Characteristics of adults who reported not having had COVID-19 in Spain after the first two years of the pandemic and associated factors

There is little evidence regarding the characteristics of adults who self-reported not having had COVID-19 after two years of the pandemic. This study aimed to analyse the characteristics of no-COVID-19 respondents and the associated factors to better understand which may have conditioned not having had the disease as guidance to help in the design of better public health strategies. This cross-sectional, observational study was conducted in the Spanish general population in a representative sample of 1051 adults who completed an online survey in September 2022. Multivariable logistic regression was performed to assess which factors were related to reporting not having had COVID-19. Almost half of the respondents (47.8%) reported not having ever had COVID-19. Significant differences were found between people who reported having had and not having had COVID-19 according to sex, age, education level, employment and living with children. No-COVID-19 respondents had greater concern and less fear of the disease and were more worried about the new variants. After the multivariable analysis, factors associated with no-COVID-19 respondents were male sex (OR)=1.40; 95% (CI=1.07–1.82), older age (OR=1.01; 95% CI=1.01–1.03), having a greater perception of disease severity if infected (OR=4.71; 95% CI=2.97–7.47), greater adherence to preventive measures (OR=1.02; 95% CI=1.01–1.03), and having received a complete vaccination schedule and booster dose (OR=1.56; 95% CI=1.03–2.36). Analysing the characteristics of people reporting not having had COVID-19 can support public health decision-makers in designing better interventions and facilitating the implementation of effective prevention and control measures to prepare for and respond to a possible future pandemic.