Factors associated with health-related quality of life 1 year after COVID-19: a cross-sectional study in Sweden
Keywords:
Health-related quality of life, COVID-19, patient-reported outcome measures, EQ-5D-5L, persistent symptoms, work ability index, six-minute walking test, dyspnoea-12 (D-12) questionnaire
Abstract
Aims: The main aim of the present study was to identify factors influencing health-related quality of life (HRQoL), as measured by EQ-5D-5L, in individuals 1 year after the acute phase of COVID-19.
Methods: This cross-sectional study included 75 participants (51% females), 1 year after confirmed SARS-CoV-2 infection (76% hospitalised). Associations between HRQoL, measured by patient-reported outcome measures (PROMs): EQ-5D-5L, and factors of interest, including persistent symptoms, comorbidities, work ability index (WAI), lung function, six-minute walking test (6MWT), and dyspnoea-12 (D-12) questionnaire, were assessed by an analysis of variance (ANCOVA) model (adjusted by various factors of interest) with post hoc pairwise comparison.
Results: In the ANCOVA, lower HRQoL was significantly associated with not having a university education (mean difference [MD] with 95% confidence interval [CI]: 0.115 [0.013–0.217]), a higher number of persistent symptoms (for 10 vs. 1–3 symptoms: −0.153 [−0.291, −0.015]), lower work ability (for poor vs. excellent: −0.283 [−0.445, −0.120]), any comorbidity (0.077 [0.015–0.138]), and affective distress in the D-12 (0.257 [0.096–0.417]). No significant sex differences in HRQoL and the level of care at the acute infection were shown. In descriptive analysis, lower HRQoL was significantly associated with age under 55, sick leave, more dyspnoea in D-12, and poorer work ability.
Conclusions: Work ability, comorbidities, persistent symptoms, and affective distress were associated with lower HRQoL at 1-year follow-up after COVID-19. No significant differences in HRQoL were observed between sexes. Our study highlights the need to address HRQoL in post-COVID-19 rehabilitation and broader public health planning.
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References
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21. Kerksieck P, Ballouz T, Haile SR, Schumacher C, Lacy J, Domenghino A, et al. Post COVID-19 condition, work ability and occupational changes in a population-based cohort. Lancet Reg Health Eur. 2023;31:100671. doi: https://doi.org/10.1016/j.lanepe.2023.100671
22. Gerritzen I, Brus IM, Spronk I, Biere-Rafi S, Polinder S, Haagsma JA. Identification of post-COVID-19 condition phenotypes, and differences in health-related quality of life and healthcare use: a cluster analysis. Epidemiol Infect. 2023;151:e123. doi: https://doi.org/10.1017/S0950268823001139
23. Fernandez-de-Las-Penas C, Palacios-Cena D, Gomez-Mayordomo V, Florencio LL, Cuadrado ML, Plaza-Manzano G, et al. Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: a systematic review and meta-analysis. Eur J Intern Med. 2021;92:55–70. doi: https://doi.org/10.1016/j.ejim.2021.06.009
24. Tan JY, Yorke J, Harle A, Smith J, Blackhall F, Pilling M, et al. Assessment of breathlessness in lung cancer: psychometric properties of the dyspnea-12 questionnaire. J Pain Symptom Manage. 2017;53:208–15. doi: https://doi.org/10.1016/j.jpainsymman.2016.08.009
25. Burkauskas J, Brozaitiene J, Bunevicius A, Neverauskas J, Zaliunaite V, Bunevicius R. Association of depression, anxiety, and type d personality with cognitive function in patients with coronary artery disease. Cogn Behav Neurol. 2016;29:91–9. doi: https://doi.org/10.1097/WNN.0000000000000093
26. Russell CD, Lone NI, Baillie JK. Comorbidities, multimorbidity and COVID-19. Nat Med. 2023;29:334–43. doi: https://doi.org/10.1038/s41591-022-02156-9
27. van der Vlegel M, Spronk I, Oude Groeniger J, Toet H, Panneman MJM, Polinder S, et al. Health care utilization and health-related quality of life of injury patients: comparison of educational groups. BMC Health Serv Res. 2021;21:988. doi: https://doi.org/10.1186/s12913-021-06913-3
28. Ose D, Rochon J, Campbell SM, Wensing M, Freund T, van Lieshout J, et al. Health-related quality of life and risk factor control: the importance of educational level in prevention of cardiovascular diseases. Eur J Public Health. 2014;24:679–84. doi: https://doi.org/10.1093/eurpub/ckt139
29. Wilson D, Parsons J, Wakefield M. The health-related quality-of-life of never smokers, ex-smokers, and light, moderate, and heavy smokers. Prev Med. 1999;29:139–44. doi: https://doi.org/10.1006/pmed.1999.0523
30. Tomioka H, Sekiya R, Nishio C, Ishimoto G. Impact of smoking cessation therapy on health-related quality of life. BMJ Open Respir Res. 2014;1:e000047. doi: https://doi.org/10.1136/bmjresp-2014-000047
31. Vogl M, Wenig CM, Leidl R, Pokhrel S. Smoking and health-related quality of life in English general population: implications for economic evaluations. BMC Public Health. 2012;12:203. doi: https://doi.org/10.1186/1471-2458-12-203
32. Zillich AJ, Ryan M, Adams A, Yeager B, Farris K. Effectiveness of a pharmacist-based smoking-cessation program and its impact on quality of life. Pharmacotherapy. 2002;22:759–65. doi: https://doi.org/10.1592/phco.22.9.759.34073
2. Soriano JB, Murthy S, Marshall JC, Relan P, Diaz JV. A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis. 2022;22:e102–7. doi: https://doi.org/10.1016/S1473-3099(21)00703-9
3. Fernandez-de-Las-Penas C, Notarte KI, Macasaet R, Velasco JV, Catahay JA, Ver AT, et al. Persistence of post-COVID symptoms in the general population two years after SARS-CoV-2 infection: a systematic review and meta-analysis. J Infect. 2024;88:77–88. doi: https://doi.org/10.1016/j.jinf.2023.12.004
4. Kisiel MA, Nordqvist T, Westman G, Svartengren M, Malinovschi A, Janols H. Patterns and predictors of sick leave among Swedish non-hospitalized healthcare and residential care workers with Covid-19 during the early phase of the pandemic. PLoS One. 2021;16:e0260652. doi: https://doi.org/10.1371/journal.pone.0260652
5. Karimi M, Brazier J. Health, health-related quality of life, and quality of life: what is the difference? Pharmacoeconomics. 2016;34:645–9. doi: https://doi.org/10.1007/s40273-016-0389-9
6. Taquet M, Luciano S, Geddes JR, Harrison PJ. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. Lancet Psychiatry. 2021;8:130–40. doi: https://doi.org/10.1016/S2215-0366(20)30462-4
7. Hansel TC, Saltzman LY, Melton PA, Clark TL, Bordnick PS COVID-19 behavioral health and quality of life. Sci Rep. 2022;12:961. doi: https://doi.org/10.1038/s41598-022-05042-z
8. Webb EJD, Kind P, Meads D, Martin A. COVID-19 and EQ-5D-5L health state valuation. Eur J Health Econ. 2024;25:117–45. doi: https://doi.org/10.1007/s10198-023-01569-8
9. Sun S, Chuang LH, Sahlen KG, Lindholm L, Norstrom F. Estimating a social value set for EQ-5D-5L in Sweden. Health Qual Life Outcomes. 2022;20:167. doi: https://doi.org/10.1186/s12955-022-02083-w
10. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20:1727–36. doi: https://doi.org/10.1007/s11136-011-9903-x
11. Janols H, Wadsten C, Forssell C, Raffeti E, Janson C, Zhou X, et al. Enhancing EQ-5D-5L sensitivity in capturing the most common symptoms in post-COVID-19 patients: an exploratory cross-sectional study with a focus on fatigue, memory/concentration problems and dyspnea dimensions. Int J Environ Res Public Health. 2024;21:591. doi: https://doi.org/10.3390/ijerph21050591
12. Kisiel MA, Lee S, Malmquist S, Rykatkin O, Holgert S, Janols H, et al. Clustering analysis identified three long COVID phenotypes and their association with general health status and working ability. J Clin Med. 2023;12:3617. doi: https://doi.org/10.3390/jcm12113617.
13. Kisiel MA, Janols H, Nordqvist T, Bergquist J, Hagfeldt S, Malinovschi A, et al. Predictors of post-COVID-19 and the impact of persistent symptoms in non-hospitalized patients 12 months after COVID-19, with a focus on work ability. Ups J Med Sci. 2022;127. doi: https://doi.org/10.48101/ujms.v127.8794
14. Hellman T, & Wåhlin, C. Företagshälsans guide om arbetsförmåga – begrepp, samtal och utredning [Work Ability Guide]. Sveriges Företagshälsor. Available from: https://www.foretagshalsor.se/sites/default/files/2021-11/Arbetsfo%CC%88rma%CC%8Ageguide_2021.pdf2021
15. Yorke J, Moosavi SH, Shuldham C, Jones PW. Quantification of dyspnoea using descriptors: development and initial testing of the Dyspnoea-12. Thorax. 2010;65:21–6. doi: https://doi.org/10.1136/thx.2009.118521
16. Ekstrom MP, Bornefalk H, Skold CM, Janson C, Blomberg A, Bornefalk-Hermansson A, et al. Minimal clinically important differences and feasibility of dyspnea-12 and the multidimensional dyspnea profile in cardiorespiratory disease. J Pain Symptom Manage. 2020;60:968–75e1. doi: https://doi.org/10.1016/j.jpainsymman.2020.05.028
17. Laboratories ATSCoPSfCPF. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111–7. doi: https://doi.org/10.1164/ajrccm.166.1.at1102
18. Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med. 1998;158:1384–7. doi: https://doi.org/10.1164/ajrccm.158.5.9710086
19. Stanojevic S, Kaminsky DA, Miller MR, Thompson B, Aliverti A, Barjaktarevic I, et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J. 2022;60:2101499. doi: https://doi.org/10.1183/13993003.01499-2021
20. Lemhofer C, Sturm C, Loudovici-Krug D, Guntenbrunner C, Bulow M, Reuken P, et al. Quality of life and ability to work of patients with Post-COVID syndrome in relation to the number of existing symptoms and the duration since infection up to 12 months: a cross-sectional study. Qual Life Res. 2023;32:1991–2002. doi: https://doi.org/10.1007/s11136-023-03369-2
21. Kerksieck P, Ballouz T, Haile SR, Schumacher C, Lacy J, Domenghino A, et al. Post COVID-19 condition, work ability and occupational changes in a population-based cohort. Lancet Reg Health Eur. 2023;31:100671. doi: https://doi.org/10.1016/j.lanepe.2023.100671
22. Gerritzen I, Brus IM, Spronk I, Biere-Rafi S, Polinder S, Haagsma JA. Identification of post-COVID-19 condition phenotypes, and differences in health-related quality of life and healthcare use: a cluster analysis. Epidemiol Infect. 2023;151:e123. doi: https://doi.org/10.1017/S0950268823001139
23. Fernandez-de-Las-Penas C, Palacios-Cena D, Gomez-Mayordomo V, Florencio LL, Cuadrado ML, Plaza-Manzano G, et al. Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: a systematic review and meta-analysis. Eur J Intern Med. 2021;92:55–70. doi: https://doi.org/10.1016/j.ejim.2021.06.009
24. Tan JY, Yorke J, Harle A, Smith J, Blackhall F, Pilling M, et al. Assessment of breathlessness in lung cancer: psychometric properties of the dyspnea-12 questionnaire. J Pain Symptom Manage. 2017;53:208–15. doi: https://doi.org/10.1016/j.jpainsymman.2016.08.009
25. Burkauskas J, Brozaitiene J, Bunevicius A, Neverauskas J, Zaliunaite V, Bunevicius R. Association of depression, anxiety, and type d personality with cognitive function in patients with coronary artery disease. Cogn Behav Neurol. 2016;29:91–9. doi: https://doi.org/10.1097/WNN.0000000000000093
26. Russell CD, Lone NI, Baillie JK. Comorbidities, multimorbidity and COVID-19. Nat Med. 2023;29:334–43. doi: https://doi.org/10.1038/s41591-022-02156-9
27. van der Vlegel M, Spronk I, Oude Groeniger J, Toet H, Panneman MJM, Polinder S, et al. Health care utilization and health-related quality of life of injury patients: comparison of educational groups. BMC Health Serv Res. 2021;21:988. doi: https://doi.org/10.1186/s12913-021-06913-3
28. Ose D, Rochon J, Campbell SM, Wensing M, Freund T, van Lieshout J, et al. Health-related quality of life and risk factor control: the importance of educational level in prevention of cardiovascular diseases. Eur J Public Health. 2014;24:679–84. doi: https://doi.org/10.1093/eurpub/ckt139
29. Wilson D, Parsons J, Wakefield M. The health-related quality-of-life of never smokers, ex-smokers, and light, moderate, and heavy smokers. Prev Med. 1999;29:139–44. doi: https://doi.org/10.1006/pmed.1999.0523
30. Tomioka H, Sekiya R, Nishio C, Ishimoto G. Impact of smoking cessation therapy on health-related quality of life. BMJ Open Respir Res. 2014;1:e000047. doi: https://doi.org/10.1136/bmjresp-2014-000047
31. Vogl M, Wenig CM, Leidl R, Pokhrel S. Smoking and health-related quality of life in English general population: implications for economic evaluations. BMC Public Health. 2012;12:203. doi: https://doi.org/10.1186/1471-2458-12-203
32. Zillich AJ, Ryan M, Adams A, Yeager B, Farris K. Effectiveness of a pharmacist-based smoking-cessation program and its impact on quality of life. Pharmacotherapy. 2002;22:759–65. doi: https://doi.org/10.1592/phco.22.9.759.34073
Published
2025-12-22
How to Cite
Kisiel , M. A., Janols , H., Hiller , A.-M., Forsell , C., Kock , C., Neiderud , C.-J., Westman , G., Janini , J., Ekström , M., Malinovschi , A., & Janson , C. (2025). Factors associated with health-related quality of life 1 year after COVID-19: a cross-sectional study in Sweden. Upsala Journal of Medical Sciences, 130, e13260. https://doi.org/10.48101/ujms.v130.13260
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