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Situación laboral en personas con Long-COVID: Análisis de factores

sociodemográficos y clínicos asociados

de Domingo Miral, s/n, 50009 Zaragoza.

RD21/0016/0005), Instituto de Salud Carlos III, Madrid, España.

España.

50009 Zaragoza, España.

*Corresponding author: msamperpardo@gmail.com

situación laboral de las personas que padecen este síndrome y sus factores sociodemográficos y

clínicos asociados. Material y métodos: Se realizó un estudio transversal con la participación de 83

pacientes con diagnóstico de Long-COVID, mayores de 18 años y atendidos desde Atención Primaria

de Salud en la Comunidad Autónoma de Aragón. La variable principal de estudio fue la situación

laboral de los participantes, además de recogerse datos sociodemográficos y clínicos mediante la

realización de una entrevista estructurada. Posteriormente se realizó un análisis estadístico

descriptivo, de correlación y de regresión mediante el programa SPSS Statistics. Resultados: De los 83

participantes del estudio, un 55,4% se encontraba en situación laboral activa, y un 44,6% en situación

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de incapacidad laboral temporal. Un mayor número de síntomas persistentes y pertenecer al género

masculino fueron factores predictores de una mayor probabilidad de encontrarse en situación de

estudio cuantitativo.

Abstract

Introduction: The characteristic symptomatology of Long-COVID syndrome affects the physical and

cognitive functioning of people who suffer from it, creating challenges when returning to their usual

job. The objective of this study was to deepen the understanding of the employment status of people

with this syndrome and its associated sociodemographic and clinical factors. Material and methods:

A cross-sectional study was carried out with the participation of 83 patients diagnosed with Long-

COVID, over 18 years of age and attended by Primary Health Care in the Autonomous Community of

Aragon. The main study variable was the employment status of the participants, in addition to

leave or temporary incapacity for work, which makes it necessary to develop prevention and action

programs from socio-health care teams with the aim of these people not losing their jobs temporarily

or permanently or, if this has already happened, return to their previous work situation as soon as

possible.

Keywords: Long-COVID; temporary incapacity for work; Primary Health Care; gender; quantitative

study.

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INTRODUCTION

Most people infected with COVID-19 recover within a few weeks of infection. However, since the start

typically occur 3 months after the onset of the confirmed (via suspicion or test) SARS-CoV-2 infection

and persist for at least two months (Ceban et al., 2022).

At least 203 symptoms of this disease have been recorded (Davis et al., 2021). These symptoms are

more frequent in middle-aged women, around the age of 40, having no relevant prior health issues

(López-Sampalo et al., 2022). The most common symptoms include: general malaise, dyspnea, fatigue,

muscle weakness, headache, neurocognitive conditions, and irritability, stress, frustration, or

confusion (Rodriguez-Sanchez et al., 2022).

Most research on COVID-19 has focused on analyzing its nature, symptoms, therapeutic interventions,

vaccine effectiveness, etc. Studies on the ongoing impact of Long COVID on the quality of life of

affected patients are quite limited (Jandhyala, 2021). Scientific evidence suggests that individuals

become highly limiting, affecting physical and cognitive functioning and creating challenges when

returning to work (Davis et al., 2021; Westerlind et al., 2021; Brehon et al., 2022; Ziauddeen et al.,

2022).

Employment is an essential aspect of adult life, providing not only economic income, but also a sense

of commitment, identification with a social role, and physical and mental stimulation (Noh et al.,

2015). Real and perceived employability has even been proposed as a useful concept in health

promotion, at both an individual and organizational level (Berntson & Marklund, 2007).

On the other hand, the inability to work has negative effects on the state of health (Boot et al., 2011),

resulting in a higher probability of suffering from mental health issues (Nystuen et al., 2016) and other

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consequences such as inactivity, social isolation, lower self-confidence and even an increased risk of

suicide (Vingård et al., 2016). Individuals who cannot work tend to experience declines in their health-

Therefore, the objective of this study was to further the understanding of the employment situation

of Long COVID patients and the sociodemographic and clinical factors associated with it, within the

context of a sample of primary healthcare (PHC) patients from the autonomous community of Aragon.

MATERIAL AND METHODS

Study design

This cross-sectional study is based on the analysis of sociodemographic and clinical data. It was framed

within a randomized clinical trial: "Analysis of the symptoms and quality of life of people diagnosed

with Long COVID-19, and effectiveness of the Recommendations for Health Assets from PHC" (ref.

ISRCTN91104012), approved in mid-2021.

This research has used the same exclusion criteria established for the clinical trial: not having had a

positive COVID-19 diagnostic test performed at least 3 months previously; having a diagnosis of

severe, uncontrolled illness; having a significant risk of suicide; being in a state of pregnancy or period

of lactation; participating in a clinical trial over the past six months; engaging in rehabilitative or

psychotherapeutic treatment structured by health professionals; and the presence of any medical,

psychological or social problems that could significantly interfere with the patient's participation in

the study.

A necessary sample size of 78 subjects was estimated. Initially, there were 100 potential participants,

of whom 20 were men and 80 were women. However, 17 of these patients were excluded given that

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their work situation did not correspond to the inclusion criteria mentioned above. Finally, the sample

consisted of 83 patients.

consent was obtained from all participants. An individual appointment was subsequently arranged.

All data was processed according to the current regulations on data protection (Organic Law 3/2018,

of December 5, Protection of Personal Data and guarantee of digital rights).

Study variables

The main study variable was the employment status of the Long COVID patients, considered to be

either: active employment status or on temporary leave.

The following secondary study variables were collected:

- Sociodemographic variables: sex (male/female/other), age (number), marital status (married or with

a partner/single, separated, divorced or widowed), area of residence (rural/urban), education

(without studies or with primary/secondary education or university studies), and personal economic

without fever, bruising, myalgia, headache, sore throat, dyspnea, somnolence, dizziness, tachycardia,

orthostatic hypotension, arthralgia, chest pain, back pain (cervical, thoracic or lumbar), neurological

symptoms (tingling, spasms, etc.), memory loss, foggy mental illness, lack of attention and ability to

concentrate, loss of libido or erectile dysfunction, menstrual cycle alterations, urinary symptoms

(infections, overactive bladder), hair loss and other seemingly residual symptoms.

Statistical analysis

Statistical analyses were performed using the IBMR SPSSR Statistics version 22.0.0.0 software and

Microsoft Excel. First, sample distribution was analyzed using non-parametric statistics, obtaining

Shapiro-Wilk statistic values of less than 0.05 for all variables except for the number of symptoms.

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Subsequently, a descriptive analysis was performed: for the continuous variables, median and

interquartile range were used; for categorical variables, frequencies and percentages were used. A

model was obtained. Sex, marital status, education, economic level, and number of persistent

symptoms were entered into the model. All significance levels were established at 0.05.

Ethical considerations

The Clinical Research Ethics Committee of Aragon (CEICA) granted ethical approval to conduct this

study (PI21/139 and PI21/454). The procedures contemplated for the creation of this work complied

with the ethical standards of CEICA and the Declaration of Helsinki of 1975. All participating subjects

signed an informed consent form. Their data were anonymized and were only used for study purposes.

RESULTS

A total of 83 individuals suffering from Long COVID participated in the study. They were actively

€2,000/month and having a median of 16 persistent symptoms.

Table 1

Description of the sociodemographic and clinical variables of the total sample.

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Table 2 presents the bivariate analysis related to employment status (employee and temporary work

incapacity) and the sociodemographic and clinical variables collected. A relationship clearly existed

between employment status and sex. Males had a larger possibility of being in a situation of temporary

work incapacity. Having a larger number of persistent symptoms was also found to be related to this

employment situation.

Table 2

Comparison of the current employment situation and the sociodemographic and clinical variables of the study participants.

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Chi-Square test for categorical qualitative variables (sex, marital status, housing area, educational level, economic situation); *Mann Whitney

U test for continuous quantitative variables (age and number of symptoms)

As for the logistic regression model, the results are presented in Table 3. Gender and number of

symptoms were significant variables when in a situation of temporary sick leave. A higher number of

persistent symptoms and being male were predictors of having a greater probability of being in a

situation of temporary work incapacity.

Logistic regression model on the temporary incapacity work situation.

Number of persistent symptoms less than or

equal to 16

DISCUSSION

To the best of our knowledge, this is the first study considering the employment situation of patients

affect it and what factors may be linked to affectation. This will permit interdisciplinary socio-

healthcare teams to help prevent work modification or loss, and develop action programs so that

these individuals can return to their work and recover their prior employment status as quickly as

possible.

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The results of our study suggest that many participants (almost half) were in a situation of temporary

work incapacity. This confirms the existence of a negative modification of the employment status of

Going to work and having a job is a fundamental part of human life. Work provides structure to daily

life, as well as a sense of value and social commitment, and is associated with increased social well-

being. Therefore, the loss of the same has major repercussions, beyond mere economic insecurity

(Modini et al., 2016).

Sick leave is intended to facilitate the recovery of work capacity. However, it may have negative and

unexpected physical, emotional, and social effects on the individual (Floderus et al., 2005). The

temporary or permanent loss of one’s ability to work has consequences, mainly psychosocial ones,

such as the loss of personal identity and self-esteem, lower social support, and anxious-depressive

symptoms. Physical health may also be severely affected. Some studies have established a relationship

with reduced immune function, and an increased risk of conditions such as headaches,

work incapacity situation. As for the clinical factors analyzed, it was found that having a larger number

of persistent symptoms was associated with an increased tendency to be in a temporary work

incapacity situation. Other studies have referred to the disabling nature of Long COVID symptoms,

which result in a limited ability to perform work and an accompanying loss of social identity (Herr et

al., 2022).

In this study, we did not consider which symptoms may have the largest impact on the ability to work.

However, Herr et al. (2022) suggested that fatigue and cognitive dysfunction are the most disabling

symptoms with regard to work. A careful and individualized evaluation of each symptom is necessary,

given the numerous potential aspects affecting this area (Hereth et al., 2022).