Socio-economic conditions affect health-related quality of life, during recovery from acute SARS-CoV-2 infection

• Published in: BMC infectious diseases Vol. 24; no. 1; pp. 1 - 13
• Main Authors: Benatti, Simone Vasilij, Venturelli, Serena, Buzzetti, Roberto, Binda, Francesca, Belotti, Luca, Soavi, Laura, Biffi, Ave Maria, Spada, Maria Simonetta, Casati, Monica, Rizzi, Marco, Alessio, Maria Grazia, Ambaglio, Chiara, Barbui, Tiziano, Bonaffini, Pietro Andrea, Bondi, Emi, Camera, Giorgia, Carioli, Greta, Carobbio, Alessandra, Cesa, Simonetta, Conti, Caterina, Cosentini, Roberto, Crotti, Giacomo, Falanga, Anna, Gerevini, Simonetta, Ghirardi, Arianna, Giammarresi, Andrea, Greco, Giuseppe, Imeri, Gianluca, Marchetti, Marina, Marinaro, Claudia, Ouabou, Aicha, Pellegrini, Ramona, Previtali, Giulia, Quinzan, Giampaolo, Rossini, Alessandro, Seghezzi, Michela, Sessa, Maria, Severgnini, Roberta, Suardi, Claudia, Zanoletti, Adriana, Zucchi, Alberto, Zuglian, Gianluca
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 12.08.2024; BioMed Central; BMC
• Subjects: Analysis; Complications; COVID-19; Dyspnea; Economic aspects; Economic conditions; Epidemiology; Exercise; Expected values; Fatigue; Health aspects; Health-related-quality-of-life; Healthcare disparities; Hospitals; Hypotheses; Medical research; Medicine, Experimental; Mental disorders; Myalgia; Nosocomial infections; Pain; Patients; Post traumatic stress disorder; Psychological stress; Quality of life; Recovery; Recovery of function; Respiration; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Signs and symptoms; Social aspects; Socioeconomic factors; Socioeconomic status; Socioeconomics; Statistical analysis; Structural damage; Variables; Ventilation; Ventilators; Viral diseases; United Kingdom; United States; Italy
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-024-09502-x

Recovery from acute COVID-19 may be slow and incomplete: cases of Post-Acute Sequelae of COVID (PASC) are counted in millions, worldwide. We aimed to explore if and how the pre-existing Socio-economic-status (SES) influences such recovery. We analyzed a database of 1536 consecutive patients from the first wave of COVID-19 in Italy (February-September 2020), previously admitted to our referral hospital, and followed-up in a dedicated multidisciplinary intervention. We excluded those seen earlier than 12 weeks (the conventional limit for a possible PASC syndrome), and those reporting a serious complication from the acute phase (possibly accounting for symptoms persistence). We studied whether the exposition to disadvantaged SES (estimated through the Italian Institute of Statistics's model - ISTAT 2017) was affecting recovery outcomes, that is: symptoms (composite endpoint, i.e. at least one among: dyspnea, fatigue, myalgia, chest pain or palpitations); Health-Related-Quality-of-Life (HRQoL, as by SF-36 scale); post-traumatic-stress-disorder (as by IES-R scale); and lung structural damage (as by impaired CO diffusion, DLCO). Eight-hundred and twenty-five patients were included in the analysis (median age 59 years; IQR: 50-69 years, 60.2% men), of which 499 (60.5%) were previously admitted to hospital and 27 (3.3%) to Intensive-Care Unit (ICU). Those still complaining of symptoms at follow-up were 337 (40.9%; 95%CI 37.5-42.2%), and 256 had a possible Post-Traumatic Stress Disorder (PTSD) (31%, 95%CI 28.7-35.1%). DLCO was reduced in 147 (19.6%, 95%CI 17.0-22.7%). In a multivariable model, disadvantaged SES was associated with a lower HRQoL, especially for items exploring physical health (Limitations in physical activities: OR = 0.65; 95%CI = 0.47 to 0.89; p = 0.008; AUC = 0.74) and Bodily pain (OR = 0.57; 95%CI = 0.40 to 0.82; p = 0.002; AUC = 0.74). We did not observe any association between SES and the other outcomes. Recovery after COVID-19 appears to be independently affected by a pre-existent socio-economic disadvantage, and clinical assessment should incorporate SES and HRQoL measurements, along with symptoms. The socioeconomic determinants of SARS-CoV-2 disease are not exclusive of the acute infection: this finding deserves further research and specific interventions.