Data Analysis Shows Significant New Onset Morbidity Post-COVID-19 in Children, Adolescents, Adults

Although long-term health issues from COVID-19 are a major public health concern, evidence on post-COVID-19 symptoms are still limited, specifically among children and adolescents.

Study authors of a recent study published in PLOS Medicine explained that they observed significant new onset morbidity in children, adolescents, and adults across 13 prespecified diagnosis/symptom complexes following COVID-19 infection. Although long-term health issues from COVID-19 are a major public health concern, evidence on post-acute COVID-19 syndrome, or post-COVID-19, is still limited, specifically among children and adolescents.

During the study, the researchers used comprehensive health care data on approximately 46% of the German population and analyzed post-COVID-19-associated morbidity among 2 groups—children/adolescents and adults. The study authors noted that routine data from German statutory health insurance organizations covering the period between January 1, 2019 and December 31, 2020 were used for their analysis, with the base population including all individuals insured for at least 1 day in 2020. The team then identified individuals with polymerase chain reaction (PCR)-confirmed COVID-19 through June 30, 2020.

The researchers then assigned a control cohort using 1:5 exact matching on age and sex, and propensity score matching on preexisting medical conditions. Further, the date of COVID-19 diagnosis was used as index date for both cohorts, which were followed for incident morbidity outcomes documented in the second quarter after index date or later.

In all, 96 prespecified outcomes were aggregated into 13 diagnosis/symptom complexes and 3 domains (physical, mental, and physical/mental overlap). The researchers then used Poisson regression to estimate incidence rate ratios with 95% confidence intervals.

The population of participants included 11,950 children/adolescents between age 0 and 11 years and 145,184 adults between age 18 and 49 years. The mean follow-up time was 236 days in children/adolescents and 254 days in adults, and the COVID-19 and control cohorts were well balanced regarding covariates.

In at least 1/100 person-years in the COVID-19 cohort in children and adolescents, the specific outcomes with the highest incidence rate ratios (IRR) and an incidence rate (IRs) were malaise/fatigue/exhaustion, cough, and throat/chest pain.

In adults, this included disturbances of smell and taste, fever, and dyspnea. For health outcomes combined, IRs per 1000 person-years in the COVID-19 cohort were significantly higher than those in the control in both children/adolescents and adults. The magnitude of increased documented morbidity was similar for the physical, mental, and physical/mental overlap domain.

In the COVID-19 cohort, IRs were higher in all 13 diagnosis/symptom complexes in adults and in 10 diagnosis/symptom complexes in children/adolescents. The IRR estimates were similar for age groups 0 to 11 and 12 to 17, and IRs in children/adolescents were consistently lower than those in adults.

Additionally, the study authors noted that there were study limitations, such as potentially unmeasured confounding and detection bias. However, the study authors also explained that these findings expand the existing available evidence on post-COVID-19 conditions in younger age groups and confirm previous findings in adults.


Roessler M, Tesch F, Batram M, et al. Post-COVID-19-associated morbidity in children, adolescents, and adults: A matched cohort study including more than 157,000 individuals with COVID-19 in Germany. PLOS Medicine. November 10, 2022. Accessed November 18, 2022.

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