A multinational cross-sectional study on the prevalence and predictors of long COVID across 33 countries
Mohamed Sayed Zaazouee, Eman Ayman Nada, Mohammed Al‐kafarna, Shaheen Ahmed, Shivabalan Kathavarayan Ramu, Abdelrahman Hafez, Sajeda Ghassan Matar, Ahmed N Assar, Mohamed Elshennawy, Hazem Abu El-Enien, Hala Jamal Redwan, Sarah Makram Elsayed, Maha Jabir Omran, Omar H. Salloum, Hossam Waleed Almadhoon, Mohamed Mamdouh, Engy A. Wahsh, Anas Zakarya Nourelden, Alaa Ahmed Elshanbary, Walid Abdel‐Aziz, Hivan Haji Rashid, Iman A. Basheti, Khaled Mohamed Ragab, Ahmed Taher Masoud, Abdelrahman Ibrahim Abushouk, Long-COVID International Team (LCIT), Aya Abdalhady Saleh, Ashraf Ahmed Hassan Hamed, Asmaa Gomaa Alwarraqi, Ahmed Mohamed Nour El-deen, Bashar Khaled Almaghary, Hedaya Ramzi Khrawat, Yousef Raid AbdAlrazeq, Saba Usama Turk, Shomoa Alaa Elhajjar, Yousuf Mohammed Deeb, Malak Yousef Badawi, Roa’a Mohammad Aljuneidi, Saja Emad Abusabha, Fida Hussien Al-Ali, Anwar Yousef Jabari, Nusaiba Mohamad Al Zaalan, Ahmed Hashem Fathallah, Dina Ibrahim, Eman Mahmoud, Bethel Abraha Gebremeskel, Abdelrahman Mohamed Mahmoud, Mai Mohammad Abdalraouf, Doaa Salah Elgendy, M.A. Elsayed, Hadir Atef Soliman, Manal Mohamed Ali, Mohamed A. Abd Elhameed, Asmaa Mohamed Saber, Taghreed Reda Moustafa, Shereen Elsayed Tawfeek, Rania Ramadan, Mahmoud M. Elhady, Arun Quadros Darian, Victor Carrera Gomes, Gabriela Maria Roncon, Fabio Deltreggia, Flavio Castagna de Sousa, João Vitor Eugenio Seabra, Ronaldo Sousa Oliveira Filho, Nada Mohammed Abdel-Aziz Mohammed Zaho, Talha Hannan Chaudhry, Kimanthi Cyrus, Nafisa Agil Hussein, Harshil Girish Patel, Waseth Joy Noela, Preetesh Jakharia, Misbah Akhtar, Mohamed Masoud, Mohamed A. El-Saied, Mohamed Reda Ezz, Aya Mohamed Rabie Abd Elghany, Ghadeer Magdy Elshafey, Khaled Abouelmagd, Ahmed Gamal Ahmed Shetia, Ghader Mofed Alibrahem, Rashid Ibrahim, Hala Aldeeb, Nouha Halim Moustafa, Ali Hosni, Souliman Ahmad Radeef, Lina Dalati, Elaf Sa’ad Aldeen Alashkar, Abdelkader Nabeel Malih, Hisham Alhosni, Mohammed Amir Rais, Bouchra Belhocine, Hadil Elbatoul Meguellatni, Samah Chaib, Hanane Hammoumi, Hadjer Belmerabet, Rayhana Khellafi, M. Amrani, Bouthaina Memmou, Abdelkader Kherbache
Abstract
The symptoms of long COVID (LC) can be debilitating and may be associated with anxiety, social stigma, and quality of life deterioration. Identifying patients at risk of LC is important to offer follow-up care and plan population-level public health measures. The current multinational study aimed to assess the prevalence and predictors of LC in the general population. We conducted an online, multinational, cross-sectional survey between April 2022 and January 2023, targeting participants 18 years and older with a previously confirmed COVID-19 infection. We used convenience sampling to recruit participants through an online Google form. We collected demographic data, past medical history, infection details, post-COVID-19 symptoms, and quality of life. Responses were then translated into English. LC was defined as per the World Health Organization. A single-variable analysis was conducted to identify factors significantly associated with LC development. Following the removal of multicollinear variables, a generalized linear model was established to estimate the contribution of different predictors to LC occurrence. A total of 11,801 respondents from 33 countries were included in the analysis. The mean age for participants was 32.7 ± 12.8 years, with 61% being females. BMI averaged 25.2 ± 4.8 across participants, and 14.8% of them were smokers. Seventy-eight percent of participants reported receiving the COVID-19 vaccine. Respondents with PCR-confirmed COVID-19 were then categorized into those with LC (N = 2335, 19.8%) and without LC (N = 9466 individuals, 80.2%). Our model identified 25 significant predictors. The predictors of higher LC risk included ICU admission (OR 2.08; 95% CI 1.36, 3.18; P = 0.001), female sex (OR 1.8; 95% CI 1.61, 2.02; P < 0.001), fatigue during the infection (OR 1.6; 95% CI 1.43, 1.78; P < 0.001), identifying as Hispanic (OR 1.53; 95% CI 1.26, 1.85; P < 0.001), and pre-existing gastrointestinal disease (OR 1.48; 95% CI 1.22, 1.8; P < 0.001). In conclusion, we identified key LC predictors, including ICU admission, female sex, and acute fatigue as primary risk factors, while African American and Asian ethnicities and receiving even one dose of vaccination demonstrated protective effects.