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Symptoms and Health Outcomes Among Survivors of COVID-19 Infection 1 Year After Discharge From Hospitals in Wuhan, China

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Key Points

Question  What are the long-term health outcomes associated with COVID-19 infection 1 year after hospital discharge?

Findings  In this cohort study of 2433 patients who had been hospitalized with COVID-19, the most common symptoms at 1 year after discharge were fatigue, sweating, chest tightness, anxiety, and myalgia. Patients with severe disease had more postinfection symptoms and higher chronic obstructive pulmonary disease assessment test scores.

Meaning  This study reported prolonged symptoms of COVID-19 and found that severe disease during hospitalization was a risk factor for more symptoms and higher chronic obstructive pulmonary disease assessment test scores.


Importance  The long-term health outcomes and symptom burden of COVID-19 remain largely unclear.

Objective  To evaluate health outcomes of COVID-19 survivors 1 year after hospital discharge and to identify associated risk factors.

Design, Setting, and Participants  This retrospective, multicenter cohort study was conducted at 2 designated hospitals, Huoshenshan Hospital and Taikang Tongji Hospital, both in Wuhan, China. All adult patients with COVID-19 discharged between February 12 and April 10, 2020, were screened for eligibility. Of a consecutive sample of 3988 discharged patients, 1555 were excluded (796 declined to participate and 759 were unable to be contacted) and the remaining 2433 patients were enrolled. All patients were interviewed via telephone from March 1 to March 20, 2021. Statistical analysis was performed from March 28 to April 18, 2021.

Exposures  COVID-19.

Main Outcomes and Measures  All patients participated in telephone interviews using a series of questionnaires for evaluation of symptoms, along with a chronic obstructive pulmonary disease (COPD) assessment test (CAT). Logistic regression models were used to evaluate risk factors for fatigue, dyspnea, symptom burden, or higher CAT scores.

Results  Of 2433 patients at 1-year follow-up, 1205 (49.5%) were men and 680 (27.9%) were categorized into the severe disease group as defined by the World Health Organization guideline; the median (IQR) age was 60.0 (49.0-68.0) years. In total, 1095 patients (45.0%) reported at least 1 symptom. The most common symptoms included fatigue, sweating, chest tightness, anxiety, and myalgia. Older age (odds ratio [OR], 1.02; 95% CI, 1.01-1.02; P < .001), female sex (OR, 1.27; 95% CI, 1.06-1.52; P = .008), and severe disease during hospital stay (OR, 1.43; 95% CI, 1.18-1.74; P < .001) were associated with higher risks of fatigue. Older age (OR, 1.02; 95% CI, 1.01-1.03; P < .001) and severe disease (OR, 1.51; 95% CI, 1.14-1.99; P = .004) were associated with higher risks of having at least 3 symptoms. The median (IQR) CAT score was 2 (0-4), and a total of 161 patients (6.6%) had a CAT score of at least 10. Severe disease (OR, 1.84; 95% CI, 1.31-2.58; P < .001) and coexisting cerebrovascular diseases (OR, 1.95; 95% CI, 1.07-3.54; P = .03) were independent risk factors for CAT scores of at least 10.

Conclusions and Relevance  This study found that patients with COVID-19 with severe disease during hospitalization had more postinfection symptoms and higher CAT scores.

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Article Information

Accepted for Publication: July 17, 2021.

Published: September 29, 2021. doi:10.1001/jamanetworkopen.2021.27403

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Zhang X et al. JAMA Network Open.

Corresponding Authors: Li Li, MD, Professor, Department of Respiratory Medicine (, and Lixia Cheng, MS, Department of Medical Quality Management (, Daping Hospital, Army Medical University, Chongqing 400042, China.

Author Contributions: Dr Li and L. Cheng had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Mss Zhang and F. Wang and Dr Shen contributed equally to this work.

Concept and design: Shen, Liu, He, Cao, Cheng, Li.

Acquisition, analysis, or interpretation of data: Xue Zhang, F. Wang, Shen, Xiao-Hua Zhang, Cen, B. Wang, Zhao, Zhou, Hu, M. Wang, Miao, Jones, Ma, Cao, Cheng, Li.

Drafting of the manuscript: Xue Zhang, F. Wang, Shen, Xiao-Hua Zhang, Cen, B. Wang, Zhou, Hu, M. Wang, He, Cao, Cheng, Li.

Critical revision of the manuscript for important intellectual content: Shen, Zhao, Liu, Miao, Jones, Ma, Li.

Statistical analysis: F. Wang, Shen, Zhao, Ma.

Obtained funding: Ma, Cheng, Li.

Administrative, technical, or material support: Shen, Liu.

Supervision: Shen.

Conflict of Interest Disclosures: Dr Jones reported personal fees from GlaxoSmithKline Employee and stocks and shares from GlaxoSmithKline outside the submitted work. No other disclosures were reported.

Funding/Support: This work was supported by the National Natural Science Foundation of China (81672287), the Joint Scientific Research Project of the Chongqing Health Commission and the Science and Technology Commission (2020FYYX213),the Outstanding Youth Science Fund of Chongqing (cstc2020jcyjjqX0014), Chongqing Talent Fund (CQYC202005003) and by the Science Foundation for Outstanding Young People of the Army Medical University.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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