A Catalonia-based cohort study of 8,322 adults identified distinct pre-COVID disease trajectories that increased long COVID risk, particularly among women. Long COVID affected 12.4% of participants and reached 66.7% in those with severe infection. Using 15 years of health records, investigators linked 23 conditions and 23 two-condition sequences—rising to 34 in women—to elevated risk. Nearly half of these involved mental health–neurologic patterns such as depression, anxiety, migraine, and stress. Temporality mattered: 73.7% of trajectories increased risk only when diagnoses occurred in a specific order. No genome-wide genetic correlations emerged, though select polygenic scores were linked in women.