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Social Determinants of Health and Risk for Long COVID in the U.S. RECOVER-Adult Cohort
Candace H Feldman1, Leah Santacroce2, Ingrid V Bassett3
1Division of Rheumatology, Inflammation and Immunity, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts (C.H.F., E.W.K.).
Background:
Social determinants of health (SDoH) contribute to disparities in SARS-CoV-2 infection, but their associations with long COVID are unknown.
Objective:
To determine associations between SDoH at the time of SARS-CoV-2 infection and risk for long COVID.
Design:
Prospective observational cohort study.
Setting:
33 states plus Washington, DC, and Puerto Rico.
Participants:
Adults (aged ≥18 years) enrolled in RECOVER-Adult (Researching COVID to Enhance Recovery) between October 2021 and November 2023 who were within 30 days of SARS-CoV-2 infection; completed baseline SDoH, comorbidity, and pregnancy questionnaires; and were followed prospectively.
Measurements:
Social risk factors from SDoH baseline questionnaires, ZIP code poverty and household crowding measures, and a weighted score of 11 or higher on the Long COVID Research Index 6 months after infection.
Results:
Among 3787 participants, 418 (11%) developed long COVID. After adjustment for demographic characteristics, pregnancy, disability, comorbidities, SARS-CoV-2 severity, and vaccinations, financial hardship (adjusted marginal risk ratio [ARR], 2.36 [95% CI, 1.97 to 2.91]), food insecurity (ARR, 2.36 [CI, 1.83 to 2.98]), less than a college education (ARR, 1.60 [CI, 1.30 to 1.97]), experiences of medical discrimination (ARR, 2.37 [CI, 1.94 to 2.83]), skipped medical care due to cost (ARR, 2.87 [CI, 2.22 to 3.70]), and lack of social support (ARR, 1.79 [CI, 1.50 to 2.17]) were associated with increased risk for long COVID. Living in ZIP codes with the highest (vs. lowest) household crowding was also associated with greater risk (ARR, 1.36 [CI, 1.05 to 1.71]).
Limitation:
Selection bias may influence observed associations and generalizability.
Conclusion:
Participants with social risk factors at the time of SARS-CoV-2 infection had greater risk for subsequent long COVID than those without. Future studies should determine whether social risk factor interventions mitigate long-term effects of SARS-CoV-2 infection.
Primary Funding Source:
National Institutes of Health.
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