{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T05:46:14Z","timestamp":1790660774523,"version":"4.1.0"},"reference-count":25,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,3,27]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate health outcomes and identify risk factors for reinfection and persistent symptoms among COVID-19 survivors 4 years after hospital discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Longitudinal cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Two hospitals in Wuhan, China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>1076 COVID-19 survivors discharged from hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Self-reported symptom questionnaire, Chronic Obstructive Pulmonary Disease Assessment Test, Hospital Anxiety and Depression Scale and Checklist Individual Strength (CIS) fatigue subscale. Long covid was defined according to WHO criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Median age was 58 years and 50.2% were male. Reinfection during December 2022\u2013April 2023 occurred in 36.1%; 21 developed pneumonia and 14 required hospitalisation. At least 12 months after reinfection, 12.1% reported sequelae compared with 46.9% after the initial infection. At 4 years, 16.7% reported long covid symptoms, commonly fatigue, chest tightness, cough and dyspnoea. In multivariable analysis, risk factors for abnormal fatigue (CIS \u226527) included age (OR 1.020, 95%\u2009CI 1.007 to 1.034; p=0.003), reinfection (OR 2.393, 95%\u2009CI 1.708 to 3.352; p&lt;0.001), severe disease (OR 1.553, 95%\u2009CI 1.088 to 2.218; p=0.015) and tumour (OR 3.420, 95%\u2009CI 1.177 to 9.936; p=0.024).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>At 4 years post discharge, symptom burden was lower than at earlier follow-up time points for most survivors. Reinfection and older age were associated with persistent symptoms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-113446","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T17:35:23Z","timestamp":1775842523000},"page":"e113446","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Health outcomes and reinfection among COVID-19 survivors 4 years after hospital discharge in Wuhan, China: a cohort study"],"prefix":"10.1136","volume":"16","author":[{"given":"Yang","family":"Dai","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huanyu","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofeng","family":"Liu","sequence":"additional","affiliation":[{"name":"Chongqing Hospital of People\u2019s Armed Police, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bao Man","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Man","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li Xia","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Medical and Research Management, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China"},{"name":"Taikang Tongji (Wuhan) Hospital, Wuhan, Hubei, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiang-yu","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoqiang","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China"},{"name":"Wuhan Huoshenshan Hospital, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9268-4846","authenticated-orcid":false,"given":"Qingxiang","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0208-7475","authenticated-orcid":false,"given":"Li","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China"},{"name":"Wuhan Huoshenshan Hospital, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"2026091107000936000_16.4.e113446.1","unstructured":"Organization WH . 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