Post-COVID-19 health-related quality of life in India: A systematic review and meta-analytic assessment of recovery outcomes.

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has had profound physical, psychological, and social consequences, with lasting effects on health-related quality of life (HRQoL) among people with a history of COVID-19.

Aim: To synthesize the current evidence on HRQoL and long-term health outcomes among people with a history of COVID-19 in India.

Methods: We incorporated studies from India reporting post-COVID HRQoL outcomes using validated instruments, including the 5-level EuroQol 5-Dimensional questionnaire, the EuroQol Visual Analogue Scale, the Short Form-36 Health Survey, the World Health Organization Quality of Life-Brief Version, and the European Health Interview Survey-Quality of Life. Pooled mean 5-level EuroQol 5-Dimensional questionnaire scores with 95%CIs were calculated for HRQoL. Adjusted odds ratios were pooled for comorbidity, disease severity, intensive care unit admission, age, sex, and vaccination status using random-effects models.

Results: Three studies (n = 1526) reported EuroQol instruments, with the 5-level EuroQol 5-Dimensional questionnaire utility scores suitable for quantitative pooling. The pooled mean utility was 0.83 (95%CI: 0.75-0.92), although heterogeneity was high because the included studies represented clinically distinct populations. Across all studies, several determinants were consistently associated with impaired HRQoL. Older adults (≥ 60 years) had higher odds of poor HRQoL [pooled odds ratio (OR) = 1.83, 95%CI: 1.43-2.35], and females were more likely to experience impaired HRQoL (pooled OR = 1.74, 95%CI: 1.44-2.10), whereas males had a lower risk (pooled OR = 0.58, 95%CI: 0.48-0.70). Being unvaccinated increased the likelihood of persistent symptoms or reduced HRQoL (pooled OR = 1.60, 95%CI: 1.21-2.14). Comorbidity (pooled OR = 1.94, 95%CI: 1.43-2.63) and severe acute COVID-19 or intensive care unit admission (pooled OR = 2.77, 95%CI: 2.13-3.59) were also strongly associated with poorer HRQoL Six additional studies utilizing disparate instruments (EuroQol Visual Analogue Scale, Short Form-36 Health Survey, World Health Organization Quality of Life-Brief Version, European Health Interview Survey-Quality of Life) were excluded from quantitative synthesis due to measurement heterogeneity.

Conclusion: Post-COVID HRQoL in people with a history of COVID-19 in India is suboptimal, with greater impairment observed among older adults, females, patients with comorbidities or severe disease, and unvaccinated individuals. These findings highlight the need for targeted rehabilitation and preventive strategies.