cohort) and 186 matched comparators who did not have documented COVID-19 infections (ie, control cohort). This match balanced the risk of COVID-19 based on 39 variables measured in the 24 months before infection or match, using principles of target trial emulation. Data were analyzed from December 2022 to December 2023.

Exposure

First documented COVID-19.

Main Outcome and Measures

The differences in self-reported everyday functioning 18 months after COVID-19 infection were estimated and compared with their matched comparators. Within–matched pair logistic and linear regressions assessed differences in outcomes and were weighted to account for sampling and nonresponse.

Results

Among the 186 matched pairs of participants, their weighted mean age was 60.4 (95% CI, 57.5 to 63.2) years among veterans in the COVID-19 cohort (weighted sample, 91 459 of 101 133 [90.4%] male; 30 611 [30.3%] Black or African American veterans; 65 196 [64.4%] White veterans) and 61.1 (95% CI, 57.8 to 64.4) years among their comparators in the control cohort (91 459 [90.4%] male; 24 576 [24.3%] Black or African American veterans; 70 157 [69.4%] White veterans). A high proportion of veterans in the COVID-19 cohort (weighted percentage, 44.9% [95% CI, 34.2% to 56.2%]) reported that they could do less than what they felt they could do at the beginning of 2020 compared with the control cohort (weighted percentage, 35.3%; [95% CI, 25.6% to 46.4%]; within–matched pair adjusted odds ratio [OR], 1.52 [95% CI, 0.79 to 2.91]). There was no association of documented COVID-19 infection with fatigue, substantial pain, limitations in either activities of daily living and instrumental activities of daily living, severely curtailed life-space mobility, employment, or mean health-related quality of life on a utility scale.

Conclusions and Relevance

In this cohort study of veterans with and without documented COVID-19, many reported a substantial loss of everyday functioning during the pandemic regardless of whether or not they had a documented infection with COVID-19. Future work with larger samples is needed to validate the estimated associations.