Associations between SARS-CoV-2 infection and incidence of new chronic condition diagnoses: a systematic review

ABSTRACT

Because of the large number of infected individuals, an estimate of the future burdens of the long-term consequences of SARS-CoV-2 infection is needed. This systematic review examined associations between SARS-CoV-2 infection and incidence of categories of and selected chronic conditions, by age and severity of infection (inpatient vs. outpatient/mixed care). MEDLINE and EMBASE were searched (1 January 2020 to 4 October 2022) and reference lists scanned. We included observational studies from high-income OECD countries with a control group adjusting for sex and comorbidities. Identified records underwent a two-stage screening process. Two reviewers screened 50% of titles/abstracts, after which DistillerAI acted as second reviewer. Two reviewers then screened the full texts of stage one selections. One reviewer extracted data and assessed risk of bias; results were verified by another. Random-effects meta-analysis estimated pooled hazard ratios (HR). GRADE assessed certainty of the evidence. Twenty-five studies were included. Among the outpatient/mixed SARS-CoV-2 care group, there is high certainty of a small-to-moderate increase (i.e. HR 1.26–1.99) among adults ≥65 years of any cardiovascular condition, and of little-to-no difference (i.e. HR 0.75–1.25) in anxiety disorders for individuals <18, 18–64, and ≥65 years old. Among 18–64 and ≥65 year-olds receiving outpatient/mixed care there are probably (moderate certainty) large increases (i.e. HR ≥2.0) in encephalopathy, interstitial lung disease, and respiratory failure. After SARS-CoV-2 infection, there is probably an increased risk of diagnoses for some chronic conditions; whether the magnitude of risk will remain stable into the future is uncertain.

KEYWORDS:

• COVID-19
• SARS-CoV-2
• incidence
• chronic conditions
• systematic review
• meta-analysis

Acknowledgements

Thank you to Becky Skidmore for peer-reviewing the database search strategies. We also thank Jingxuan Zhang, Murray Weeks, and Cynthia Robitaille for their guidance and insightful comments on this manuscript. The Public Health Agency of Canada funded this work under Contract no. 4500429095. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors. No endorsement by the Public Health Agency of Canada is intended or inferred.

Data availability statement

Data are available from the authors on reasonable request.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Public Health Agency of Canada, Canadian Institutes of Health Research, and the Stollery Children's Hospital Foundation. The Public Health Agency of Canada funded this work under Contract no. 4500429095. Dr. Hartling is supported by a Canada Research Chair in Knowledge Synthesis and Translation, and is a Distinguished Researcher with the Stollery Science Lab supported by the Stollery Children’s Hospital Foundation.