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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2024年8月12日

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  • Simone Vasilij Benatti,
  • Serena Venturelli,
  • Roberto Buzzetti,
  • Francesca Binda,
  • Luca Belotti,
  • Laura Soavi,
  • Ave Maria Biffi,
  • Maria Simonetta Spada,
  • Monica Casati,
  • Marco Rizzi,
  • Maria Grazia Alessio,
  • Chiara Ambaglio,
  • Tiziano Barbui,
  • Pietro Andrea Bonaffini,
  • Emi Bondi,
  • Giorgia Camera,
  • Greta Carioli,
  • Alessandra Carobbio,
  • Simonetta Cesa,
  • Caterina Conti,
  • Roberto Cosentini,
  • Giacomo Crotti,
  • Anna Falanga,
  • Simonetta Gerevini,
  • Arianna Ghirardi,
  • Andrea Giammarresi,
  • Giuseppe Greco,
  • Gianluca Imeri,
  • Marina Marchetti,
  • Claudia Marinaro,
  • Aicha Ouabou,
  • Ramona Pellegrini,
  • Giulia Previtali,
  • Giampaolo Quinzan,
  • Alessandro Rossini,
  • Michela Seghezzi,
  • Maria Sessa,
  • Roberta Severgnini,
  • Claudia Suardi,
  • Adriana Zanoletti,
  • Alberto Zucchi,
  • Gianluca Zuglian

摘要

Background

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.

Methods

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).

Results

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.

Conclusions

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.