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Abstract：
BACKGROUND: Recovery from acute COVID-19 may be slow and incomplete: cases of Post-Acute Sequelae of COVID (PASC) are counted in millions, worldwide. We aimed to explore if and how the pre-existing Socio-economic-status (SES) influences such recovery.
METHODS: We analyzed a database of 1536 consecutive patients from the first wave of COVID-19 in Italy (February-September 2020), previously admitted to our referral hospital, and followed-up in a dedicated multidisciplinary intervention. We excluded those seen earlier than 12 weeks (the conventional limit for a possible PASC syndrome), and those reporting a serious complication from the acute phase (possibly accounting for symptoms persistence). We studied whether the exposition to disadvantaged SES (estimated through the Italian Institute of Statistics\'s model - ISTAT 2017) was affecting recovery outcomes, that is: symptoms (composite endpoint, i.e. at least one among: dyspnea, fatigue, myalgia, chest pain or palpitations); Health-Related-Quality-of-Life (HRQoL, as by SF-36 scale); post-traumatic-stress-disorder (as by IES-R scale); and lung structural damage (as by impaired CO diffusion, DLCO).
RESULTS: Eight-hundred and twenty-five patients were included in the analysis (median age 59 years; IQR: 50-69 years, 60.2% men), of which 499 (60.5%) were previously admitted to hospital and 27 (3.3%) to Intensive-Care Unit (ICU). Those still complaining of symptoms at follow-up were 337 (40.9%; 95%CI 37.5-42.2%), and 256 had a possible Post-Traumatic Stress Disorder (PTSD) (31%, 95%CI 28.7-35.1%). DLCO was reduced in 147 (19.6%, 95%CI 17.0-22.7%). In a multivariable model, disadvantaged SES was associated with a lower HRQoL, especially for items exploring physical health (Limitations in physical activities: OR = 0.65; 95%CI = 0.47 to 0.89; p = 0.008; AUC = 0.74) and Bodily pain (OR = 0.57; 95%CI = 0.40 to 0.82; p = 0.002; AUC = 0.74). We did not observe any association between SES and the other outcomes.
CONCLUSIONS: Recovery after COVID-19 appears to be independently affected by a pre-existent socio-economic disadvantage, and clinical assessment should incorporate SES and HRQoL measurements, along with symptoms. The socioeconomic determinants of SARS-CoV-2 disease are not exclusive of the acute infection: this finding deserves further research and specific interventions.
METHODS: We analyzed a database of 1536 consecutive patients from the first wave of COVID-19 in Italy (February-September 2020), previously admitted to our referral hospital, and followed-up in a dedicated multidisciplinary intervention. We excluded those seen earlier than 12 weeks (the conventional limit for a possible PASC syndrome), and those reporting a serious complication from the acute phase (possibly accounting for symptoms persistence). We studied whether the exposition to disadvantaged SES (estimated through the Italian Institute of Statistics\'s model - ISTAT 2017) was affecting recovery outcomes, that is: symptoms (composite endpoint, i.e. at least one among: dyspnea, fatigue, myalgia, chest pain or palpitations); Health-Related-Quality-of-Life (HRQoL, as by SF-36 scale); post-traumatic-stress-disorder (as by IES-R scale); and lung structural damage (as by impaired CO diffusion, DLCO).
RESULTS: Eight-hundred and twenty-five patients were included in the analysis (median age 59 years; IQR: 50-69 years, 60.2% men), of which 499 (60.5%) were previously admitted to hospital and 27 (3.3%) to Intensive-Care Unit (ICU). Those still complaining of symptoms at follow-up were 337 (40.9%; 95%CI 37.5-42.2%), and 256 had a possible Post-Traumatic Stress Disorder (PTSD) (31%, 95%CI 28.7-35.1%). DLCO was reduced in 147 (19.6%, 95%CI 17.0-22.7%). In a multivariable model, disadvantaged SES was associated with a lower HRQoL, especially for items exploring physical health (Limitations in physical activities: OR = 0.65; 95%CI = 0.47 to 0.89; p = 0.008; AUC = 0.74) and Bodily pain (OR = 0.57; 95%CI = 0.40 to 0.82; p = 0.002; AUC = 0.74). We did not observe any association between SES and the other outcomes.
CONCLUSIONS: Recovery after COVID-19 appears to be independently affected by a pre-existent socio-economic disadvantage, and clinical assessment should incorporate SES and HRQoL measurements, along with symptoms. The socioeconomic determinants of SARS-CoV-2 disease are not exclusive of the acute infection: this finding deserves further research and specific interventions.
摘要：
背景：急性COVID-19的恢复可能缓慢且不完整：急性COVID后遗症（PASC）的病例以数百万计，全世界。我们旨在探讨先前存在的社会经济地位（SES）是否以及如何影响这种复苏。
方法：我们分析了来自意大利第一波COVID-19（2020年2月至9月）的1536名连续患者的数据库，以前住在我们的转诊医院，并采取专门的多学科干预措施。我们排除了那些早于12周的患者（可能的PASC综合征的常规限制），和那些从急性期报告严重并发症的人（可能是症状持续的原因）。我们研究了对弱势SES的阐述（通过意大利统计研究所的模型-ISTAT2017估计）是否会影响恢复结果，即：症状(复合终点，即至少一种：呼吸困难，疲劳,肌痛，胸痛或心悸)；与健康相关的生活质量(HRQoL，如SF-36量表)；创伤后应激障碍(如IES-R量表)；和肺结构损伤(如CO扩散受损，DLCO）。
结果：分析中纳入了八百二十五例患者（中位年龄59岁；IQR：50-69岁，60.2%男性)，其中499人(60.5%)以前曾入院治疗,27人(3.3%)曾入住重症监护病房(ICU).随访时仍有症状的患者为337人（40.9%；95CI37.5-42.2%），256人可能患有创伤后应激障碍（PTSD）（31％，95CI28.7-35.1%）。DLCO减少了147人(19.6%，95CI17.0-22.7%）。在多变量模型中，弱势SES与较低的HRQoL相关，特别是对于探索身体健康的项目(体力活动限制:OR=0.65;95CI=0.47~0.89;p=0.008;AUC=0.74)和身体疼痛(OR=0.57;95CI=0.40~0.82;p=0.002;AUC=0.74)。我们没有观察到SES和其他结果之间的任何关联。
结论：COVID-19后的恢复似乎受到先前存在的社会经济劣势的独立影响，临床评估应包括SES和HRQoL测量，连同症状。SARS-CoV-2疾病的社会经济决定因素并不排除急性感染：这一发现值得进一步研究和具体干预。
方法：我们分析了来自意大利第一波COVID-19（2020年2月至9月）的1536名连续患者的数据库，以前住在我们的转诊医院，并采取专门的多学科干预措施。我们排除了那些早于12周的患者（可能的PASC综合征的常规限制），和那些从急性期报告严重并发症的人（可能是症状持续的原因）。我们研究了对弱势SES的阐述（通过意大利统计研究所的模型-ISTAT2017估计）是否会影响恢复结果，即：症状(复合终点，即至少一种：呼吸困难，疲劳,肌痛，胸痛或心悸)；与健康相关的生活质量(HRQoL，如SF-36量表)；创伤后应激障碍(如IES-R量表)；和肺结构损伤(如CO扩散受损，DLCO）。
结果：分析中纳入了八百二十五例患者（中位年龄59岁；IQR：50-69岁，60.2%男性)，其中499人(60.5%)以前曾入院治疗,27人(3.3%)曾入住重症监护病房(ICU).随访时仍有症状的患者为337人（40.9%；95CI37.5-42.2%），256人可能患有创伤后应激障碍（PTSD）（31％，95CI28.7-35.1%）。DLCO减少了147人(19.6%，95CI17.0-22.7%）。在多变量模型中，弱势SES与较低的HRQoL相关，特别是对于探索身体健康的项目(体力活动限制:OR=0.65;95CI=0.47~0.89;p=0.008;AUC=0.74)和身体疼痛(OR=0.57;95CI=0.40~0.82;p=0.002;AUC=0.74)。我们没有观察到SES和其他结果之间的任何关联。
结论：COVID-19后的恢复似乎受到先前存在的社会经济劣势的独立影响，临床评估应包括SES和HRQoL测量，连同症状。SARS-CoV-2疾病的社会经济决定因素并不排除急性感染：这一发现值得进一步研究和具体干预。
