{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T06:09:25Z","timestamp":1784182165460,"version":"3.55.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Long COVID has been associated with an increased incidence of chronic diseases, including type 2 diabetes (T2D), which has been suggested to have a bidirectional relationship with COVID-19. We examined these associations in a population-based cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Chronic non-communicable diseases (NCDs) diagnosed before (2010\u20132019) or after (2021\u20132023) the COVID-19 pandemic onset were tested for associations with Long COVID among Estonian Biobank participants (\n                      <jats:italic>N<\/jats:italic>\n                      \u202f=\u202f2,639 with Long COVID,\n                      <jats:italic>N<\/jats:italic>\n                      \u202f=\u202f199,171 controls) using logistic regression. Interrupted time-series analysis using a SARIMA model assessed changes in monthly T2D incidence after March 2020. A polygenic risk score (PRS) for severe COVID-19 was examined for association with new-onset T2D.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Pre-existing NCDs were associated with Long COVID, and individuals with Long COVID had increased odds of first-recorded NCD diagnoses after 2020. Long COVID was associated with COPD (OR\u202f=\u202f2.33), asthma (OR\u202f=\u202f2.18), and chronic kidney disease (OR\u202f=\u202f2.15). It was also associated with higher odds of incident asthma (OR\u202f=\u202f5.12), COPD (OR\u202f=\u202f4.08), and sleep apnea (OR\u202f=\u202f3.05), while the association with T2D did not surpass Bonferroni correction. However, T2D incidence increased after March 2020 beyond expected trends (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f1.84\u202f\u00d7\u202f10\n                      <jats:sup>\u221280<\/jats:sup>\n                      ). Individuals in the highest PRS quantile for severe COVID-19 had increased odds of T2D (OR\u202f=\u202f1.19).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings support bidirectional associations between COVID-19 and NCDs, including T2D. Pre-existing T2D was associated with increased odds of Long COVID, while the pandemic period showed increasing trends in T2D incidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1834448","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T05:37:11Z","timestamp":1784180231000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Bidirectional associations between chronic diseases and Long COVID: a population-based cohort and interrupted time-series analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"Hanna","family":"S\u00f5najalg","sequence":"first","affiliation":[{"name":"Estonian Genome Centre, Institute of Genomics, University of Tartu","place":["Tartu, Estonia"]},{"name":"Institute of Mathematics and Statistics, University of Tartu","place":["Tartu, Estonia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martti","family":"Vanker","sequence":"additional","affiliation":[{"name":"Institute of Biomedicine and Translational Medicine, University of Tartu","place":["Tartu, Estonia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristi","family":"L\u00e4ll","sequence":"additional","affiliation":[{"name":"Estonian Genome Centre, Institute of Genomics, University of Tartu","place":["Tartu, Estonia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e4rt","family":"M\u00f6ls","sequence":"additional","affiliation":[{"name":"Estonian Genome Centre, Institute of Genomics, University of Tartu","place":["Tartu, Estonia"]},{"name":"Institute of Mathematics and Statistics, University of Tartu","place":["Tartu, Estonia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maris","family":"Alver","sequence":"additional","affiliation":[{"name":"Estonian Genome Centre, Institute of Genomics, University of Tartu","place":["Tartu, Estonia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Milani","sequence":"additional","affiliation":[{"name":"Estonian Genome Centre, Institute of Genomics, University of Tartu","place":["Tartu, Estonia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Kisand","sequence":"additional","affiliation":[{"name":"Institute of Biomedicine and Translational Medicine, University of Tartu","place":["Tartu, Estonia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u00e4rt","family":"Peterson","sequence":"additional","affiliation":[{"name":"Institute of Biomedicine and Translational Medicine, University of Tartu","place":["Tartu, Estonia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"On behalf of the Estonian Biobank Research Team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1038\/s41577-023-00904-7","article-title":"The immunology of long COVID","volume":"23","author":"Altmann","year":"2023","journal-title":"Nat Rev Immunol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1564","DOI":"10.1038\/s41591-024-02987-8","article-title":"Three-year outcomes of post-acute sequelae of COVID-19","volume":"30","author":"Cai","year":"2024","journal-title":"Nat Med"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2148","DOI":"10.1038\/s41591-024-03173-6","article-title":"Long COVID science, research and policy","volume":"30","author":"Al-Aly","year":"2024","journal-title":"Nat Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e1004052","DOI":"10.1371\/journal.pmed.1004052","article-title":"Cardiometabolic outcomes up to 12 months after COVID-19 infection. A matched cohort study in the UK","volume":"19","author":"Rezel-Potts","year":"2022","journal-title":"PLoS Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2528","DOI":"10.1136\/bmjresp-2024-002528","article-title":"Risk of long COVID in patients with pre-existing chronic respiratory diseases: a systematic review and meta-analysis","volume":"12","author":"Terry","year":"2025","journal-title":"BMJ Open Respir Res"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.2215\/CJN.0000000773","article-title":"The association of long COVID and CKD: findings from the National Clinical Cohort Collaborative","volume":"20","author":"Anzalone","year":"2025","journal-title":"Clin J Am Soc Nephrol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"155330","DOI":"10.1016\/j.metabol.2022.155330","article-title":"Risk of incident diabetes after COVID-19 infection: a systematic review and meta-analysis","volume":"137","author":"Lai","year":"2022","journal-title":"Metabolism"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"110896","DOI":"10.1016\/j.diabres.2023.110896","article-title":"Type 2 diabetes and COVID-19: lessons learnt, unanswered questions and hints for the future","volume":"204","author":"Nazari","year":"2023","journal-title":"Diabetes Res Clin Pract"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e1164","DOI":"10.1210\/clinem\/dgad284","article-title":"New-onset diabetes after COVID-19","volume":"108","author":"Kim","year":"2023","journal-title":"J Clin Endocrinol Metab"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1016\/S2213-8587(22)00044-4","article-title":"Risks and burdens of incident diabetes in long COVID: a cohort study","volume":"10","author":"Xie","year":"2022","journal-title":"Lancet Diabetes Endocrinol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"102235","DOI":"10.1016\/j.dsx.2021.102235","article-title":"Post COVID-19 syndrome (\"long COVID\") and diabetes: challenges in diagnosis and management","volume":"15","author":"Raveendran","year":"2021","journal-title":"Diabetes Metab Syndr"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"110202","DOI":"10.1016\/j.diabres.2022.110202","article-title":"The bidirectional association between diabetes and long-COVID-19 - a systematic review","volume":"195","author":"Harding","year":"2023","journal-title":"Diabetes Res Clin Pract"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"102607","DOI":"10.1016\/j.eclinm.2024.102607","article-title":"The prevalence of long COVID in people with diabetes mellitus-evidence from a UK cohort","volume":"71","author":"Heald","year":"2024","journal-title":"EClinicalMedicine"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e0317348","DOI":"10.1371\/journal.pone.0317348","article-title":"SARS-CoV-2 infection is associated with higher chance of diabetes remission among veterans with incident diabetes","volume":"20","author":"Wander","year":"2025","journal-title":"PLoS One"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e238866","DOI":"10.1001\/jamanetworkopen.2023.8866","article-title":"Association of COVID-19 infection with incident diabetes","volume":"6","author":"Naveed","year":"2023","journal-title":"JAMA Netw Open"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"101793","DOI":"10.1016\/j.beem.2023.101793","article-title":"Newly detected diabetes during the COVID-19 pandemic: what have we learnt?","volume":"37","author":"Hirani","year":"2023","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1186\/s12916-022-02656-y","article-title":"Risk for newly diagnosed diabetes after COVID-19: a systematic review and meta-analysis","volume":"20","author":"Zhang","year":"2022","journal-title":"BMC Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"245","DOI":"10.3803\/EnM.2023.1662","article-title":"Risk for newly diagnosed type 2 diabetes mellitus after COVID-19 among Korean adults: a Nationwide matched Cohort study","volume":"38","author":"Choi","year":"2023","journal-title":"Endocrinol Metab (Seoul)"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1016\/S2213-8587(24)00159-1","article-title":"Incidence of diabetes after SARS-CoV-2 infection in England and the implications of COVID-19 vaccination: a retrospective cohort study of 16 million people","volume":"12","author":"Taylor","year":"2024","journal-title":"Lancet Diabetes Endocrinol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"3270","DOI":"10.1038\/s41467-025-58465-3","article-title":"The Estonian biobank's journey from biobanking to personalized medicine","volume":"16","author":"Milani","year":"2025","journal-title":"Nat Commun"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1186\/s13034-024-00757-5","article-title":"The COVID-19 pandemic and the use of benzodiazepines and benzodiazepine-related drugs in Estonia: an interrupted time-series analysis","volume":"18","author":"Kurvits","year":"2024","journal-title":"Child Adolesc Psychiatry Ment Health"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"dyw098","DOI":"10.1093\/ije\/dyw098","article-title":"Interrupted time series regression for the evaluation of public health interventions: a tutorial","volume":"46","author":"Bernal","year":"2017","journal-title":"Int J Epidemiol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s12874-021-01235-8","article-title":"Interrupted time series analysis using autoregressive integrated moving average (ARIMA) models: a guide for evaluating large-scale health interventions","volume":"21","author":"Schaffer","year":"2021","journal-title":"BMC Med Res Methodol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1038\/s41431-020-0636-6","article-title":"The COVID-19 host genetics initiative, a global initiative to elucidate the role of host genetic factors in susceptibility and severity of the SARS-CoV-2 virus pandemic","volume":"28","year":"2020","journal-title":"Eur J Hum Genet"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.1086\/521987","article-title":"Rapid and accurate haplotype phasing and missing-data inference for whole-genome association studies by use of localized haplotype clustering","volume":"81","author":"Browning","year":"2007","journal-title":"Am J Hum Genet"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1038\/ejhg.2017.51","article-title":"Improved imputation accuracy of rare and low-frequency variants using population-specific high-coverage WGS-based imputation reference panel","volume":"25","author":"Mitt","year":"2017","journal-title":"Eur J Hum Genet"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1038\/nature09298","article-title":"Integrating common and rare genetic variation in diverse human populations","volume":"467","author":"Altshuler","year":"2010","journal-title":"Nature"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1038\/nature15393","article-title":"A global reference for human genetic variation","volume":"526","author":"Auton","year":"2015","journal-title":"Nature"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"830","DOI":"10.1126\/science.adl0867","article-title":"Solving the puzzle of long Covid","volume":"383","author":"Al-Aly","year":"2024","journal-title":"Science"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1016\/S0140-6736(24)02256-6","article-title":"Learning from long COVID: conceptualising action to tackle infection-associated non-communicable diseases","volume":"405","author":"Alwan","year":"2025","journal-title":"Lancet"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"2347","DOI":"10.1038\/s41591-023-02521-2","article-title":"Postacute sequelae of COVID-19 at 2 years","volume":"29","author":"Bowe","year":"2023","journal-title":"Nat Med"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1737894","DOI":"10.3389\/fendo.2025.1737894","article-title":"Molecular analysis of long COVID and new-onset diabetes mellitus: pathobiological relationships and current mechanistic views","volume":"16","author":"Shitaye","year":"2025","journal-title":"Front Endocrinol (Lausanne)"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1038\/s42003-024-05799-1","article-title":"Type 2 diabetes and its genetic susceptibility are associated with increased severity and mortality of COVID-19 in UK biobank","volume":"7","author":"Lee","year":"2024","journal-title":"Commun Biol"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1834448\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T05:37:12Z","timestamp":1784180232000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1834448\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,16]]},"references-count":33,"alternative-id":["10.3389\/fpubh.2026.1834448"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1834448","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,16]]},"article-number":"1834448"}}