Background Coronavirus disease 2019 (COVID-19) has been linked to the development of post-COVID-19 conditions (PCCs). We investigated whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection increases the risk of selected PCCs or death up to 1 year after infection, separately in the wild-type (WT), Alpha-transition, Delta, and Omicron eras and by vaccination status.Methods We used health records of the Veterans Health Administration to emulate a hypothetical target trial of SARS-CoV-2 infection versus no infection. Veterans who tested positive for SARS-CoV-2 between March 2020 and April 2022 (n = 430 160) were matched 1:1 to veterans who had not tested positive for SARS-CoV-2. All-cause mortality and cumulative incidence of 32 potential PCCs were ascertained at 31-180 and 181-365 days after infection or matched index date.Results From 31 to 180 days, the cumulative incidence of death and all organ-level PCCs was greater in infected versus uninfected participants, with cumulative incidence differences lower in the Omicron than in the WT era and lower in vaccinated than in unvaccinated persons. In the Omicron era, the cumulative incidence of death and most PCCs from day 181-365 were higher in infected than in uninfected participants only among unvaccinated but not among vaccinated persons.Conclusions Excess burden of PCCs and mortality persisted 31-180 days after infection in the Omicron era, albeit at a lower level than in the WT and Delta eras. Excess burden of mortality and most PCCs was much lower 181-365 days after infection and was observed in the Omicron era only among unvaccinated persons, suggesting a protective effect of vaccination. The excess burden of mortality and post-coronavirus disease 2019 conditions was lower in Omicron than in wild-type and Delta eras, lower in vaccinated than in unvaccinated persons, and much lower 181-365 days than 31-180 days after infection.
[1]Vet Affairs Puget Sound Hlth Care Syst, Res & Dev, Seattle, WA USA.
[2]Vet Affairs Puget Sound Healthcare Syst, Div Gastroenterol, Seattle, WA USA.
[3]Univ Washington, Seattle, WA USA.
[4]Vet Affairs Connecticut Healthcare Syst, Vet Affairs Cooperat Studies Program Clin Epidemio, West Haven, CT USA.
[5]Yale Sch Med, Biomed Informat & Data Sci, New Haven, CT USA.
[6]Yale Sch Publ Hlth, Dept Biostat, New Haven, CT USA.
[7]Vet Affairs Portland Hlth Care Syst, Res & Dev, Portland, OR USA.
[8]Vet Affairs Portland Healthcare Syst, Ctr Innovat Improve Vet Involvement Care CIV, Portland, OR USA.
[9]Oregon State Univ, Coll Hlth, Hlth Management & Policy, Corvallis, OR USA.
[10]Oregon State Univ, Ctr Quantitat Life Sci, Hlth Data & Informat Program, Corvallis, OR USA.
[11]Portland State Univ, Sch Publ Hlth, Portland, OR USA.
[12]VA Portland Hlth Care Syst, Ctr Improve Vet Involvement Care, Portland, OR USA.
[13]Oregon Hlth & Sci Univ OHSU, Sch Publ Hlth, Portland, OR USA.
[14]Vet Hlth Adm, Digital Hlth, Populat Hlth Informat, Washington, DC USA.
[15]Vet Affairs Ann Arbor Healthcare Syst, Ctr Clin Management Res, Ann Arbor, MI USA.
[16]Univ Michigan, Dept Anesthesiol, Ann Arbor, MI USA.
[17]Vet Affairs Puget Sound Hlth Care Syst, Seattle Epidemiol Res & Informat Ctr, Seattle, WA USA.
[18]Johns Hopkins, Sch Med, Dept Med, Baltimore, MD USA.
[19]Johns Hopkins, Sch Publ Hlth, Dept Med, Baltimore, MD USA.
[20]Durham Vet Affairs Med Ctr, Ctr Innovat Accelerate Discovery & Practice Transf, Durham, NC USA.
[21]Duke Univ, Sch Med, Dept Populat Hlth Sci, Durham, NC USA.
[22]Duke Univ, Sch Med, Dept Biostat & Bioinformat, Durham, NC USA.
[23]Duke Univ, Sch Med, Dept Med, Div Gen Internal Med, Durham, NC USA.
[24]Vet Affairs Puget Sound Hlth Care Syst, Hlth Serv Res & Dev Ctr Innovat Vet, Ctr & Value Driven Care, Seattle, WA USA.
[25]Univ Washington, Dept Hlth Syst & Populat Hlth, Seattle, WA USA.
[26]Univ Washington, Div Nephrol, Seattle, WA USA.
[27]Vet Affairs Palo Alto Hlth Care Syst, Dept Med, Palo Alto, CA USA.
[28]Stanford Univ, Sch Med, Dept Radiol, Stanford, CA USA.
[29]Univ Michigan, Dept Internal Med, Ann Arbor, MI USA.
[30]Yale Sch Med, Dept Med, New Haven, CT USA.
[31]Oregon Hlth & Sci Univ, Dept Med, Div Infect Dis, Portland, OR USA.
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