MULTIMORBIDITY, MORBIDITIES, AND LONG COVID – findings of the Sulcovid longitudinal study (preprint)

Background The aim of this study was to evaluate the association between long COVID, morbidities, and multimorbidity in adults and older adults six to nine months after infection with the SARS-CoV-2 virus in Southern Brazil.Methods Baseline data were obtained from the longitudinal study, Sulcovid, conducted on individuals diagnosed with COVID-19 through RT-PCR testing from December 2020 to March 2021, who were symptomatic and living in a city in southern Brazil. Long COVID was assessed based on the affirmative response to at least one of the 18 symptoms investigated and categorized as musculoskeletal, neurological, respiratory, sensory, or digestive. Morbidities were assessed based on the presence of at least one of nine self-reported diseases. Data were analyzed using the Stata 15.0 statistical package. Crude and adjusted analyses were performed using Poisson regression to assess the relationships between morbidity, multimorbidity, and long COVID.Results In total, 2,919 people were interviewed. The most prevalent morbidities were anxiety (26.3%), hypertension (25.3%), and depression (19.4%). In addition, 17.8% reported two previous morbidities and 22.6% had three or more comorbidities. Individuals with depression (PR = 1.17 95% CI 1.05–1.30), anxiety (PR = 1.33 95% CI 1.21–1.47), two or more morbidities (PR = 1.22 95% CI 1.07–1.39), and three or more morbidities (PR = 1.40; 95% CI 1.24–1.57) were more likely to have long COVID. A linear trend was observed, where individuals with two and three or more morbidities were 1.22 (95% CI 1.07–1.39) and 1.40 (95% CI 1.24–1.57) times more likely to develop long COVID than those with no or one morbidity.Conclusions The findings of this study reinforce that individuals with morbidities and multimorbidities prior to infection had greater vulnerability to long COVID.

Demand met by health services by individuals with musculoskeletal pain starting after covid-19 infection? (preprint)

Objective: The present work was aimed to verify the relationship between the use of health services and the presence of discomfort and musculoskeletal discomfort after Covid-19 infection in adults and elderly people in the southern region of Brazil.  Methodology: This is a cross-sectional study with individuals over 18 years of age who were diagnosed with covid-19 between December 2020 and March 2021. Questionnaires were collected electronically (with tablets) through the REDCap plataform by means of phone calls. The outcomes used were the use of health services: Primary Health Care, general practitioner, unit and private emergency care and specialized services. The presence of musculoskeletal pain exposure was assessed using the Nordic questionnaire on musculoskeletal symptoms before and during and/or after COVID-19 infection in the following regions: cervical, upper limbs, thoracic, lumbar, and lower limbs. Poisson regression was used to assess the relationship between health care service use after covid-19 infection and musculoskeletal pain. Data were analyzed using the Stata 16.1 statistical package.  Results: A total of 2,919 individuals were interviewed. Overall, the use of health services was about 15 percentage points (p.p) higher in individuals with musculoskeletal pain when compared with people without musculoskeletal pain. In adjusted analysis, individuals who reported pain in all outcomes during and after covid-19 infection was up to twice as likely to use health services and, among them, the emergency care unit was the most used, especially in those with pain in the lower limbs RP=2.19 (CI95% 1.66-2.87) and chest pain RP=2.04 (CI95% 1.47-2.84). In view of this, the highest magnitudes of association were related to emergency care units, doctors, and specialized services, especially neurologists, who were two to three times more likely to seek this profession, followed by pulmonologists.  Conclusion: In view of this, a new demand for more integrated care is recommended in a care model that offers comprehensive follow-up due to the diversity of users with specific needs.

Health Services Use After Covid-19 Infection in Persons With Non-communicable Diseases (preprint)

The COVID-19 pandemic has triggered several changes in health care service at all levels, the primary and specialized care services had to be restructured hampering longitudinal follow-up. Thus, this scenario led to impaired disease management of patients with non-communicable diseases (NCDs), worsening the clinical picture of their pre-existing disease. This study aimed to evaluate the use of health services after COVID-19 infection in persons with non-communicable diseases (NCDs). This is a cross-sectional study in the city of Rio Grande with individuals aged 18 or older, from the urban area of the city, who had a positive diagnosis of COVID-19 by reverse transcription followed by polymerase chain reaction (RT-PCR) from December 2020 to March 2021. Participants were asked if they attend any healthcare services after COVID-19 infection. Regarding exposure, participants were asked if they had a medical diagnosis of the following NCDs: systemic arterial hypertension (SAH), diabetes mellitus (DM), respiratory diseases (RD) and heart diseases (HD). Descriptive analyzes were carried out and the Poisson regression was used to verify associations, with robust adjustment of variance. The likelihood of using healthcare services among participants with NCDs was up to four times when compared to individuals without it. Specifically, participants with NCDs were 67% (95% CI 1.33; 2.11) more likely to use urgent and emergency services. When analyzed by specific NCDs, only HD was associated with emergency room and emergency care unit use  (PR 2.14; CI95%1.30-3.54; PR1.70; CI95%1.31-2.20, respectively). An increased use of specialized services (i.e., cardiologist) is highlighted among individuals with at least one NCD (PR:3.77; CI95%2.97-4.80), SAH (PR:3.47; CI95%2.97-4.31) and DM (PR:3.87; CI95%3.11-4.81). People with NCD required more healthcare services after COVID-19 infection, regardless of their disease when compared to those without it.

Long COVID and Associated Factors in Individuals From Southern Brazil: a Population-based Study on COVID (preprint)

COVID-19 is an infection in which symptoms may persist after the acute phase. The aim of the present study was to verify the prevalence and factors associated with COVID-19 and to describe the main residual symptoms after 6–10 months of infection in individuals from the extreme south of Brazil. This was a cross-sectional study of 2919 individuals older than 18 diagnosed by RT‒PCR with COVID-19 in the city of Rio Grande/RS, Brazil, from December 2020 to March 2021 who were symptomatic, with data collected by telephone interview or home visit. The COVID-19 outcome was obtained from the sum of all symptoms that the individual claimed to continue having at the time of the interview, ranging from zero to 19. For the crude and adjusted analyses, we used Poisson regression with robust adjustment of variance calculating prevalence ratios (PRs) and their respective 95% confidence intervals. The adjusted analysis was performed by means of a hierarchical model built in four levels. The significance level adopted was 5%, and the analyses were performed with the statistical package Stata 16.1. The prevalence of COVID-long was 48.3% (95% CI 46.5; 50.1). The most prevalent residual symptoms were fatigue, memory loss, loss of attention, headache, loss of smell, muscle pain and loss of taste. The groups more likely to develop COVID-19 were female, exhibited anxiety, hypertension, heart problems, diabetes mellitus, musculoskeletal problems, respiratory problems, previous morbidities and hospitalization in a ward or ICU. Physical activity and self-perception of good and very good health were protective factors for the outcome. When adjusted, female gender, anxiety, morbidities and who were hospitalized remained associated with the outcome, while self-perception of good and very good health had a lower probability. This study showed that almost half of the individuals in the sample developed long COVID after 6–9 months of infection. Among the associated factors, female individuals and those with chronic conditions stand out, demanding the creation of public policies to promote integral and continued assistance to these individuals.

Socioeconomic inequities in the use of specialized health services following COVID-19 infection in individuals from Southern Brazil (preprint)

Background: Evidence on inequalities in the use of health services is important for public policy formulation, even more so in a pandemic context. The aim of this study was to evaluate socioeconomic inequities in the use of specialized health services according to health insurance and income, following COVID-19 infection in individuals residing in Southern Brazil. Methods: This was a cross-sectional telephone survey with individuals aged 18 years or older diagnosed with symptomatic COVID-19 using the RT-PCR test between December 2020 and March 2021. Questions were asked about attendance at a health care facility following COVID-19 infection, the facilities used, health insurance and income. Inequalities were assessed by the following measures: Slope Index of Inequality (SII) and Concentration Index (CIX). Adjusted analyses were performed using Poisson regression with robust variance adjustment using the Stata 16.1 statistical package.  Results: 2,919 people (76.4% of those eligible) were interviewed. Of these, 24.7% (95%CI 23.2; 36.3) used at least one specialized health service and 20.3% (95%CI 18.9; 21.8) had at least one consultation with a medical specialist after diagnosis of COVID-19 infection. Individuals with health insurance were more likely to use specialist services. The probability of using specialized services was up to three times higher among the richest compared to the poorest.  Conclusions: There are socioeconomic inequalities in the use of specialized services by individuals following COVID-19 infection in the far south of Brazil. There is a need to reduce difficulty in accessing and using specialized services.