tetano
Editor, Senior Moderator
Health Soc Care Deliv Res
. 2026 Aug;14(29):1-160.
doi: 10.3310/GJMA0602.
Myzoon Ali 1 2 , Marian C Brady 1 , Pauline Campbell 1 , Scott Rooney 3 , Linda Williams 4 , Lorna Paul 3 , Helen Mason 5 , Sarkis Manoukian 5 , Charlie Chung 6 , Mark Barber 7 , Claire McGoldrick 8 , Andrew Smith 9 , Neil Basu 10 , Manish Patel 9 , Kathryn VandenBerg 1 , Aikaterini Papadopoulou 5 , Azza Abdelaal 11 , Samuel Jk Abraham 12 , Alaa Abu Sayf 13 , Jane Agergaard 14 , Motaz Alawna 15 , Sergiu Albu 16 17 , Laurent Alric 18 , Paulette Andino 19 , Jakub Antczak 20 , Alexander Arutyunov 21 , Aylin Ayyıldız 22 , Ellena Badrick 23 , Pınar Yalcin Bahat 24 , Tala Ballouz 25 , Clara Balsano 26 , Matteo Bassetti 27 , Mariana Bendersky 28 , Danilo Berton 29 , Fausto Biancari 30 , Bjorn Blomberg 31 , Gianluca Em Boari 32 , Silvia Bonetti 33 , Mohammad Bosaeed 34 , Benoit Bouteleux 35 , Salvatore Brugaletta 36 , Mikhail Bychinin 37 , Ina Callebaut 38 , Stephen J Carter 39 , Michal Chudzik 40 , Julien Coelho 41 , Mario Cornejo-Giraldo 42 , Stefania Costi 43 , Gilles Darcis 44 , David R Darley 45 , Antonio Di Baigio 27 , Arianna Di Stadio 46 , Michael Dreher 47 , Dmitry Enikeev 48 , Rachael Evans 49 , Luiz Fábio Magno Falcão 50 , Clara Fehrmann 51 , Stefania Fugazzaro 52 , Lorenzo Gamberini 53 , Fatma Ketenci Gencer 54 , Carlos Alberto Gonzalez 55 , Fergus Hamilton 56 , Chelsea Harrison 57 , Markus C Hayden 58 , Haley Hedlin 59 , Majanka Heijenbrok-Kal 60 , Merel E Hellemons 61 , Brynja Ingadottir 62 , Prasanna Jagannathan 63 , Roman Khokhlov 64 , Leonid Khokhlov 65 , Dacre Knight 66 , Marc Kollum 67 , Henrik Kolstad 68 , Luciane Kopittke 69 , Linda Ashman Kröönström 70 71 , Nina Langeland 72 , Christian Lawlor 73 , Mark L Levitt 74 , Fabio Santos Lira 75 , Judith Loffler-Ragg 76 , David Tw Lui 77 , Reaz Mahmud 78 , Łukasz Małek 79 , Ili Margalit 80 , Sergi Marti-Beltran 81 82 , Adrian Martineau 83 , Mar Masia 84 , Paul Mathew 73 , Gisela Mautner 85 , Aurélien Mazeraud 86 , Dominik Menges 25 , Christian S Meyhoff 87 , Alice Milne 88 , Fatemeh Sadat Mirfazeli 89 , Shima T Moein 90 , Aliae Ar Mohamed-Hussein 91 , Giovanni Monteleone 92 , Igor H Murai 93 , Andreas Steenholt Niklassen 94 , Arvind Nune 95 , Maria Natividad Seisdedos Nunez 96 , Luis Ortega-Paz 97 , Daniel Ouellette 98 , Alna Carolina Mendes Paranhos 99 , Esra Pehlivan 100 , Giovanna Pelà 101 , Filipe Alexandre Pereira 102 , Hanna C Persson 70 71 , Simone Piva 103 , Terry F Plasse 74 , Tamara Platteel 104 , Simone Porcelli 105 , Irene Prediletto 106 , Gilead Raday 74 , Kadalraja Raghavan 107 108 , Kathrin Reetz 109 , Damiano Rizzoni 110 , Mauricio Salinas 111 , Gillian Santorelli 112 , H N Sarker 113 , Sathyamurthy P 114 , Islam Galal Sayed 115 , Leo Sekine 116 117 , Susan Shapiro 118 , Samuel Katsuyuki Shinjo 119 , Ventura Simonovich 120 , Gaia Sinatti 26 , Thomas Sonnweber 121 , Vasileios T Stavrou 122 , Björn Stessel 38 , Katharina Stibrant Sunnerhagen 70 123 , Julio Vallejos 124 , Rita Jg van den Berg-Emons 60 , Lavanya Visvabharathy 125 , Yize I Wan 126 , John Wilkinson 85 , Clarissa Lin Yasuda 127 , Zuobiao Yuan 128 , Alexandre Prehn Zavascki 117 , Maria Del Pilar Brito Zeron 129 , Sigridur Zoëga 62 , Cesar Zoni 130
Affiliations
Background: Identifying and addressing long-term health and societal challenges after COVID-19 is a research priority.
Objectives: To create an international, multidisciplinary COVID-19 database, and synthesise long-term outcomes, predictors and costs.
Design: Systematic identification of COVID-19 data sets and meta-analysis of individual participant data on long-term outcomes after COVID-19.
Setting: Contributed data were collected in clinical, community and research settings.
Interventions: Interventions from original studies were included as covariates in models.
Data sources: MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, PsycInfo® (American Psychological Association, Washington, DC, USA), Cumulative Index to Nursing and Allied Health Literature, World Health Organization Global Index Medicus, Epistemonikos, LitCOVID; World Health Organization International Clinical Trials Registry Platform; ClinicalTrials.gov and supplementary searches for studies (November 2019-November 2021) were searched for studies on > 10 people from cohort, case-control, survey or randomised controlled trial studies, across any setting, describing validated assessment instruments, symptoms, hospitalisation, discharge destination or mortality beyond 28-days after COVID-19 onset. Data were extracted by two independent reviewers.
Methods: Principal investigators contributed fully anonymised individual participant data. Demography, equity and symptoms were described. Assessment instruments were mapped to the International Classification of Functioning, Disability and Health. Factors associated with outcomes at 3-6 months, 9-12 months and beyond 12 months of index infection, for n > 500 individual participant data and > 1 data set were described using ratio of difference, point estimates, odds ratio and 95% confidence interval, as appropriate. The Mixed Methods Appraisal Tool described study quality; models were appraised using a Grading of Recommendations Assessment, Development and Evaluation-informed approach; heterogeneity was described using I2.
Outcome measures: Included overall perception of health, multidomain cognitive function, anxiety, depression, stress, post-traumatic stress disorder, fatigue, strength, walking ability, mobility, coping with daily life, breathlessness, mortality, later hospitalisation and health-related quality of life.
Results: PRECIOUS collated 116 data sets from 40 countries (individual participant data = 62,849), comprising 20 randomised controlled trials, 13 case-control, 60 cohort 2 longitudinal, 1 survey and 20 other study types. Participants' median age was 58 years interquartile range (45-68); 34,185 (54.4%) were female; 158 unique symptoms and 137 unique assessment instruments were captured, predominantly describing International Classification of Function, Disability and Health-body functions. Women had poorer outcomes across 30/37 models, compared with men. In 15/37 models, pre-existing lung disease and increasing age were associated with poorer outcomes; hospitalisation, diabetes and chronic kidney disease were each associated with poorer outcomes in 8/37 models. Initial hospitalisation resulted in lower health-related quality of life that did not recover for up to 2 years after initial infection. Heterogeneity was low in 34/37 models; 22/37 models were of moderate and 11/37 were of low quality.
Limitations: Use of secondary data limits available covariates, outcomes and time points to those included in primary data sets; evidence was primarily based on high-income countries. There was a lack of data on longer-term healthcare resource use to estimate the costs to the healthcare system.
Conclusions: PRECIOUS contributes to the overall picture of long-term COVID-19 outcomes beyond the long-COVID condition and highlights poorer long-term outcomes in women and people with pre-existing comorbidities.
Future work: Evidence gaps included healthcare resource use, isolation, loneliness, societal participation and return to work outcomes. Data are needed on the role of health inequity on long-term outcomes.
Study registration: This study is registered as PROSPERO (CRD42020224323, IRAS ID: 293578).
Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132895) and is published in full in Health and Social Care Delivery Research; Vol. 14, No. 29. See the NIHR Funding and Awards website for further award information.
Keywords: COVID-19; DISABILITY AND HEALTH (ICF); EVIDENCE GAPS; INDIVIDUAL PARTICIPANT DATA (IPD) META-ANALYSIS; INTERNATIONAL CLASSIFICATION OF FUNCTION; LONG-TERM OUTCOMES; PREDICTORS; QUALITY OF LIFE; REGRESSION; SYMPTOMS.
. 2026 Aug;14(29):1-160.
doi: 10.3310/GJMA0602.
Individual Participant Data Meta-Analysis (IPDMA) of long-term COVID-19 outcomes in a systematic review-informed, international, multidisciplinary database
Myzoon Ali 1 2 , Marian C Brady 1 , Pauline Campbell 1 , Scott Rooney 3 , Linda Williams 4 , Lorna Paul 3 , Helen Mason 5 , Sarkis Manoukian 5 , Charlie Chung 6 , Mark Barber 7 , Claire McGoldrick 8 , Andrew Smith 9 , Neil Basu 10 , Manish Patel 9 , Kathryn VandenBerg 1 , Aikaterini Papadopoulou 5 , Azza Abdelaal 11 , Samuel Jk Abraham 12 , Alaa Abu Sayf 13 , Jane Agergaard 14 , Motaz Alawna 15 , Sergiu Albu 16 17 , Laurent Alric 18 , Paulette Andino 19 , Jakub Antczak 20 , Alexander Arutyunov 21 , Aylin Ayyıldız 22 , Ellena Badrick 23 , Pınar Yalcin Bahat 24 , Tala Ballouz 25 , Clara Balsano 26 , Matteo Bassetti 27 , Mariana Bendersky 28 , Danilo Berton 29 , Fausto Biancari 30 , Bjorn Blomberg 31 , Gianluca Em Boari 32 , Silvia Bonetti 33 , Mohammad Bosaeed 34 , Benoit Bouteleux 35 , Salvatore Brugaletta 36 , Mikhail Bychinin 37 , Ina Callebaut 38 , Stephen J Carter 39 , Michal Chudzik 40 , Julien Coelho 41 , Mario Cornejo-Giraldo 42 , Stefania Costi 43 , Gilles Darcis 44 , David R Darley 45 , Antonio Di Baigio 27 , Arianna Di Stadio 46 , Michael Dreher 47 , Dmitry Enikeev 48 , Rachael Evans 49 , Luiz Fábio Magno Falcão 50 , Clara Fehrmann 51 , Stefania Fugazzaro 52 , Lorenzo Gamberini 53 , Fatma Ketenci Gencer 54 , Carlos Alberto Gonzalez 55 , Fergus Hamilton 56 , Chelsea Harrison 57 , Markus C Hayden 58 , Haley Hedlin 59 , Majanka Heijenbrok-Kal 60 , Merel E Hellemons 61 , Brynja Ingadottir 62 , Prasanna Jagannathan 63 , Roman Khokhlov 64 , Leonid Khokhlov 65 , Dacre Knight 66 , Marc Kollum 67 , Henrik Kolstad 68 , Luciane Kopittke 69 , Linda Ashman Kröönström 70 71 , Nina Langeland 72 , Christian Lawlor 73 , Mark L Levitt 74 , Fabio Santos Lira 75 , Judith Loffler-Ragg 76 , David Tw Lui 77 , Reaz Mahmud 78 , Łukasz Małek 79 , Ili Margalit 80 , Sergi Marti-Beltran 81 82 , Adrian Martineau 83 , Mar Masia 84 , Paul Mathew 73 , Gisela Mautner 85 , Aurélien Mazeraud 86 , Dominik Menges 25 , Christian S Meyhoff 87 , Alice Milne 88 , Fatemeh Sadat Mirfazeli 89 , Shima T Moein 90 , Aliae Ar Mohamed-Hussein 91 , Giovanni Monteleone 92 , Igor H Murai 93 , Andreas Steenholt Niklassen 94 , Arvind Nune 95 , Maria Natividad Seisdedos Nunez 96 , Luis Ortega-Paz 97 , Daniel Ouellette 98 , Alna Carolina Mendes Paranhos 99 , Esra Pehlivan 100 , Giovanna Pelà 101 , Filipe Alexandre Pereira 102 , Hanna C Persson 70 71 , Simone Piva 103 , Terry F Plasse 74 , Tamara Platteel 104 , Simone Porcelli 105 , Irene Prediletto 106 , Gilead Raday 74 , Kadalraja Raghavan 107 108 , Kathrin Reetz 109 , Damiano Rizzoni 110 , Mauricio Salinas 111 , Gillian Santorelli 112 , H N Sarker 113 , Sathyamurthy P 114 , Islam Galal Sayed 115 , Leo Sekine 116 117 , Susan Shapiro 118 , Samuel Katsuyuki Shinjo 119 , Ventura Simonovich 120 , Gaia Sinatti 26 , Thomas Sonnweber 121 , Vasileios T Stavrou 122 , Björn Stessel 38 , Katharina Stibrant Sunnerhagen 70 123 , Julio Vallejos 124 , Rita Jg van den Berg-Emons 60 , Lavanya Visvabharathy 125 , Yize I Wan 126 , John Wilkinson 85 , Clarissa Lin Yasuda 127 , Zuobiao Yuan 128 , Alexandre Prehn Zavascki 117 , Maria Del Pilar Brito Zeron 129 , Sigridur Zoëga 62 , Cesar Zoni 130
Affiliations
- PMID: 42663308
- DOI: 10.3310/GJMA0602
Abstract
Background: Identifying and addressing long-term health and societal challenges after COVID-19 is a research priority.
Objectives: To create an international, multidisciplinary COVID-19 database, and synthesise long-term outcomes, predictors and costs.
Design: Systematic identification of COVID-19 data sets and meta-analysis of individual participant data on long-term outcomes after COVID-19.
Setting: Contributed data were collected in clinical, community and research settings.
Interventions: Interventions from original studies were included as covariates in models.
Data sources: MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, PsycInfo® (American Psychological Association, Washington, DC, USA), Cumulative Index to Nursing and Allied Health Literature, World Health Organization Global Index Medicus, Epistemonikos, LitCOVID; World Health Organization International Clinical Trials Registry Platform; ClinicalTrials.gov and supplementary searches for studies (November 2019-November 2021) were searched for studies on > 10 people from cohort, case-control, survey or randomised controlled trial studies, across any setting, describing validated assessment instruments, symptoms, hospitalisation, discharge destination or mortality beyond 28-days after COVID-19 onset. Data were extracted by two independent reviewers.
Methods: Principal investigators contributed fully anonymised individual participant data. Demography, equity and symptoms were described. Assessment instruments were mapped to the International Classification of Functioning, Disability and Health. Factors associated with outcomes at 3-6 months, 9-12 months and beyond 12 months of index infection, for n > 500 individual participant data and > 1 data set were described using ratio of difference, point estimates, odds ratio and 95% confidence interval, as appropriate. The Mixed Methods Appraisal Tool described study quality; models were appraised using a Grading of Recommendations Assessment, Development and Evaluation-informed approach; heterogeneity was described using I2.
Outcome measures: Included overall perception of health, multidomain cognitive function, anxiety, depression, stress, post-traumatic stress disorder, fatigue, strength, walking ability, mobility, coping with daily life, breathlessness, mortality, later hospitalisation and health-related quality of life.
Results: PRECIOUS collated 116 data sets from 40 countries (individual participant data = 62,849), comprising 20 randomised controlled trials, 13 case-control, 60 cohort 2 longitudinal, 1 survey and 20 other study types. Participants' median age was 58 years interquartile range (45-68); 34,185 (54.4%) were female; 158 unique symptoms and 137 unique assessment instruments were captured, predominantly describing International Classification of Function, Disability and Health-body functions. Women had poorer outcomes across 30/37 models, compared with men. In 15/37 models, pre-existing lung disease and increasing age were associated with poorer outcomes; hospitalisation, diabetes and chronic kidney disease were each associated with poorer outcomes in 8/37 models. Initial hospitalisation resulted in lower health-related quality of life that did not recover for up to 2 years after initial infection. Heterogeneity was low in 34/37 models; 22/37 models were of moderate and 11/37 were of low quality.
Limitations: Use of secondary data limits available covariates, outcomes and time points to those included in primary data sets; evidence was primarily based on high-income countries. There was a lack of data on longer-term healthcare resource use to estimate the costs to the healthcare system.
Conclusions: PRECIOUS contributes to the overall picture of long-term COVID-19 outcomes beyond the long-COVID condition and highlights poorer long-term outcomes in women and people with pre-existing comorbidities.
Future work: Evidence gaps included healthcare resource use, isolation, loneliness, societal participation and return to work outcomes. Data are needed on the role of health inequity on long-term outcomes.
Study registration: This study is registered as PROSPERO (CRD42020224323, IRAS ID: 293578).
Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132895) and is published in full in Health and Social Care Delivery Research; Vol. 14, No. 29. See the NIHR Funding and Awards website for further award information.
Keywords: COVID-19; DISABILITY AND HEALTH (ICF); EVIDENCE GAPS; INDIVIDUAL PARTICIPANT DATA (IPD) META-ANALYSIS; INTERNATIONAL CLASSIFICATION OF FUNCTION; LONG-TERM OUTCOMES; PREDICTORS; QUALITY OF LIFE; REGRESSION; SYMPTOMS.