Health behaviours the month prior to COVID-19 infection and the development of self-reported long COVID and specific long COVID symptoms: A longitudinal analysis of 1,811 UK adults
PhD Elise Paul, PhD Daisy Fancourt
doi:10.1101/2022.04.12.22273792
Background Demographic and infection-related characteristics have been identified as risk factors for long COVID, but research on the influence of health behaviours (e.g., exercise, smoking) immediately preceding the index infection is lacking. Methods 1,811 UK adults from the UCL COVID-19 Social Study and who had previously been infected with COVID-19 were analysed. Health behaviours in the month before infection were weekly exercise frequency, days of fresh air per week, sleep quality, smoking, consuming more than the number of recommended alcoholic drinks per week (>14), and the number of mental health care behaviours (e.g., online mental health programme). Logistic regressions controlling for covariates (e.g., COVID-19 infection severity and pre-existing health conditions) examined the impact of health behaviours on long COVID and three long COVID symptoms (difficulty with mobility, cognition, and self-care).
Results In the month before infection with COVID-19, poor quality sleep increased the odds of long COVID (odds ratio [OR]: 3.53; (95% confidence interval [CI]: 2.01 to 6.21), as did average quality sleep (OR: 2.44; 95% CI: 1.44 to 4.12). Having smoked (OR: 8.39; 95% CI: 1.86 to 37.91) increased and meeting recommended weekly physical activity guidelines (3+ hours) (OR: 0.05; 95% CI: 0.01 to 0.39) reduced the likelihood of difficulty with self-care (e.g., washing all over or dressing) amongst those with long COVID.
Conclusion Results point to the importance of sleep quality for long COVID, potentially helping to explain previously demonstrated links between stress and long COVID. Results also suggest that exercise and smoking may be modifiable risk factors for preventing the development of difficulty with self-care.
Ethics approval and consent to participate Ethical approval for the COVID-19 Social Study was granted by the UCL Ethics Committee. All participants provided fully informed consent and the study is GDPR compliant.
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'abstract': '<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Demographic '
'and infection-related characteristics have been identified as risk factors for long COVID, '
'but research on the influence of health behaviours (e.g., exercise, smoking) immediately '
'preceding the index infection is '
'lacking.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>1,811 UK adults '
'from the UCL COVID-19 Social Study and who had previously been infected with COVID-19 were '
'analysed. Health behaviours in the month before infection were weekly exercise frequency, '
'days of fresh air per week, sleep quality, smoking, consuming more than the number of '
'recommended alcoholic drinks per week (>14), and the number of mental health care '
'behaviours (e.g., online mental health programme). Logistic regressions controlling for '
'covariates (e.g., COVID-19 infection severity and pre-existing health conditions) examined '
'the impact of health behaviours on long COVID and three long COVID symptoms (difficulty with '
'mobility, cognition, and '
'self-care).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In the month '
'before infection with COVID-19, poor quality sleep increased the odds of long COVID (odds '
'ratio [OR]: 3.53; (95% confidence interval [CI]: 2.01 to 6.21), as did average quality sleep '
'(OR: 2.44; 95% CI: 1.44 to 4.12). Having smoked (OR: 8.39; 95% CI: 1.86 to 37.91) increased '
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'COVID.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Results point '
'to the importance of sleep quality for long COVID, potentially helping to explain previously '
'demonstrated links between stress and long COVID. Results also suggest that exercise and '
'smoking may be modifiable risk factors for preventing the development of difficulty with '
'self-care.</jats:p></jats:sec><jats:sec><jats:title>Funding</jats:title><jats:p>The Nuffield '
'Foundation [WEL/FR-000022583], the MARCH Mental Health Network funded by the '
'Cross-Disciplinary Mental Health Network Plus initiative supported by UK Research and '
'Innovation [ES/S002588/1], and the Wellcome Trust [221400/Z/20/Z and '
'205407/Z/16/Z].</jats:p></jats:sec><jats:sec><jats:title>What is already known on the '
'topic</jats:title><jats:p>Long COVID is rapidly becoming a public health concern. Although '
'existing evidence to date has identified health characteristics such as obesity as risk '
'factors, hardly any research on modifiable risk factors such as health behaviours has been '
'conducted.</jats:p></jats:sec><jats:sec><jats:title>What this study '
'adds</jats:title><jats:p>This study adds to the dearth of evidence on modifiable risk factors '
'occurring before COVID-19 infection. Findings suggest a role of poor sleep quality for the '
'development of long COVID, and for meeting physical activity guidelines (3+ hours per week) '
'and not smoking as modifiable risk factors for self-care difficulties amongst those with long '
'COVID.</jats:p></jats:sec>',
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'https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19/latestinsights#infections'}],
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