Objective To evaluate the excess risk and relative hazards for developing incident clinical sequelae after the acute phase of SARS-CoV-2 infection in adults aged 18-65. Design Retrospective cohort study. Setting Three merged data sources from a large United States health plan: a large national administrative claims database, an outpatient laboratory testing database, and an inpatient hospital admissions database. Participants Individuals aged 18-65 with continuous enrollment in the health plan from January 2019 to the date of a diagnosis of SARS-CoV-2 infection. Three comparator groups, matched by propensity score, to individuals infected with SARS-CoV-2: a 2020 comparator group, an historical 2019 comparator group, and an historical comparator group with viral lower respiratory tract illness. Main outcome measures More than 50 clinical sequelae after the acute phase of SARS-CoV-2 infection (defined as the date of first SARS-CoV-2 diagnosis (index date) plus 21 days) were identified using ICD-10 (international classification of diseases, 10th revision) codes. Excess risk in the four months after acute infection and hazard ratios with Bonferroni corrected 95% confidence intervals were calculated. Results 14% of adults aged ≤65 who were infected with SARS-CoV-2 (27 074 of 193 113) had at least one new type of clinical sequelae that required medical care after the acute phase of the illness, which was 4.95% higher than in the 2020 comparator group. The risk for specific new sequelae attributable to SARS-Cov-2 infection after the acute phase, including chronic respiratory failure, cardiac arrythmia, hypercoagulability, encephalopathy, peripheral neuropathy, amnesia (memory difficulty), diabetes, liver test abnormalities, myocarditis, anxiety, and fatigue, was significantly greater than in the three comparator groups (2020, 2019, and viral lower respiratory tract illness groups) (all P<0.001). Significant risk differences because of SARS-CoV-2 infection ranged from 0.02 to 2.26 per 100 people (all P<0.001), and hazard ratios ranged from 1.24 to 25.65 compared with the 2020 comparator group. Conclusions The results indicate the excess risk of developing new clinical sequelae after the acute phase of SARS-CoV-2 infection, including specific types of sequelae less commonly seen in other viral illnesses. Although individuals who were older, had pre-existing conditions, and were admitted to hospital because of covid-19 were at greatest excess risk, younger adults (aged ≤50), those with no pre-existing conditions, or those not admitted to hospital for covid-19 also had an increased risk of developing new clinical sequelae. The greater risk for incident sequelae after the acute phase of SARS-CoV-2 infection is relevant for healthcare planning.

中文翻译：

---

SARS-CoV-2 感染急性期后出现临床后遗症的风险：回顾性队列研究

目的 评估 18-65 岁成年人感染 SARS-CoV-2 急性期后发生临床后遗症的超额风险和相对危险。设计回顾性队列研究。设置来自美国大型医疗计划的三个合并数据源：大型国家行政索赔数据库、门诊实验室检测数据库和住院病人入院数据库。参与者 2019 年 1 月至诊断 SARS-CoV-2 感染之日期间连续参加健康计划的 18-65 岁个人。三个比较组，通过倾向评分与 SARS-CoV-2 感染者相匹配：2020 年比较组、2019 年历史比较组和患有病毒性下呼吸道疾病的历史比较组。主要结果指标 使用 ICD-10（国际分类标准）确定了 SARS-CoV-2 感染急性期（定义为首次 SARS-CoV-2 诊断日期（指数日期）加 21 天）后的 50 多种临床后遗症。疾病，第 10 次修订）代码。计算了急性感染后四个月内的超额风险和 Bonferroni 校正的 95% 置信区间的风险比。结果 感染 SARS-CoV-2 的 65 岁以下成年人中，有 14%（193 113 人中的 27 074 人）在疾病急性期后出现至少一种需要医疗护理的新型临床后遗症，这一比例高出 4.95%与 2020 年比较组相比。急性期后因 SARS-Cov-2 感染而出现特定新后遗症的风险，包括慢性呼吸衰竭、心律失常、高凝状态、脑病、周围神经病变、健忘症（记忆困难）、糖尿病、肝功能检查异常、心肌炎、焦虑、和疲劳，显着高于三个比较组（2020 年、2019 年和病毒性下呼吸道疾病组）（所有 P<0.001）。与 2020 年对照组相比，SARS-CoV-2 感染造成的显着风险差异为每 100 人 0.02 至 2.26 人（均 P<0.001），风险比为 1.24 至 25.65。结论 结果表明，在 SARS-CoV-2 感染急性期后出现新的临床后遗症的风险很高，包括其他病毒性疾病中不太常见的特定类型的后遗症。尽管年龄较大、患有既往病史并因 covid-19 入院的个体的超额风险最大，但较年轻的成年人（年龄 ≤ 50 岁）、没有既往病史或未入院的人covid-19 出现新的临床后遗症的风险也增加。SARS-CoV-2 感染急性期后发生后遗症的风险更大，这与医疗保健规划相关。