The long-term impact of the burden of COVID-19 on health-related quality of life

A recent study conducted on residents of Amsterdam, the Netherlands, described that people with mild coronavirus disease 2019 (COVID-19) had a better health-related quality of life one year after the onset of the disease than those with moderate or severe form of COVID-19. The study is published in the journal BMC Medicine.

Study: Health-related quality of life among persons with initial mild, moderate, and severe or critical COVID-19 at 1 and 12 months post-infection: a prospective cohort study. Image credit: fizkes/Shutterstock

Background

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has severely affected the physical and mental health of affected people around the world. A significant proportion of people affected by COVID-19 have been found to have long-term health effects even a year after initial diagnosis.

Studies examining health-related quality of life among patients with COVID-19 have mostly observed poor physical, mental, and social functioning among participants after the onset of illness. In contrast, several studies have documented satisfactory physical and functional recovery among participants. However, these studies were conducted on hospitalized patients with severe COVID-19.

In the current study, scientists examined the impact of mild, moderate, and severe COVID-19 on patients’ physical, mental, and social functioning (health-related quality of life) 1 and 12 months after illness onset. They also assessed the impact of pandemic-related control measures on health-related quality of life.

I study design

The study was conducted on adults in Amsterdam, the Netherlands, who had laboratory-confirmed COVID-19 of varying severity (mild, moderate, or severe). The 36-item Medical Outcomes Survey Short Form was administered to assess health-related quality of life one month and 12 months after disease onset.

The survey consisted of 36 items specifically focused on eight different domains, including physical, social and emotional functioning, mental health, amount of energy and pain, and general health perception.

Impact of COVID-19 burden on health-related quality of life

A total of 269 participants completed the health-related quality of life survey.

When disease severity was considered, participants with mild COVID-19 showed significantly better health-related quality of life than those with moderate or severe COVID-19. However, the level of health status was significantly higher at the 12th month than at the first month after the onset of the disease.

When migration status was taken into account, participants of Dutch origin had significantly better quality of health in terms of physical and social functioning and energy and pain levels than those with a migration origin from high- or low-/middle-income countries. Regarding the domains of general and mental health, participants of Dutch origin and those from low/middle income countries had significantly higher quality of life than participants from high income countries.

Participants with three or more high-risk comorbidities had the worst health-related quality of life than those with fewer than three comorbidities. Specifically, immunosuppression and psychiatric illness have the greatest impact on physical functioning and overall health, respectively.

Health-related quality of life assessed among participants in the first month after disease onset revealed significant deviation from reference standards at the population level. The highest and lowest deviations were observed for social functioning and bodily pain, respectively.

In terms of general health, participants with mild COVID-19 were within reference standards. Conversely, participants with moderate or severe COVID-19 had significantly lower quality of health.

Health-related quality of life assessed at 12 months revealed that participants with mild illness had physical, emotional and social functioning, energy level and general health similar to reference standards. However, no such improvement in health quality was observed in participants with moderate or severe COVID-19.

Impact of pandemic-related restrictions on health-related quality of life

Participants who completed the survey during the period of pandemic-related restrictions reported less mental health impairment and fewer limitations in social and physical functioning than those who completed the survey during the period without restrictions .

Significance of the study

The study shows that people with mild COVID-19 are able to regain normal levels of physical, social and emotional functioning one year after the initial diagnosis of the disease. However, people with initial moderate or severe COVID-19 experience a decline in health-related quality of life even one year after illness onset.

People with a migrant background or with a greater number of high-risk co-morbidities are more susceptible to a decline in health-related quality of life.

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