Association between SARS-CoV-2 infection and select symptoms and conditions 31 to 150 days after testing among children and adults
Authors: Zhang Yongkang , Romieu-Hernandez Alfonso , Boehmer Tegan K. , Azziz-Baumgartner Eduardo , Carton Thomas W. , Gundlapalli Adi V. , Fearrington Julia , Nagavedu Kshema , Dea Katherine , Moyneur Erick , Cowell Lindsay G. , Kaushal Rainu , Mayer Kenneth H. , Puro Jon , Rasmussen Sonja A. , Thacker Deepika , Weiner Mark G. , Saydah Sharon , Block Jason P. ,   PCORnet Network Partners, Ahmad Faraz S. , Bunnell H. Timothy , Carrasquillo Olveen , Chrischilles Elizabeth A. , Christakis Dimitri A. , Chang Bernard P. , Curtis Janis L. , Fernandez Soledad A. , Forrest Christopher B. , Fort Daniel , Hanauer David A. , Hess Rachel , Horne Benjamin D. , Giordano Philip , Hogan William , Mosa Abu Saleh Mohammad , McClay James C. , Nandhakumar Samyuktha , Nolan Bridget , Obeid Jihad S. , Ostasiewski Brian , Paranjape Anuradha , Patel Lav , Rao Suchitra , Robinson Patricia S. , Trick William E. , Silverstein Jonathan C. 
Published: February 2024

Abstract
Background
An increasing number of studies have described new and persistent symptoms and conditions as potential post-acute sequelae of SARS-CoV-2 infection (PASC). However, it remains unclear whether certain symptoms or conditions occur more frequently among persons with SARS-CoV-2 infection compared with those never infected with SARS-CoV-2. We compared the occurrence of specific COVID-associated symptoms and conditions as potential PASC 31- to 150-day following a SARS-CoV-2 test among adults and children with positive and negative test results.

Methods
We conducted a retrospective cohort study using electronic health record (EHR) data from 43 PCORnet sites participating in a national COVID-19 surveillance program. This study included 3,091,580 adults (316,249 SARS-CoV-2 positive; 2,775,331 negative) and 675,643 children (62,131 positive; 613,512 negative) who had a SARS-CoV-2 laboratory test during March 1, 2020–May 31, 2021 documented in their EHR. We used logistic regression to calculate the odds of having a symptom and Cox models to calculate the risk of having a newly diagnosed condition associated with a SARS-CoV-2 positive test.

Results
After adjustment for baseline covariates, hospitalized adults and children with a positive test had increased odds of being diagnosed with ≥ 1 symptom (adults: adjusted odds ratio[aOR], 1.17[95% CI, 1.11–1.23]; children: aOR, 1.18[95% CI, 1.08–1.28]) or shortness of breath (adults: aOR, 1.50[95% CI, 1.38–1.63]; children: aOR, 1.40[95% CI, 1.15–1.70]) 31–150 days following a SARS-CoV-2 test compared with hospitalized individuals with a negative test. Hospitalized adults with a positive test also had increased odds of being diagnosed with ≥ 3 symptoms or fatigue compared with those testing negative. The risks of being newly diagnosed with type 1 or type 2 diabetes (adjusted hazard ratio[aHR], 1.25[95% CI, 1.17–1.33]), hematologic disorders (aHR, 1.19[95% CI, 1.11–1.28]), or respiratory disease (aHR, 1.44[95% CI, 1.30–1.60]) were higher among hospitalized adults with a positive test compared with those with a negative test. Non-hospitalized adults with a positive test also had higher odds or increased risk of being diagnosed with certain symptoms or conditions.

Conclusions
Patients with SARS-CoV-2 infection, especially those who were hospitalized, were at higher risk of being diagnosed with certain symptoms and conditions after acute infection.