COVID-19 Pandemic
Old symptoms, new diagnoses: Frequent care-seeking behaviour predict subsequent diagnosis of Post Covid Condition and Post Viral Fatigue Syndrome in Swedish women Agnes af Geijerstam* Agnes af Geijerstam Lauren Lissner Ailiana Santosa Maria Åberg Kirsten Mehlig Annika Rosengren
Background
Recent data shows that women are at higher risk of being diagnosed with Post Covid Condition than men. As of February 2022, 2,3% of all registered female COVID-19 cases in Sweden had been given this diagnosis, the majority in primary care without prior hospitalization. SARS-CoV-2 is not unique in its ability to cause post-acute sequelae, as shown by the use of the diagnosis Post-Viral Fatigue Syndrome. Both diagnoses are symptom based with vocal patient groups.
Aims
To compare risk factors for Post Covid condition (PCC) and post-viral syndrome in primary care. Particular attention will be given to prior medically unexplained symptoms, BMI and socio-economic status.
Methods
This is a registry based prospective cohort study including 318 541 women in the Swedish Medical Birth Registry, linked to registries with primary care data and demographic data. Logistic regression was used to calculate odds ratios for receiving a diagnosis of PCC or Post-viral syndrome. Baseline was set at first measurement of BMI. Follow-up was until 3 months prior to diagnosis, or until June 2024. Main exposure value was monthly rate of general practitioner visits with a symptom diagnosis.
Results
We found a clear prediction of both PCC and Post-viral syndrome by the rate of primary care contacts with a symptom diagnosis. Having more than 0,1 visits to a physician with a symptom diagnosis per month of follow-up gave OR 5,4 (95% CI 4,7-6,2) of later diagnosis with PCC, with less than 0,01 as reference. For Post-viral syndrome, the OR was 18,7 (95% CI 14,8-23,6).
BMI had no association with PCC. For Post-viral syndrome there was a trend of lower odds ratios for higher BMI. Higher education was positively associated with both diagnoses.
Conclusions
Symptom diagnoses are common in our population and are predictors of both PCC and Post-viral syndrome. Simultaneously, many diagnosed patients had no prior contact with primary care, raising questions about differing ethology of the symptoms leading to diagnose.