Long-term healthcare use of COVID-19 cases in 2020: a two-year follow-up in Stockholm, Sweden

There is limited data on whether SARS-CoV-2 infections will result in increased long-term use of general healthcare, potentially impacting healthcare systems and management. Exploring this, we investigated the healthcare use of individuals with a SARS-CoV-2 infection in 2020 over a period of two years, using comprehensive medical records.
We followed a cohort of 365,354 individuals in Stockholm, Sweden, who had been tested with SARS-CoV-2 serology in 2020, for healthcare use during 2021/22. SARS-CoV-2 seropositive and seronegative individuals were matched 1:1 on age, sex, 2019 healthcare use, and date of last serology, and compared on healthcare use during 2021/22 using registry linkages. Seropositive individuals were stratified on hospitalization for COVID-19 in 2020. Individuals were compared for total healthcare use, measured as incidence rate rations (IRR), and healthcare type usage-or-not per month, measured as a difference-in-differences regression.
There were 272,918 seronegative and 73,814 seropositive subjects. Incidence rate ratios (IRRs) for primary healthcare use were 1.0, 1.16, and 0.98, for all, only hospitalized, and only non-hospitalized, seropositive individuals respectively. For outpatient specialist care IRRs were 0.96, 1.31, and 0.93. For inpatient care IRRs were 0.98, 1.19, and 0.95. Healthcare type usage-or-not per month showed no substantial differences, ranging from 0.01 to -0.01 in deviation. Increased healthcare use during follow-up was restricted to the seropositive individuals hospitalized for COVID-19 in 2020.
There was no increase in healthcare use in the overall population from SARS-CoV-2 infections during 2020, suggesting there is no apparent need to adapt healthcare systems at scale for the COVID-19 aftermath.