Individuals who experience long COVID are at increased risk for a range of adverse pulmonary and cardiovascular conditions and mortality, according to a new study published in JAMA Health Forum

The study, led by researchers at the Elevance Health Public Policy Institute, found substantially higher mortality rates for individuals with long COVID than what had been found in previous studies.

“We know from published literature that long COVID can result in fatigue, headache, and attention disorder,” says Andrea DeVries, PhD, staff vice president for health services research at Elevance Health and the lead author of the study, in a press release. “While those conditions are concerning, the results from this study point to even more worrisome outcomes that can severely impact quality and length of life for individuals with long COVID.”

For the study, researchers examined utilization claims data for 13,435 US adults with long COVID and 26,870 US adults with no signs of COVID for at least 18 months. After controlling for risk factors present pre-COVID-19, the researchers found that individuals diagnosed with long COVID were more likely to seek care for the following adverse outcomes:

Pulmonary events: The group with long COVID was 3.64 times more likely to experience pulmonary embolism, 1.95 times more likely to experience moderate or severe asthma, and 1.94 times more likely to experience chronic obstructive pulmonary disease.

Cardiovascular events: The group with long COVID was 2.35 times more likely to experience cardiac arrhythmias, 2.17 times more likely to experience ischemic stroke, 1.97 times more likely to experience heart failure, and 1.78 times more likely to experience coronary artery disease than the group without long COVID.

Mortality: During the follow-up period, the group with long COVID experienced increased mortality, with 2.8% of individuals with long COVID dying versus 1.2% of those without long COVID.

The researchers note that while risks were heightened for individuals who experienced a more severe episode of COVID (i.e., requiring hospitalization), most individuals (72.5%) in the group with long COVID did not experience hospitalization during the acute phase of COVID. They add that many of the resulting conditions could have lasting effects on quality of life.

In addition, researchers emphasize that, compared with previous research efforts, this study revealed substantially higher mortality rates for individuals following COVID. They attribute this finding to the ability to evaluate data, including full mortality information, comprehensively across all care settings. According to a press release by Elevance Health, the study is the largest national study of commercially insured individuals with long COVID that includes 12 months of follow-up.

“From a policy perspective, these results can inform understanding of future health care utilization, labor force participation, and analysis of public program spending and outcomes,” says Jennifer Kowalski, vice president of the Elevance Health Public Policy Institute, in a press release.