Long-Term Changes in Health-Related Quality of Life and Economic Burden After a SARS-CoV-2 Infection: Analysis of the Long COVID Prospective Cohort Study in Nairobi

OBJECTIVES: To characterize long-term changes in health-related quality of life (HRQoL) and factors associated with catastrophic expenditures and catastrophic costs after a SARS-CoV-2 infection.

METHODS: Data from 291 participants of the Long COVID Prospective Cohort Study in Nairobi were analyzed. Participants were enrolled between 2022 and 2023 and followed up for 12 months. Possible factors and outcomes (HRQoL, catastrophic expenditures, and catastrophic costs) were measured every 3 months. Changes in outcomes over time were assessed using generalized estimating equations.

RESULTS: HRQoL was significantly reduced by 11.4% (95% CI -16.3% to -6.5%), 8.6% (95% CI -12.5% to -4.6%), 6.1% (95% CI -10.5% to -1.8%), and 4.1% (95% CI -7.9% to -0.3%) at 6, 9, 12, and 15 months after a positive polymerase chain reaction test, respectively, compared with the period before COVID-19. HRQoL was significantly reduced by 3.3% (95% CI -6.2% to -0.5%), and 10.9% (95% CI -16.5% to -5.3%), respectively, in participants with any COVID-19-related symptoms or fatigue. Older age (odds ratio [OR] 5.83, 95% CI 2.11 to 16.15), no COVID-19 vaccination (OR 5.83, 95% CI 2.11 to 16.15), any COVID-19-related symptoms (OR 2.22, 95% CI 1.15 to 4.28), and pay cut or reduced income due to COVID-19-related symptoms (OR 17.36, 95% CI 2.28 to 132.07) were associated with high odds of experiencing catastrophic expenditures. Severe/critical SARS-CoV-2 infection (OR 4.77, 95% CI 1.72 to 13.25) and fatigue (OR 2.27, 95% CI 1.03 to 4.96) significantly increased the odds of experiencing catastrophic costs, whereas better HRQoL (OR 0.12, 95% CI 0.02 to 0.57) and social support (OR 0.30, 95% CI 0.09 to 0.93) decreased the odds.

CONCLUSIONS: HRQoL remains reduced up to 15 months after a SARS-CoV-2 infection compared with pre-COVID-19 levels, with participants in better health and socioeconomic status less likely to experience catastrophic expenditures and catastrophic costs.