Document Type

Capstone Experience

Graduation Date

12-2022

Degree Name

Master of Public Health

Department

Biostatistics

First Committee Member

Jianghu Don (PhD)

Second Committee Member

Daisy Dai (PhD)

Third Committee Member

Roslyn Mannon (MD)

Fourth Committee Member

Jerrod Anzalone (MS)

Abstract

Background: Coronavirus disease 2019 (COVID-19) in solid organ transplant (SOT) patients is associated with more severe outcomes than non-immunosuppressed hosts. The risk factors for developing the long COVID in acute COVID remain unknown, and the survival outcomes of long COVID in SOT patients remain understudied.

Methods: We developed several retrospective cohorts. This project included all patients identified with acute COVID in the National COVID Collaborative Cohort Registry from July 1, 2020, to June 30, 2022.

Patients with long COVID were compared to those without long COVID in the acute COVID cohorts. Similarly, we compared the patient demographic with long COVID vs. those without long-term COVID in the SOT cohort. Univariable and multivariable logistics regression was used to determine the factors related to the probability of the long COVID in the acute COVID and SOT cohorts. To investigate the patient survival of long COVID in SOT cohort, Multi-variables Cox regression was used to determine the time-to-event outcome of patient survival (death) after adjusting for another demographic.

Results: This study included 6,416,500 acute COVID patients. 31,744 patients were with long COVID, and 6,384,756 patients were with acute COVID without long-COVID. The mean (q1, q3) age was 39 [22, 57] years; 55% of patients were female. In the SOT recipient cohort, 511 patients were identified with long-COVID from ICD diagnosis and 37,771 patients with acute COVID (mean age 56 [40, 66] years; 41% of patients are female). In the long COVID SOT, age was most likely between 50-60 years and white non-Hispanic. Most SOT were kidney transplanted recipients. The Cox regression analysis revealed many significant factors related to patient survival (death), especially older SOT patients with a much higher hazard ratio.

Conclusion: This study has identified the risk factors for developing long COVID more likely in both acute COVID and SOT cohorts. For the SOT cohort, we also investigated hazard ratios of patient survival based on multivariable Cox models. We find that older patients in SOT were much more likely to die when long COVID.

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