International journal of infectious diseases : IJID : official publication of the International Society for Infectious DiseasesMar 19, 2026

Autoimmune Disease Linked to Higher Long COVID Risk but Previous Vaccination Offers Protection

Long Covid Weekly Brief ↗PubMed ↗DOI ↗

Updated Jun 27, 2026

Abstract

Essence

Pre-existing autoimmune disease was associated with higher Long COVID symptom risk after SARS-CoV-2 infection, while prior vaccination was linked to lower risk for most symptoms within autoimmune disease patients.

Evidence

This propensity-score-matched TriNetX electronic health database study analyzed 2,472,196 adults with confirmed SARS-CoV-2 infection from January 1, 2020 to September 21, 2023 and follow-up more than 90 days later.

Caveat

The findings come from observational database associations using symptom-based Long COVID definitions, so residual confounding and coding differences can still affect the estimates.

Simplified

OBJECTIVES: Patients with autoimmune disease (AD) may be predisposed to Long COVID, yet the impact of primary autoantibody-associated AD and prior immunization remains unclear.

METHODS: TriNetX, a global electronic health database, identified adults with confirmed SARS-CoV-2 infection between January 1, 2020 and September 21, 2023 and at least one follow-up visit >90 days later. Long COVID was defined as persistent or new symptoms ≥90 days after infection. Patients with and without pre-existing AD were propensity-score-matched on demographics and comorbidities. Logistic regression assessed odds of Long COVID, with additional sensitivity analyses performed.

RESULTS: Among 2,472,196 patients with SARS-CoV-2, 289,206 had AD (+AD). After matching, baseline characteristics were similar. +AD patients had higher odds of all Long COVID symptoms compared with -AD patients. The highest odds were observed for disturbance to smell/taste (OR:1.99;95%CI:1.88-2.11), hair loss (OR:1.96;95%CI:1.89-2.04), abnormal movements/tremors (OR:1.93;95%CI:1.88-1.98), and body aches (OR:1.85;95%CI:1.81-1.89). Unvaccinated +AD patients had higher odds of all symptoms compared with matched unvaccinated -AD. Within +AD, primary autoantibody-associated AD demonstrated higher odds of most symptoms.

CONCLUSION: Pre-existing AD increases the risk of Long COVID, with the highest risk in primary autoantibody-associated AD. Prior vaccination mitigates the risk of most Long COVID symptoms in +AD patients, with heightened protection observed in primary autoantibody-associated AD.

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Autoimmune Disease Linked to Higher Long COVID Risk but Previous Vaccination Offers Protection

Abstract

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