We estimated rate ratios for death, readmission, and multiorgan dysfunction after discharge from hospital compared with those in a matched general population control group, and the variations in the rate ratio (comparing outcome rates after hospital admission for covid-19 with expected risk in the general population) across demographic groups. From national electronic health records and death registrations for individuals in England, we quantified the incidence of mortality, use of health services, and organ specific impairment in individuals with covid-19 after discharge from hospital. ![]() We aimed to estimate the excess morbidity after severe covid-19 disease, reflecting an urgent need for such evidence by policy makers. Most studies so far have focused on symptoms associated with post-covid syndrome rather than organ dysfunction, and few have made use of a control group, allowing the inference of counterfactual outcomes. The existing evidence suggests large variations in estimates of the prevalence and incidence of post-covid syndrome because of the differences in study populations, recruitment methods, follow-up periods, and sample sizes. ![]() When post-covid syndrome clinics are established, characterisation of the epidemiology of the disease will help with appropriate diagnosis, care, public health interventions and policy, and resource planning. 14 Pre-existing conditions and risk factors are predictors of acute covid-19 outcomes (such as admission to the intensive care unit and mortality 2), but the epidemiology of post-covid syndrome has been less well defined 15 16 because of the unclear medium and long term pathophysiology across organ systems. Long covid, or post-covid syndrome, is not one condition, and is defined by the National Institute for Health and Care Excellence (NICE) as “signs and symptoms that develop during or after an infection consistent with covid-19 which continue for more than 12 weeks and are not explained by an alternative diagnosis.” 14 NICE guidelines recommend referral to post-covid syndrome assessment clinics if post-covid symptoms persist for 6-12 weeks. 11 12 13 Although the long term effects of covid-19 on individuals and health systems are becoming clear, investigation across organ systems is urgently needed. 5 Increasing evidence exists for direct multiorgan effects, 6 7 8 9 10 however, and indirect effects on other organ systems and disease processes, such as cardiovascular diseases and cancers, through changes in healthcare delivery and patient behaviours. Since SARS-CoV-2 infection was recognised in late 2019, the academic and clinical emphasis has been on respiratory manifestations. 3 4 Studies of the longer term effects on morbidity are needed to effectively plan healthcare delivery and capacity. 1 Research, health services, and the media have mostly focused on direct (through infection) and indirect (through changes in individual behaviours and health systems) effects of covid-19 on mortality, 2 particularly in the short term. ![]() In the early stages of the covid-19 pandemic, the estimated infection rate of SARS-CoV-2 in the United Kingdom was 6% (13% in London). Rate ratios were greater for individuals aged less than 70 than for those aged 70 or older, and in ethnic minority groups compared with the white population, with the largest differences seen for respiratory disease (10.5 (95% confidence interval 9.7 to 11.4) for age less than 70 years v 4.6 (4.3 to 4.8) for age ≥70, and 11.4 (9.8 to 13.3) for non-white v 5.2 (5.0 to 5.5) for white individuals). ![]() Rates of respiratory disease (P<0.001), diabetes (P<0.001), and cardiovascular disease (P<0.001) were also significantly raised in patients with covid-19, with 770 (95% confidence interval 758 to 783), 127 (122 to 132), and 126 (121 to 131) diagnoses per 1000 person years, respectively. Results Over a mean follow-up of 140 days, nearly a third of individuals who were discharged from hospital after acute covid-19 were readmitted (14 060 of 47 780) and more than 1 in 10 (5875) died after discharge, with these events occurring at rates four and eight times greater, respectively, than in the matched control group.
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