Older Age, Persistent Symptoms Associated With Decreased Quality of Life in Nonhospitalized COVID-19

Caring for an older patient during a pandemic.
Caring for an older patient during a pandemic.
Researchers conducted a study that assessed the long-term burden of nonhospitalized COVID-19 infection, estimated via quality-adjusted life-days lost.

Older age and persistent symptoms at 6 months were found to be associated with increases in the number of quality-adjusted life-days (QALD) lost among nonhospitalized patients with COVID-19 infection, according to results of a study published in Clinical Infectious Diseases.

In this longitudinal, prospective, cohort study, researchers from England assessed the long-term burden of COVID-19 infection among patients aged 12 to 85 years with polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection. They sought to evaluate losses in health-related quality of life associated with COVID-19 infection via estimated losses in QALDs and EQ-5D instrumentation. The primary outcomes were QALDs lost, physical symptoms, and private expenditures related to COVID-19 infection; the duration of follow-up was 6 months. In addition, they used multivariable regression models with post hoc weighting on the basis of patient age and sex. Eligible patients (cases) were frequency-matched in a 1:3 fashion against healthy patients (controls) on the basis of geographic location to account for spatial distribution. Physical symptoms related to COVID-19 infection associated with EQ-5D limitation were assessed between the 2 groups via conditional logistic regression. At the time of enrollment, COVID-19 cases in England were predominantly caused by the wild-type strain and the Alpha variant.

The study comprised a total of 548 patients in the cases group vs 651 in the control group. Of patients in the cases and control groups, the mean age was 41.5 and 45.4 years, 61.5% and 70.7% were women, 1.28% and 0.77% were pregnant, and 81.57% and 86.79% were White, with figures calculated at baseline and at 6 months, respectively.  

More than 95% of patients with COVID-19 infection reported physical symptoms within 7 days of initial onset, of whom more than 50% had headache, severe fatigue, loss of taste and/or smell, and muscle ache. In regard to healthcare resources, 15.5% of patients in the cases group reported visits to a general practitioner, 45.3% managed their infection with nonprescription medications, and 52.7% missed school or work for a mean duration of 12 days.

After adjustment for age, sex, and geographic location, the estimated QALDs lost at baseline and at 6 months were 13.7 (95% CI, 9.7-17.7) and 32.9 (95% CI, 24.5-37.6), respectively, among all patients with COVID-19 infection. On further analysis of these patients, the researchers found that estimated losses in QALDs increased with age. Among patients aged between 12 and 24 years and those older than 65, the estimated number of QALDs lost were 7.2 (95% CI, 5.5-9.0) and 22.4 (95% CI, 14.6-30.2), respectively.

This study may have been limited by recall bias due to its retrospective design.

According to the researchers, “[these findings] stress the importance of COVID-19-related morbidity and the shortcoming of using deaths and hospitalizations as the main metrics for the severity of an epidemic.” Findings from this study “also showed that there is a substantial quality of life burden due to non-fatal COVID-19 at a population level, and particularly in younger ages,” the researchers concluded.

Disclosures: Some authors declared affiliations with pharmaceutical, biotech, and/or device companies. Please see the reference for a full list of disclosures.


Sandmann FG, Tessier E, Lacy J, et al. Long-term health-related quality of life in non-hospitalised COVID-19 cases with confirmed SARS-CoV-2 infection in England: longitudinal analysis and cross-sectional comparison with controls. Clin Infect Diseas. Published online March 5, 2022. doi.10.1093/cid/ciac151