Abstract
Background/Objectives: Emerging evidence suggests that individuals infected with SARS-CoV-2 are at an elevated risk of developing anxiety. This study investigated the association and risk factors of anxiety diagnosis in COVID-19 patients compared to non-COVID-19 patients up to four years post index date. Methods: We conducted a retrospective case-control study on a cohort consisting of 1.3 million patients, of which 85,229 had a clinical anxiety diagnosis (defined by ICD code) and 1,214,598 did not from the Montefiore Medical Center in the Bronx, New York, from 1 March 2020 to 31 January 2024. COVID-19 patients were those who tested positive for SARS-CoV-2 by polymerase chain reaction. COVID-19 negative patients were those who did not have a recorded positive test. The outcome was an anxiety diagnosis between one month and four years post-index date. Analysis was performed with unmatched and matched cohorts. The matched variables included age, sex, race, and ethnicity. The multivariate logistic regression adjusted odds ratio (aOR) and 95% confidence interval were computed. Results: COVID-19 was more prevalent among patients with anxiety compared to those without anxiety (6.92% vs. 4.14%, p < 0.001). COVID-19 patients were more likely to develop anxiety compared to non-COVID-19 patients (multivariate aOR = 2.13 [2.06-2.20] for unmatched cohort, and aOR = 1.26 [1.22, 1.31] for the matched cohort). Female (aOR = 1.54 [1.52, 1.56]), Black (aOR = 1.38 [1.35, 1.41]), Asian (aOR = 1.48 [1.41, 1.55]) (vs. White), and Hispanic patients were more likely to develop anxiety compared to their counterparts (unmatched cohort). Conclusions: COVID-19 is associated with a greater likelihood of having anxiety. Black and Hispanic patients were at higher risk, suggestive of the COVID-19 pandemic exacerbating health disparities. An improved understanding of long-term anxiety is crucial for developing effective interventions and support systems for COVID-19 survivors.