# The impact of testing positive versus negative for COVID-19 on health-related quality of life: cross-sectional evidence from the Alberta post-COVID-19 follow-up survey

## TL;DR

This study shows that testing positive for COVID-19 leads to a greater decline in health-related quality of life compared to testing negative, especially in mental health and daily functioning.

## Contribution

The study provides new evidence on the long-term impact of COVID-19 on HRQoL using a large population-based dataset in Alberta.

## Key findings

- People who tested positive for COVID-19 experienced a larger drop in health-related quality of life than those who tested negative.
- The largest effects were observed in mental health, with over 10% of positive cases reporting worsening mental health.
- The decline in HRQoL persisted for over a year in some individuals, particularly those with comorbidities or living in deprived areas.

## Abstract

The novel Coronavirus Disease 2019 (COVID-19) can have lasting physical and psychological outcomes, though little is known about the long-term impact of COVID-19 on the health-related quality of life (HRQoL) of Canadians. The aim of this study is to estimate the impacts of testing positive for COVID-19 using the EQ-5D-5 L instrument.

Our study is a secondary analysis of data collected in the Alberta POST-COVID-19 Follow-up Study, linking survey responses to administrative health data. The data included 11,705 individuals tested for COVID-19 in Alberta from October 2021 to September 2023. Survey data included test results, age, sex, and EQ-5D-5 L response. Linked administrative data included socioeconomic status, comorbidities, hospital, and intensive care unit admissions. We used linear regression to estimate differences in HRQoL pre- and post-COVID-19 testing and ordinal logistic regression to estimate the odds of worsening HRQoL in each of the EQ-5D domains.

COVID-19-positive individuals were younger (mean 48.5 vs. 53.4 years), more often female (64.4% vs. 62.6%), and tested more recently (mean 274 vs. 519 days since test) compared to COVID-19-negative respondents. We estimated reductions in EQ-5D-5 L index score ranging from 0.0464 (CI 0.0393-0.0536) to 0.0702 (CI 0.0626-0.0777) points for respondents testing positive, and up to 0.0276 (CI 0.0190-0.0362) points for respondents testing negative. Positive respondents were also more likely to report problems within each of the EQ-5D-5 L domains.

Previous COVID-19 infection has an important impact on HRQoL. These results can support health economic models and provide insight into optimal COVID-19 mitigation strategies.

This study was developed to better understand how testing positive for COVID-19 affects people’s overall health and well being. The key issue that this study address is if COVID-19 infection has a measurable and lasting effect people’s heath related quality of life.

This study used data from over 11,000 adults in Alberta to see how people’s overall health and well-being changed before and after testing positive for COVID-19. The survey was conducted between 2021 and 2023, and included individuals who tested positive or negative for COVID-19.

The study found that people who tested positive for COVID-19 reported a bigger drop in their health-related quality of life than those who tested negative. This decline impacted several areas of daily life such as mobility, ability to partake in usual activities, pain, and mental health. The largest differences were seen within the first three months of COVID-19 infection, but they continued over a year later for some individuals. The biggest effects were in mental health, where over 10% of people who tested positive worsening mental health, compared to only 3% of people testing negative. Overall people with long-term health conditions (comorbidities) other than COVID-19 or who lived in more deprived areas reported worse outcomes.

These findings suggest that testing positive for COVID-19 is linked to lasting impacts on physical and mental health, even after the initial illness has passed.