Two-year trajectories of COVID-19 symptoms and their association with illness perception: A prospective cohort study in Amsterdam, the Netherlands 6 185 4 compared to Trajectory 1 (p=0.046) when adjusting for other covariates, although this estimate is likely to be inflated given only 2 individuals infected during the first wave belonged to Trajectory 4. In a sensitivity analysis where all reported symptoms (not only those commencing <1 month of illness onset) were included, the overall course of symptom trajectories did not change, but the mean total number of symptoms reported was higher, especially for Trajectories 3 and 4 (Supplementary Figure S1). Table 3. Determinants of belonging to each trajectory based on mean total number of long COVID symptoms Long COVID symptom trajectory Trajectory 2 vs. 1 Trajectory 3 vs. 1 Trajectory 4 vs. 1 aOR (95%CI) p-value aOR (95%CI) p-value aOR (95%CI) p-value Age (years) 1.01 (0.99-1.04) 0.348 1.01 (0.98-1.03) 0.635 1.01 (0.97-1.05) 0.659 BMI Normal weight Ref. Ref. Ref. Overweight 1.50 (0.70-3.24) 0.298 2.08 (0.84-5.12) 0.112 4.10 (1.16-14.5) 0.029 Obese 1.65 (0.63-4.35) 0.308 3.09 (1.07-8.98) 0.038 5.03 (1.18-21.4) 0.029 Sex Male Ref. Ref. Ref. Female 3.35 (1.56-7.21) 0.002 3.19 (1.34-7.56) 0.009 11.11 (3.35-36.9) <0.001 COVID-19 wave First wave Ref. Ref. Ref. Subsequent waves 0.78 (0.37-1.65) 0.520 0.98 (0.42-2.29) 0.964 5.26 (1.03-26.9) 0.046 BMI was defined in kg/m2 as: <25, underweight or normal weight; 25-29, overweight; ≥30, obese. COVID-19 wave defined as: first wave (up to 1 June 2020) and subsequent waves (on or after 1 June 2020). Long COVID symptoms were defined as those developing within 1 month of overall illness onset, in order to exclude sporadic symptoms that were less likely to be attributed to the consequences of COVID-19. CI= confidence interval; aOR= adjusted odds ratio. Group-based trajectories of individual symptoms When considering adjusted group-based trajectories of individual symptoms, distinct patterns were observed (Figures 2A-D). Among participants with fatigue, 14.7% of participants demonstrated a steady recovery from fatigue over two years whilst 35.1% of participants experienced chronic fatigue after adjusting for age, sex, BMI category and timing of infection (Figure 2A). More than half of study participants (57.7%) did not report loss of smell and/or taste, and the three other trajectories of participants all demonstrated improvement over time after adjustment (either complete resolution within 10 months or a more gradual improvement; Figure 2B). Among one-eighth (12.3%) of participants, the proportion reporting myalgia became gradually higher over the course of two years (Figure
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