2024 Theses Doctoral

Risk and resilience factors for acute and post-acute COVID-19 outcomes: The Collaborative Cohort of Cohorts for COVID-19 Research (C4R)

Oelsner, Elizabeth Christine

COVID-19 continues to have a major impact on US health and society. Robust research on the epidemiology of acute and post-acute COVID-19 remains fundamentally important to informing policy makers, scientists, as well as the public.

This dissertation reports on the development of a large, diverse, United States general population-based meta-cohort with standardized, prospective ascertainment of SARS-CoV-2 and COVID-19, integrated with comprehensive pre-pandemic phenotyping from 14 extant cohort studies. Meta-cohort data were used to investigate risk and resilience factors for incident severe (hospitalized or fatal) and non-severe COVID-19 and correlates of time-to-recovery from SARS-CoV-2 infection.

Results support the major acute and post-acute public health impact of COVID-19 and the vital role of modifiable (e.g., obesity, diabetes, cardiovascular disease) and non-modifiable (e.g., age, sex) risk factors for adverse COVID-19 outcomes. Findings suggest that standard primary care interventions—including obesity and cardiometabolic disease prevention and treatment, depression care, and vaccination—remain fundamental to COVID-19 risk mitigation among US adults.

Given its longitudinal design and comprehensive pre-pandemic and pandemic-era measurements, the meta-cohort is well suited to support ongoing work regarding the public health impact of SARS-CoV-2 infection, COVID-19, post-acute sequelae, and pandemic-related social and behavioral changes across multiple health domains.