Health-related quality of life among persons with initial mild, moderate, and severe or critical COVID-19 at 1 and 12 months after infection: a prospective cohort study
Authors: Verveen Anouk , Wynberg Elke , van Willigen Hugo D. G. , Davidovich Udi , Lok Anja , Moll van Charante Eric P. , de Jong Menno D. , de Bree Godelieve , Prins Maria , Knoop Hans , Nieuwkerk Pythia T. ,   the RECoVERED Study Group, Agard Ivette , Ayal Jane , Cavdar Floor , Craanen Marianne , Deuring Annemarieke , van Dijk Annelies , Ersan Ertan , del Grande Laura , Hartman Joost , Koedoot Nelleke , Leenstra Tjalling , Lebbink Romy , Loomans Dominique , Makowska Agata , du Maine Tom , de Man Ilja , Matser Amy , van der Meij Lizenka , van Polanen Marleen , Oud Maria , Reid Clark , Storey Leeann , van Wijk Marc , van den Aardweg Joost , van Assem Joyce , van Beek Marijne , Blankert Thyra , Dijkstra Maartje , Figaroa Orlane , Frenkel Leah , van Gils Marit , van Haga Jelle , Han Xiaochuan Alvin , Harskamp-Holwerda Agnes , Hazenberg Mette , Hidad Soemeja , de Jong Nina , Kootstra Neeltje , Kuijt Lara , Russell Colin , van der Straten Karlijn , van der Veen Annelou , Verkaik Bas , Visser Gerben-Rienk 
Published: November 2022

Background

Currently, there is limited evidence about the long-term impact on physical, social and emotional functioning, i.e. health-related quality of life (HRQL) after mild or moderate COVID-19 not requiring hospitalization. We compared HRQL among persons with initial mild, moderate or severe/critical COVID-19 at 1 and 12 months following illness onset with Dutch population norms and investigated the impact of restrictive public health control measures on HRQL.

Methods

RECoVERED, a prospective cohort study in Amsterdam, the Netherlands, enrolled adult participants after confirmed SARS-CoV-2 diagnosis. HRQL was assessed with the Medical Outcomes Study Short Form 36-item health survey (SF-36). SF-36 scores were converted to standard scores based on an age- and sex-matched representative reference sample of the Dutch population. Differences in HRQL over time were compared among persons with initial mild, moderate or severe/critical COVID-19 using mixed linear models adjusted for potential confounders.

Results

By December 2021, 349 persons were enrolled of whom 269 completed at least one SF-36 form (77%). One month after illness onset, HRQL was significantly below population norms on all SF-36 domains except general health and bodily pain among persons with mild COVID-19. After 12 months, persons with mild COVID-19 had HRQL within population norms, whereas persons with moderate or severe/critical COVID-19 had HRQL below population norms on more than half of the SF-36 domains. Dutch-origin participants had significantly better HRQL than participants with a migration background. Participants with three or more COVID-19 high-risk comorbidities had worse HRQL than part participants with fewer comorbidities. Participants who completed the SF-36 when restrictive public health control measures applied reported less limitations in social and physical functioning and less impaired mental health than participants who completed the SF-36 when no restrictive measures applied.

Conclusions

Twelve months after illness onset, persons with initial mild COVID-19 had HRQL within population norms, whereas persons with initial moderate or severe/critical COVID-19 still had impaired HRQL. Having a migration background and a higher number of COVID-19 high-risk comorbidities were associated with worse HRQL. Interestingly, HRQL was less impaired during periods when restrictive public health control measures were in place compared to periods without.