Even as national institutions struggle to coordinate meaningful trials for possible long COVID treatments, researchers continue to tally the damage. New findings suggest that the disease’s reach isn’t merely long—it’s still growing.

Three years after their initial bouts with COVID-19, patients who’d once been hospitalized with the virus remained at “significantly elevated” risk of death or worsening health from long COVID complications, according to a paper published May 30 in Nature Medicine.

Even among those whose initial cases didn’t require a hospital stay, the threat of long COVID and several of its associated issues remained real, the researchers found. And cumulatively, at three years, long COVID results in 91 disability-adjusted life years (DALY) per 1,000 people—DALYs being a measure of years lost to poor health or premature death. That is a higher incidence than either heart disease or cancer.

“People are developing new-onset disease as the result of an infection that they had three years ago,” says Dr. Ziyad Al-Aly, a clinical epidemiologist at Washington University in St. Louis and lead author of the study. “It challenges the notion that these viruses are sort of self-contained or that after the acute first phase, they become inconsequential.”

With more than 130,000 patients, the study is by far the largest so far to track the progress of the virus over a full three-year period. It expands on work by Al-Aly and others at the two-year mark that found patients had elevated risk for long-COVID-related conditions that included diabetes, lung problems, fatigue, blood clots, and gastrointestinal and musculoskeletal disorders.

At three years, Al-Aly tells Fortune, the primary complications among those with mild initial COVID cases were found in the neurological, GI, and pulmonary systems. The persistent risk among those who’d been hospitalized, meanwhile, extended to seven organ systems and included severe conditions such as strokes, heart attacks, heart failure, and even Alzheimer’s disease.

The study included nationally recognized researchers Al-Aly and coauthor Dr. Eric Topol, executive vice president and professor of molecular medicine at Scripps Research. It drew from patients within the Veterans Affairs St. Louis Health Care system. As such, the scientists note, the demography skews more male, white, and slightly older than other patient studies might.