Long COVID-19: A Four-Year prospective cohort study of risk factors, recovery and quality of life, Kamal et al, 2025

[Kalliope]

Journal BMC Infectious Diseases

Abstract​

Purpose
Long COVID-19 is a growing public health concern, but its long-term burden and predictors remain underexplored, particularly in underrepresented populations.

Methods
This four-year prospective cohort study was conducted in Saudi Arabia, enrolling adults with confirmed acute COVID-19 from multiple affiliated healthcare centers between March 2020 and March 2024. Of 1,521 screened patients, 816 were enrolled and followed for up to four years (median: 24 months). Per WHO criteria, participants were classified as having long COVID-19 (n = 238) or resolved infection (n = 578). Demographics, comorbidities, vaccination, reinfection, and acute illness severity were recorded. Health-related quality of life (HRQoL) was assessed using SF-36 and EQ-5D-5 L. Logistic regression identified predictors of long COVID-19, and Cox proportional hazards models evaluated time to recovery.

Results
Fatigue (57.1%), post-exertional malaise (45.8%), cough (41.2%), and cognitive dysfunction (30.7%) were the most common persistent symptoms. Female sex (adjusted OR 11.11; 95% CI: 4.48–26.24) and diabetes mellitus (adjusted OR 14.3; 95% CI: 7.0–29.4) independently predicted long COVID-19. Delayed recovery was associated with female sex (aHR 3.36; 95% CI: 1.85–6.10), diabetes (aHR 1.57; 95% CI: 1.00–2.46), reinfection (aHR 1.86; 95% CI: 1.05–3.29), and hospitalization (aHR 1.08; 95% CI: 1.01–1.16). HRQoL scores remained significantly lower at 6 and 12 months. In the long COVID-19 group, 38.7% of patients normally resumed work within 12 months, compared to 82.3% in the resolved COVID-19 group.

Conclusions
Nearly 29% of post-acute COVID-19 patients developed long COVID-19 in this Middle Eastern cohort. Female sex, diabetes, reinfection, and hospitalization predicted delayed recovery. Persistent symptoms and impaired HRQoL highlight the need for early risk stratification and structured post-COVID care.

Long COVID-19: a Four-Year prospective cohort study of risk factors, recovery, and quality of life - BMC Infectious Diseases

Long COVID-19 is a growing public health concern, but its long-term burden and predictors remain underexplored, particularly in underrepresented populations. This four-year prospective cohort study was conducted in Saudi Arabia, enrolling adults with confirmed acute COVID-19 from multiple...

bmcinfectdis.biomedcentral.com

 

[Yann04]

the prevalence of long COVID-19 declined progressively: 34.7% (2020–2021), 30.1% (2021–2022), 26.8% (2022–2023), and 23.2% (2023–2024). (Supplementary Fig. 3B)

those rates of decline are way lower than I would have imagined. I was under the impression we thought the majority of cases resolved within 6ish months.
Those stats are grim.

 

[Eleanor]

Our estimated long COVID-19 prevalence of 29.2% should be interpreted in the context of a hospital-affiliated cohort that included a high proportion of patients with pre-existing comorbidities and more severe acute infections, including hospitalized cases.

 

[Peter T]

those rates of decline are way lower than I would have imagined. I was under the impression we thought the majority of cases resolved within 6ish months.
Those stats are grim.

Sorry not read the article, but presumably this includes those with identifiable physiological damage, such as lung damage, who would be more frequent in the patients hospitalised in the acute phase, who will not resolve so easily, as well as those with post viral fatigue that might be expected to resolve more readily and ME/CFS that presumably is less likely to resolve.

 

[perchance dreamer]

My 43-year-old niece has type 1 diabetes and learned that earlier this year when she went to the ER with what turned out to be ketoacidosis. She was shocked because diabetes type 1 was not on her radar at all for why she had been feeling bad. My sister and I had an aunt with T1D, but she was the only relative on either side of my niece's family for 3 generations with the disease. That, along with my niece being in her 40s, would seem to make her an unlikely person to contract T1D although older people can get it.

I wonder if her having had covid some time before her diagnosis (not sure when she had it) could have triggered this seemingly slight genetic predispostion. I've read studies that suggest that long covid can result in T1D, but no real evidence.

 

[Yann04]

Sorry not read the article, but presumably this includes those with identifiable physiological damage, such as lung damage, who would be more frequent in the patients hospitalised in the acute phase, who will not resolve so easily, as well as those with post viral fatigue that might be expected to resolve more readily and ME/CFS that presumably is less likely to resolve.

True. But even then the data is weird. You’d expect a the largest dropoff in the first year then quasi-exponentially diminishing returns.
Here you get ~4% first year, ~4% second year, ~3% third year.